Me, Erin and Penny the Pelvis
I know this blog post has been a LONG time coming, and I’m so excited to be able to hit “publish” today!
As you know if you follow along over on Instagram (I have a highlight on it right here!) I started proactive pelvic floor physical therapy near the beginning of my third trimester, and quickly hit it off with Erin Conroy, my PT, who owns her practice, West Town Physical Therapy.
She is AMAZING, and not only has she helped me navigate through pregnancy with VERY little pain, but I also feel so much more empowered/prepared about labor. She’s also just a joy to work with. I was thrilled when I pitched her the idea of contributing to some helpful content, and she was so game. She’s equally as passionate about helping women, so here we are with our first pelvic floor physical therapy blog post!
If the concept of pelvic floor physical therapy is new to you and sounds a little foreign, don’t worry–I was the same way! Here in the states, it’s not normalized or common at all! Erin and I are both determined to help this concept become more normalized among women as well as their doctors!
Pelvic Floor Physical Therapy–Your Questions, Answered! Plus, how it’s helped me during pregnancy!
The only reason I know about pelvic floor PT is from reading Bringing Up Bebe a couple years back (a book I HIGHLY recommend anyone read–definitely not a pregnancy book, I thought it was so interesting just from a culture standpoint, but particularly helped me see parenthood through the lens of “you don’t have to lose your entire life or become a miserable mom martyr if you want kids”–as the common American dialogue around motherhood would suggest. (But more on that another day!)
Anyway, pelvic floor PT is a standard in many other countries, like France. In fact, it’s the standard of care! All women typically receive a postpartum pelvic floor checkup, and continued therapy as needed–covered by insurance. I hope one day we can get there here in the US too!
Childbirth especially puts the body through some major trauma–you would get PT for say, a knee injury–why would you not get PT for your pelvic floor? Especially because it can affect SO many aspects of your life!
SO many women struggle with pelvic floor issues that they don’t know can be easily helped with physical therapy–it’s just not a “thing” that has hit the US yet.
Every day I hear stories of American women (many of YOU all–whether you’re moms, or not!) who tell me your doctors have either dismissed your concerns, told you “it’s the new normal” or that you should “get surgery”–to address things like pelvic pain, leaking pee when you workout or laugh, painful sex, and more–living with these problems is NOT “the new normal”–they’re COMMON, but they’re not NORMAL, and you don’t have to live with them!
After doing a lot of research, I knew that I wanted to at least meet with a PT during my pregnancy. I wasn’t sure WHAT it would entail exactly, but I figured it couldn’t hurt, and at the very least, I would have a relationship established with a PT so I could then make an appointment 6 weeks postpartum. A google search and some good old fashioned internet stalking lead me to Erin’s practice, West Town Physical Therapy.
A couple things that drew me to Erin: She had impressive credentials, I liked that she was younger in age, and felt relatable to me. Her practice office is nearby, AND she does home visits for all of her pelvic floor PT patients–which I really liked and knew would come in even handier once LR was here! Once I met her, I felt like we’d been friends for years already! She took the time to give me a super helpful pelvic floor overview (see ‘Penny the Pelvis’ above – I barely even knew what a pelvic floor WAS) and we devised a plan for both pregnancy and labor prep!
How pelvic floor PT has helped me during pregnancy:
Pain management: Obviously I will have more to report once I have gone through labor and recovery, but I have already seen the benefits during pregnancy!
At the beginning of my third trimester (once I started showing) I started getting some pain in my lower back, near my tailbone on the left side. Erin helped identify the reason for this (a lot having to do with posture, a lot having to do with the way my other muscles were compensating for a shift in my posture to balance out my belly) and with her tips, we avoided further damage to this joint, worked on strengthening and lengthening the supporting muscles, and now I can go days without my back hurting. Seeing as back pain is the #1 complaint of all my friends who have gone through pregnancy (some saying it’s so excruciating that they can’t sleep) I am SO THANKFUL and I know this has made a huge difference for me!
Additionally, I really think the pelvic floor strengthening/control work has helped me avoid leaking during pregnancy (AKA losing bladder control/having trouble holding it in! Pregnancy is fun.) Leaking is a common issue during pregnancy, but it only happened to me once, near the beginning of my third trimester (I think before my second or third session with Erin)–it hasn’t happened since, and I really think it’s due to the strengthening from physical therapy!
In addition to targeting back pain, Erin gives me targeted exercises to do to strengthen, lengthen, and learn to control my pelvic floor, in addition to moves I can do to strengthen and stretch key muscles that will help support my body through pregnancy and labor.
