The top 4 things a pelvic floor PT wants every birthing person to know
Written by Rebecca Maidansky, PT, DPT
As a pelvic floor physical therapist working in the field for several years, I’ve fielded my fair share of pelvic health misconceptions from patients, providers and weary acquaintances at parties. While the pelvic floor is something most have never thought too hard about (present company excluded) there’s nothing mystical or mythical about this group of muscles. In this blog post, I’m going to be presenting you with the top 4 things my pelvic floor PT heart wants every birthing person to know, and debunking some fallacies while we’re at it.
But before we jump in, let’s pause for a quick anatomy lesson. Typically when I ask people if they know what the pelvic floor is, I get a half hearted shrug followed by an “ehhhh.” It’s my personal mission that you feel much more confident in your understanding of this wildly important muscle group by the end of this post.
Your pelvic floor is a hammock shaped group of muscles that live at the base of your pelvis, spanning from your pubic bone to your tailbone and from sit bone to sit bone. For people with vulvas, these muscles surround three tube shaped openings: the urethra, vagina and anus. You have superficial and deep layers which all work together to support your body in doing all sorts of things. They engage to keep pee and poop in and to allow for orgasms. They relax to allow pee and poop out and to allow for pain free penetration. The pelvic floor has a number of other roles, some of which we’ll dive into below, but those are the basics.
Now that we’re all on the same page, let’s get to business. Here are the top 4 things I want every breathing person to know about the pelvic floor.
This is going to be the shortest one on our list, but also possibly the most important. For forever, pregnant and postpartum people have been told that leaking with sneezing, pain with sex, inability to run due to heaviness in the pelvis is just part of parenthood. If you take nothing else away from this piece, please know that that simple isn’t true.
While over 50% of people experience a variety of pelvic floor symptoms after childbirth, the vast majority of these symptoms are entirely treatable. It’s never too early or too late to start working towards helping your pelvic floor recover from birth. In our clinic at Lady Bird PT, we see folks as early as 2-3 weeks postpartum and as late as decades postpartum for the same symptoms. The vast majority see significant improvement in 3-4 weeks.
There are answers to your symptoms and solutions to your pains. No matter where you are in your postpartum journey.
How hard do you have to think about turning your head? When you want to cross the street, before crossing it, you turn your head from side to side to look both ways as you were taught to. You know where you want to look, your brain knows how to help you get there. The muscles supporting your head and turn on and voila, you do what you wanted to do. It’s effortless. It’s effortless because your brain has control over the skeletal muscles surrounding your head, and you have years of practice strengthening that connection.
Your pelvic floor is not all that different except for in one key way. Your pelvic floor is also made up of skeletal muscles that your brain controls to do the important things we already discussed above. Your brain has to turn these muscles on and off throughout the day. But unlike the muscles in your neck, we can’t see the pelvic floor. We can’t easily touch it and oftentimes we don’t actually know how to use it. With your head and neck, you think look right, and you can watch yourself look right. With your pelvic floor, you say “kegel” and then what? When I ask people to do a kegel in the clinic, the majority tell me they don’t exactly know what I mean. Imagine I told people to look right and the majority didn’t know what I meant, much less where right was.
This, among other factors, is the reason why pelvic floor dysfunction is so common. This is why so many high school and college athletes, pregnant and postpartum people, children and elderly folks experience urinary leakage, pelvic pain, constipation. Because they just don’t know how to make their pelvic floor turn right. If we don’t know how to use the muscles that control our bladder, bowels and sexual function, it makes sense why symptoms in those areas occur so often.
We should, with relative ease, be able to turn our muscles on and off and understand what on and off looks like. This includes the pelvic floor.
3. The pelvic floor needs support during pregnancy and in preparing for birth, not just postpartum.
Pelvic floor PT is slowly becoming more common during postpartum recovery. We’re starting to see more folks demanding answers for their postpartum leakage, pain, and symptoms. The media is starting to talk more and more about healing your body after birth. But the reason pelvic floor symptoms are so common postpartum is because of the extra responsibility the pelvic floor has to field during pregnancy and childbirth, and there is so much that we can do during pregnancy and in preparing for birth to help reduce the likelihood and severity of pelvic floor dysfunction.
One primary role of the pelvic floor is to hold all of your organs up inside your body. Throughout pregnancy, as your uterus, belly and baby grow, the pelvic floor has to work harder and harder to perform that job. Because of the added stress, it’s not uncommon for the pelvic floor to become fatigued leading to leakage, back and pelvic pain, heaviness in the pelvis and more. During birth itself, specifically during a vaginal birth, the pelvic floor needs to be flexible in order to move out of the way of the baby to allow you to push a baby out. The pelvic floor muscles stretch 2-4 times their resting length during vaginal birth. But for many, because of the extra work these muscles were doing during pregnancy, they’re actually tight and have a hard time relaxing. That tightness can increase the likelihood and severity of perineal tearing and even increase the likelihood of progression to c-section.
Pelvic floor physical therapy can help your pelvic floor train to meet the increasing demands of pregnancy while preparing for the seemingly opposite demands of birth. As someone famous once said, an ounce of prevention is worth a pound of cure.
4. There’s no reason to wait until after you’re done having children to work on your pelvic health and in fact there are a bunch of reasons the sooner you address it, the better.
It’s not uncommon for folks to feel pretty good after their first pregnancy. It’s also not uncommon to have difficulty recovering from pregnancy #1, so if you fall into that camp, you’re not alone. But you wouldn’t believe how often people come into my office shocked that their second pregnancy feels so much harder than their first. Or that their second recovery feels so much harder than their first.
But a few things are different about a second or third pregnancy and birth.
All of this to say that rehabbing your body following pregnancy can help prepare you for a subsequent birth and recovery. The stronger you comg out of your first pregnancy, the stronger you go in to your next pregnancy, the stronger you come out after your next birth. Training your body for future pregnancies and births can help reduce the likelihood of pain, leakage and other common symptoms.
Lady Bird Physical Therapy is a clinic in Austin, TX specializing in pelvic health surrounding pregnancy, birth and postpartum recovery. To work with us 1:1 in the clinic or virtually, contact us here. Check out our self paced Birth Preparation and Postpartum Planning Course here. To learn more about pelvic health, check out Lady Bird PT’s blog, sign up for our newsletter, or check us out on IG and Youtube.
-Dr. Rebecca Maidansky, PT, DPT
Rebecca Maidansky is a pelvic floor physical therapist and the owner of Lady Bird Physical Therapy, a clinic in Austin, TX that specializes in helping people manage pregnancy pains, prepare for birth and recover postpartum. Rebecca is a passionate pelvic health advocate who is committed to promoting pelvic health education across all platforms, for all people. You can find her writing on Lady Bird PTs blog and find her on Instagram and Youtube. To work with Rebecca, check out her Birth Preparation course or contact her directly to learn more about 1:1 appointments.
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