Pelvic Physical Therapy and How It Can Help You

**I am not a doctor and this is not meant to be medical advice.**

Pelvic Physical Therapy is the unicorn of Physical Therapy

No one knows Pelvic Physical Therapy exists until they have to have it themselves.

But first, let’s start with a little back story

Well before pregnancy, I sought help from my gynecologist about a pain I was having on the left side of my vagina during sex.  My gynecologist performed a routine pelvic exam said he couldn’t find anything and sent me on my way.  He told me nothing was wrong with me, and I just needed to relax.

At that time, I was not nearly as educated as I am now, and I left agreeing with the doctor.  However, the pain never went away.

Fast forward a few years, and I have had a c-section due to a breech baby.  I am at my 6-week postpartum check-up, which is a joke by the way, and I discuss with my doctor the discomfort I am feeling between my belly button and my scar. Which I briefly discuss in this surviving postpartum post.  He says everything is still healing and to give it a little more time.  It makes sense so I go on my way.  This was in May 2018.

If you are curious what all to expect after a c-section, check out this post.

In July 2018, I go in for my annual visit to the gynecologist.  I am still feeling the same discomfort, and again, I get the “everything is still healing”.  Not long after this appointment, I discovered the existence of pelvic physical therapy; however, I still felt compelled to see if I would feel better on my own.

In December 2018, I FINALLY emailed my doctor asking for a referral to Pelvic Physical Therapy. I told him I wanted them to work my scar and get some exercises to help the discomfort.  No questions asked I was sent a referral and an appointment was set up soon after.

I still pose the question…why was this not offered to me in July?

Did you know?

A minimum of 2 weeks after a c-section you should be massaging your scar working to break up the scar tissue.  If at 2 weeks postpartum your scar is still tender, you can wait for your 6-week postpartum check-up and start massaging your scar once you are cleared by your doctor.

I had NO idea I should have already been doing this, NONE.

The only surgery I have had is the removal of my impacted wisdom teeth, and I feel as if after a c-section that doesn’t even count anymore, not that it did to begin with.

But, you aren’t massaging your gums when your wisdom teeth come out.  You are hoping you don’t get dry sockets.

So, who should be telling us to be doing this postpartum?

This leads me to Pelvic Physical Therapy.

If you have had a baby vaginally or through c-section, did your doctor recommend Pelvic Physical Therapy?

If you have an overactive bladder, incontinence, pain during sex, pelvic or back pain, did your doctor recommend Pelvic Physical Therapy?

Did your doctor just tell you to do kegels and send you on your way?

Let me know in the comments.

What is Pelvic Physical Therapy?

Pelvic Physical Therapy involves the pelvic muscle group and the pelvic area.  In Pelvic Physical Therapy, you learn exercises and techniques to strengthen your abs, hips, and pelvic floor muscles.  Keeping all of these muscles strong keeps things like your bladder and rectum where they should be.

Pelvic Physical Therapy is beneficial for both men and women.

Your physical therapy sessions can be internal, external, or both. Whatever technique is used is dependent on your unique situation.

Before I talk about my personal experience with Pelvic Physical Therapy, I want to go over a few common issues women have whether they have had a baby or not, and how Pelvic Physical Therapy can help.

  1. Given Birth or was pregnant at any point in life

Your body goes through a lot during pregnancy.  Your abdominals and pelvic floor muscles stretch and loosen due to hormones and to compensate for your growing baby and belly. This stretching and loosening can cause a weakened pelvic floor.

A weakened pelvic floor can lead to incontinence because your pelvic floor is no longer able to help hold up your bladder.

Pregnancy and birth as beautiful as it is takes its toll on our bodies, and we need to know what we can do to keep our bodies healthy and functioning before, during, and after pregnancy.

Pelvic Physical Therapy can help you strengthen a weakened pelvic floor due to pregnancy and birth.  You can start Pelvic Physical Therapy 2 weeks after birth depending on pain and discomfort if cleared by your doctor. Otherwise after 6 weeks postpartum and you are cleared by your doctor, it is recommended to begin pelvic physical therapy immediately regardless of symptoms.

You can also see a pelvic physical therapist during pregnancy especially if you are having significant lower back pain.

Having bladder prolapse after pregnancy is somewhat normal due to a newly weakened pelvic floor, however you should still see a pelvic physical therapist as soon as you are cleared by your doctor to strengthen your pelvic floor muscles.

Your physical therapist will do an initial exam whether that’s internal or external and then give you exercises to do there and at home to start improving your pelvic floor.

  1. Incontinence

Urinary incontinence is the loss of control of your bladder. Are you peeing when you cough, sneeze, laugh, bend over (kidding), etc.? This isn’t normal and possibly due to a weakened pelvic floor in men and women.

Is giving birth the only qualification to have urinary incontinence?

No! Because urinary incontinence effects men too, and last time I checked they couldn’t have babies even if we wish they could. 😉

The Mayoclinic lists several causes of urinary incontinence from what you are eating or drinking to prostate issues in men.

Will pelvic physical therapy help everyone with incontinence?

I am not a doctor, nor do I know your situation, BUT pelvic physical therapy is a wonderful noninvasive place to start. 

If any of these symptoms are happening during pregnancy, before pregnancy, after pregnancy, or in older age, discuss them with your doctor and ask about pelvic physical therapy do not just give into surgery or kegels as your only option.

You do not have to be in your 50’s or 60’s going through menopause to experience incontinence or overactive bladder which will be discussed next.  You aren’t too young and should ask your doctor about pelvic physical therapy.

  1. Overactive bladder

An overactive bladder is when you have an overwhelming urge to urinate even if your bladder isn’t full.