Last week, we started talking about labor preparation (which she typically starts with her patients around weeks 34-36) We talked about different positions/stretches I can do to ease pain during the beginning of labor (pre-epidural), tips of how to progress labor naturally, tips on pushing (positions, techniques) and how to avoid tearing and unnecessary trauma as much as possible. We’ll be diving more into that in the next few weeks and Erin is already working on a follow-up blog post on labor prep!
For THIS blog post though, we’re focusing on Pelvic Floor PT 101–I had you all submit your questions for Erin, so that’s what we’ll be going through today! I’ve broken it up into sections–more general, and then pregnancy/postpartum specific. This is the first of what will hopefully be a few more posts around pelvic floor PT–as it’s something I really want to spread the word on, it can help so many women!
Let’s jump in! 🙂
First of all, tell us about yourself and your background, Erin! How long have you had your own practice? That’s so impressive!
I’ve had my own practice, West Town Physical Therapy, since 2018 and I’ve been a licensed PT for 7 years. Working for another practice coming out of school, I soon realized that while working for someone else was great experience, I wasn’t able to treat patients the way I wanted to treat them. I wanted the focus to be on personalized experience and one-on-one care, which is not always the case at the bigger PT places! So I opened WTPT four years ago and haven’t looked back–we’re also opening a second location in Roscoe Village soon!
I grew up in Chicago and have always been fascinated by the human body and love trying to solve my clients/patients issues like a puzzle. After attending University of Michigan for undergrad and Columbia in NYC for my DPT (Doctor of Physical Therapy), I moved back to Chicago to be close to family.
I also have my OCS (orthopedic clinical specialist) and am really passionate about pelvic floor physical therapy and women’s health in general. I have gone through extensive women’s health training through the Herman & Wallace Institute which is currently the leader in the field, as well as through other sources!
Working as an orthopedic physical therapist, I felt like there was a missing link in a lot of my female patients and friends’ care especially when it comes to pregnancy and rehabbing postpartum. I became passionate about helping women because I realized so many women accepted their pelvic floor issues as just something she needs to live with and that is just not the truth!
Thankfully the conversation around pelvic PT is growing, but there is still such a need to increase awareness and encourage more PTs to go in the field.
Second, what terminology should we be using when discussing women’s health PT? Pelvic floor PT? Is one term better than another?
Pelvic Floor PT is the most encompassing term. There is a slight move away from “Women’s Health” since men also have pelvic floors and have plenty of associated issues as well!
That being said, pelvic floor PTs can specialize in different areas. For myself, I have most of my training in the women’s health area so I tend to use them interchangeably.
…Now to jump into more reader questions!
First, some general overview questions about PVPT:
What IS the pelvic floor, exactly? What does it do? Why is it important, and how does PT help it function better?
Great question! The pelvic floor is actually a group of muscles, 11 to be exact! (9 in men). These muscles are separated into 3 different layers that sit like a hammock attaching at your pubic bone all the way back to your tailbone.
Your pelvic floor has 5 main functions (often referred to the 5 S’s):
- Support: To support your organs (bladder, rectum, and uterus (which includes your baby while pregnant!)
- Sphincteric: Bowel and bladder function (holds in pee and poop and relaxes when you use the bathroom)
- Stabilization: works in coordination with your lower abdominals, respiratory diaphragm, and multifidus (all muscles in your core)to help stabilize and manage pressure
- Sexual function (assisting with arousal; contracting and relaxing during orgasm; relaxing for pain-free penetration)
- Sump Pump: helps manage blood flow and fluid around the pelvis
There are also many other muscles along the pelvic wall that affect the way your pelvic floor functions. For example, your pelvic floor is the base of your core. If this is not functioning properly, then the rest of your core is not able to optimally function!
In PT, we will evaluate exactly what is going on with your pelvic floor as well as a full body assessment to figure out how it is affecting the rest of the body or how the rest of your body is affecting the pelvic floor.
Treatments for pelvic floor will vary from person to person since each person is different. In PT we will work on your connection to the pelvic floor and then build from there depending on your evaluation findings. In PT you are going to learn how to actually use your pelvic floor effectively rather than just doing kegel after kegel.
Who can benefit from pelvic floor PT? What are some common issues that it can help?
There are so many people that can benefit from PT! Not just women, either! (Although for the purposes of this blog post, we’ll be talking more about women specifically!)
Some of the most common issues I see (from both moms/moms-to-be and women who don’t have children) are painful sex, leaking (especially with working out), prolapse, constant feeling of UTI but receiving a negative culture, pelvic pain of any kind, postpartum recovery (whether you delivered vaginally or via C-section).
Additionally, doing proactive PVPT is very beneficial to women during their pregnancy! (More on that below!)
What can someone expect from their appointments? What is the exam process like?
During the first session, we will always spend a good deal amount of time chatting and gathering information. I’ll want to know about things related specifically to the pelvic floor such as sexual function, bowel and bladder, birth history, pain, as well as other information related to the rest of your body. We will use this information to help guide the session.
This session will typically include an overall assessment of muscle strength and function, posture, joint mobility, breathing, and movement patterns.
If you are postpartum, I will assess your core function and for any presence of diastasis recti. If you have had a C-section, we will also look at scar mobility and healing.
From here, we will often go into an internal muscle assessment. This is just like at your OB except instead of a speculum, I will use a finger to assess the muscles for strength, tone, and tension. This is ALWAYS on your terms! If you are not feeling comfortable, we can always defer and try this on another date. There is a lot of information we can gather from talking and the external examination.
I will also note that internal exams are not typically done on pregnant women unless there is a specific issue we need to address (vs. doing PT proactively, like what Jess is doing!)
If we feel that it would be beneficial, then we would contact your physician to discuss if it is warranted. Otherwise, we will start doing internal exams after baby is here when they become a crucial part of the assessment.
From here, we will go through our plan and I’ll provide a lot of education. I will typically include a few exercises to start working on. At our next session, we will do a full one-on-one session that will be dictated by what we found at the first session (usually includes some internal, some external hands on, and exercises). Then we continue working from there!
How do you get started? Do you need a referral?
This varies by state. In Illinois, you do not need a referral from your doctor! A quick google search should lead you to the right answer based on your area.
If you are pregnant or post-partum, we do like to keep your OB-GYN in the loop just to make it a team effort. When booking at our office, we will usually ask for your physician’s information but you do not need a referral to come in!
Is pelvic floor PT covered by insurance?
In many instances, yes! If you have an HSA card, you can also use this to cover PT! If you go somewhere out of network, they should submit your claims to be reimbursed. (Jess’ note: FYI–Erin’s practice takes Blue Cross Blue Shield and they will happily submit any out of network claims to insurance as well!)
How do I go about finding someone in my area?
Note that these websites aren’t always totally up to date, but are definitely a good start!
More ideas: ask a friend! Ask a prenatal fitness instructor. Are you a member of a mom’s facebook group? Ask there. A lot of times people aren’t openly talking about it but you never know, they might have a good recommendation!
What kinds of qualifications should I look for in a Pelvic Floor Physical Therapist?
Pelvic Floor PTs go through extra training beyond PT school, however, not all of us treat the same. Here are some things to look for in your PT:
- Treats with a full body approach. At the evaluation, the PT should be screening more than just your pelvic floor muscles.
- Takes an active approach. You should be an active participant in your PT session. If you are laying on the table without having to consciously focus on some sort of movement, you are likely wasting your time.
- Spend the entire session with you. Pelvic rehab is complex. Doing the internal work and then handing off to an aide is unacceptable.
- Performs internal and external assessment of your pelvic floor (if you aren’t pregnant & if you give consent).
Pelvic floor physical therapy as it relates to pregnancy/postpartum:
Can all postpartum women benefit from a PT evaluation? Why/how?
In my personal opinion, I think anyone that is postpartum should at least have a pelvic floor PT evaluation whether you gave birth vaginally or via C-section.
Why? Both deliveries are a trauma to the body!
With a vaginal birth, your muscles are overstretched and often torn and with a C-section, you experienced a major abdominal surgery!
If you pull or tear a muscle, it’s often a no-brainer than you do PT but because we can’t see the pelvic floor muscles, it’s often ignored and women are sent on their way. These muscles might technically be healed, but they might now be weak and definitely need a little help regaining their function.
If you are pregnant, this is also a great time to explore pelvic floor PT. We will work on gaining optimal function of your pelvic floor, managing your pressure and stability in your abdomen and hips (which helps you avoid pain throughout your pregnancy) and also preparing you for the actual delivery! (More on that below!)
How can pregnant women benefit from PT? At what stage of pregnancy should someone engage a PT? Does it matter if someone is having a c-section or vaginal delivery? Can both benefit from PT?
Pelvic floor function and control is really important both for supporting your body during pregnancy AND during the labor and delivery process:
Helping you through your pregnancy journey: During pregnancy and postpartum, you want a strong, flexible, and coordinated pelvic floor to meet the demands of your activities and to support your growing baby.
Helping you during actual labor and delivery: During delivery, however, you want your pelvic floor to just get out of the way! This is why you need a flexible pelvic floor and to learn how to relax with birth prep. This is a very common misconception.