With overactive bladder, you may feel the need to urinate frequently. According to the Urology Care Foundation, if you are using the restroom more than 8 times in 24 hours and getting up in the night multiple times to urinate, you could have an overactive bladder and need to consult your doctor.

You can have some incontinence with overactive bladder because the urges are so frequent and sudden.

Unfortunately, the Urology Care Foundation doesn’t out right suggest pelvic physical therapy, but an exercise that sounds like a kegel.  Kegels, though great, are not for every pelvic floor problem and you should consult your pelvic physical therapist first.

If this sounds like you, do NOT jump to surgery, but ask your doctor if you can at least try pelvic

PT before considering surgery.

Again, Pelvic Physical Therapists can help you strengthen your pelvic floor muscles to where your situation is better or completely gone.

As with any physical therapy, you have to do the work as well for it to work.

  1. Pain during sex

Pain during intercourse can be with initial penetration, pain during deep thrusting, burning pain after or during, or throbbing hours after intercourse.

If you are having any of these issues after intercourse, please, consult your doctor right away. If they say nothing is wrong and just relax, ask about Pelvic Physical Therapy.  It is likely your physical therapist will do an internal exam to determine the course of treatment and the status of your pelvic floor muscles.



My Experience with Internal Pelvic Physical Therapy

As you read above, I consulted my gynecologist for pain during sex a long time ago and was told I was fine.  It wasn’t until my Pelvic Physical Therapist and I were having a conversation about my progress that we realized there was another angle we should have been working along with the other things we had been doing.

See, Pelvic PT can also be done internally.  It seems weird and unnatural, but (I’m laughing as I write this) it isn’t that bad.  Yes, your therapist has their finger inside you and you guys are talking, but it isn’t like visiting the OB/GYN where you never see their face and it just feels uncomfortable the whole time. You and your therapist are working together to determine the problem.  There is a sheet over you and your therapist is only looking down there as needed; it is mostly by feel of the muscles.

I was more embarrassed I couldn’t do a kegel than the situation we were in at the time.  With that said, my physical therapist found my problem spot IMMEDIATELY. I almost didn’t even have to tell her she could tell by how it felt.

I am still a work in progress, but things are getting better slowly but surely. And, I can do a kegel now, so that is progress!

As comical as it was not being able to do a kegel, it helped me to become more aware of how I am always sitting clinched and never relaxed.  I started to notice when I would clinch and would attempt to get myself to relax.  I am starting to get more body awareness down there.

A Helpful PT Analogy

I LOVE my therapist’s analogy of what it is happening when I sit clinched all the time.  She compares it to a flexed bicep (you are curling up in a bicep curl), but you don’t release the muscle (or extend the muscle), and you have to learn to contract and release.  I am basically hanging out all day with my bicep curled down there all the time.

She started teaching me to contract and release, and I just have to apply those techniques daily.  Insert diaphragmatic breathing and kegels.

What can you expect at your pelvic physical therapy appointment/s?

When I first started pelvic physical therapy, it was to work my scar and figure out why I was feeling discomfort between my belly button and my scar.

My description above of my internal experience was after discussing life pre-pregnancy, and that I was still uncomfortable especially right before my periods are to start.

An internal exam was performed, and we discovered I have a truly weak pelvic floor muscle.

To read about pelvic floor muscles you can check out this post.  Like I said already; I couldn’t do a kegel at all.

Prior to the internal sessions, we had several sessions where my physical therapist would massage my scar, this is what I mean when I say, “work my scar”.  I started going in January of 2019; I now have a soft scar that I can massage on my own to be sure to keep the scar tissue broken up.

You don’t have to be 6 weeks postpartum to start Pelvic Physical Therapy. Even if it has been years since you had a child, you can still start Pelvic Physical Therapy.

My physical therapist would also massage the area between my belly button and scar.  Here she discovered knots and tightness in my muscles we both assume are from pregnancy.  Think of the knots you get in your shoulders; those were on my abdominal muscles according to my PT (Physical Therapist).

All of this is done inside of an exam room just you and the PT.  You are completely covered the entire time.  If you have had a c-section, your scar will be exposed so they can massage it, but nothing else.

When we were working externally, after a few weeks, we would start each session on a stationary bike to warm up the muscles.

Your initial exam will depend on why you are there and how you answer your PT’s questions.  It is possible your initial exam could be internal.

Make sure you wear comfortable clothes to each visit.  As I stated above, there is no success in Physical Therapy unless you do your part as well.

If you have specific questions, please email me, or post in the comments below.

My New Motto, Pelvic Physical Therapy First Then Everything Else

I hope you will force your doctor to give you the referral to Pelvic Physical Therapy, so you can be on the road to feeling better.  Because running to the restroom constantly isn’t normal. Peeing when you cough, sneeze, laugh, or move is also NOT normal.   Pain during sex is NOT normal. You can find joy with sex again or for the first time.  This is not a lifestyles you have to except or live with day to day.

There is help out there for you.

Consider Pelvic Physical Therapy before medication or surgery.

Resources

If you just want a list of symptoms to compare to yours, these websites are great for that.

Urinary Incontinence

https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

Overactive Bladder

https://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)

https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715

Bladder Prolapse

I didn’t talk a lot about this one, but it is common after pregnancy.   This is from ALWAYS the pad company, but I think it does a decent job laying out what is and the symptoms.  This too is something you can see a Pelvic Physical Therapist for.

https://alwaysdiscreet.com/en-us/incontinence-advice-support/bladder-problems/bladder-prolapse-what-to-do-if-you-have-a-prolapsed-bladder

I really liked the Pelvic Guru. She is a Pelvic Physical Therapist herself, and her site has a lot of information as well as a way to find Pelvic Physical Therapists in your area.

pelvicguru.com/2013/08/05/10-common-misconceptions-about-pelvic-physical-therapy  

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