Pregnancy is a huge transformation! Not only can we help prevent back pain, tailbone pain, pubic bone pain, and urinary leakage as your body continues to change throughout the second and third trimester, but we can help you prepare for both childbirth and postpartum recovery.
Specifically, beyond pain control, pregnant women can benefit from learning how to provide muscular support to their growing bodies, learn how to control the pressure in their abdomen, prevent diastasis recti, prep for birth to reduce perineal trauma, control their leaking of urine, and many, many more!
What stage in pregnancy should you start pelvic floor physical therapy? How often?
I would say to start after you are 12 weeks if you are being proactive but it is great to start at any point in your pregnancy beyond your first trimester! You’ll learn how to use your core and pelvic floor during pregnancy and set you up for postpartum success.
Some people, I see weekly to help navigate any issues that are already presenting (i.e. if you’re having issues with leaking, tailbone pain, back pain, etc, we can work on targeting those specifically in addition to proactive things) or I might just see you once a trimester for check ins, providing you with exercises to work on on your own in between our sessions. We’ll focus on strengthening key muscles, flexibility, pelvic floor control, and helpful things like how to properly get out of bed once your bump gets bigger, posture work, etc!
At the 34-36 week mark is typically when we will start birth prep.
We’ll cater your schedule to you and your goals here! When we go through birth prep, we will prepare based on your birth preferences and also prepare for the unplanned. My goal is to help you navigate pregnancy, birth, and postpartum with a sense of control over an uncontrollable journey.
We’ll work through some tips on what to do during various stages of labor, how to relax the pelvic floor when pushing (like I said above, you want your pelvic floor to get out of the way during labor–so knowing how to do that is really important!), and more, based on your birth preferences.
Can you still benefit from pelvic floor physical therapy if you have a c-section?
Yes! You can absolutely benefit from pelvic floor PT (both preventative and postpartum recovery) if you have a C-section (planned or unplanned).
Does doing PT mean I will have an easier delivery?
Not necessarily! Of course, as with anything, there are no guarantees–everyone’s experience and every birth is unique, but it can definitely help set you up for success as much as possible, and hopefully make your pregnancy journey and postpartum recovery much more manageable and positive!
What point should you start PT postpartum? Is it ever too LATE?
It is never too late! Once you are postpartum, you are postpartum for life. I would recommend starting PT after you’ve been cleared by your doctor at your 6 weeks PP checkup, especially if you are having any pelvic floor and/core related issues, or suspect you may have them.
I see some patients years after having a baby simply because they didn’t know about PT or didn’t have the time. IT IS NEVER TOO LATE!
If I just had a baby and am planning to have another child soon, do I go to PT in between? Or should I wait until I’m done having kids?
Definitely go in between kids! Even if you are a few years postpartum, it is never too late!
I often see women who had an easy breezy first pregnancy and then struggle through their second. A lot of times this is because they did not restore their pelvic floor and core function so there is a decrease in that functional support for you and your growing baby. You want to lay the foundation for a successful and pain-free pregnancy and then set yourself up for success postpartum.
Is there anything pelvic-floor related that women should be doing before they get pregnant to set themselves up for success?
Absolutely! It’s never too early to start learning how to utilize your pelvic floor–functional movement is key. Stay away from the recommendation of “just do your kegels!” Kegels and pelvic floor strengthening is only a part of the the picture. (Not to mention, if you are experiencing pelvic pain, painful sex, urinary retention, or constipation, kegels are NOT the answer and could be doing more harm than good!) What you’ll want is something that works on both strengthening and coordination–being able to relax your pelvic floor is so important, too!
What are some example moves that help target pelvic floor coordination? It’s hard to wrap my mind around!
What do I mean by working on pelvic floor coordination and flexibility? A good example of this when doing squats or lifting. Practice inhaling and filling up the belly as you relax your pelvic floor (like you would to go to the bathroom) and then exhaling like you are a slowly deflating balloon, lifting your pelvic floor up through your abdominals as you stand up. (Some like to think of it like a zipper zipping up from your pelvic floor up through your belly button, or an elevator going up!)
To get a better feel for your pelvic floor movement and breathing coordination, it might help to do this sitting on something like a chair or a bench so you can feel the ‘lift’ better.
That’s all for today!
I hope this was helpful, HUGE thank you to Erin for answering all our FAQ’s about pelvic floor physical therapy! If you live in the Chicago area, I can’t recommend working with Erin enough! You can make an appointment to work with her via her website right here! (Her practice also offers other types of PT, not just PVPT, in case you’re looking for a different kind of referral!) Stay tuned for more soon!
Also, if you have a friend or loved one who you think could benefit from pelvic floor PT, please send this to her! The more awareness we raise about it, the more women we can help! 🙂