When you think of physical therapy (PT), you probably associate it with an injury (like a sprained ankle or carpal tunnel syndrome) and a path towards recovery. But, there’s another reason to see a PT: your pelvic floor.
Your pelvic floor is a set of muscles that you can’t “see” from the outside, so we rarely think about it. This hammock of muscles serves us every single day: it allows you to pee, poop, fart (or hold it in!), orgasm, push a baby out and so much more. It holds your organs in (like your bladder and uterus) and works in conjunction with your abdominal muscles (along your front and back) so that you can walk and stay balanced.
And, just like any other muscle, these can get tight or loose, hold tension, become injured and more. Tending to our pelvic floors — whether we’re having symptoms of dysfunction or not — can help us experience life more freely. In the same way that you can’t run with your kids if you have a charley horse in your calf, you can’t be carefree throughout the day if you’re peeing a little when you sneeze or dreading physical intimacy with your partner because it’s painful.
Here are nine reasons to call a pelvic floor PT today:
1. You’re pregnant and you want to learn how to push
Pushing in labor is not as straightforward as you might think — especially if you have an epidural and can’t “feel” the muscles down there. But knowing how to push effectively can speed up your delivery time by a lot, which is well worth it (ask, well, any mom).
“If you can’t relax your pelvic floor, you’ll have a hard time,” says Dr. Sarah Clampett, PT, DPT, the clinical director at Origin, a women’s health physical therapy clinic with three locations in California and a multi-state virtual program.
Dr. Clampett explains that her team of PTs help patients with lengthening the pelvic floor – the very move that is essential in bearing down to push the baby out. “We use a mirror and give our patients feedback,” she says. “We look at your functionality in different positions to see where you are most effective and then you can take that back to your OB. We’ll teach you verbal cues that you can give them to your partner and doula, if you have one, so they can cue you to bear down and you’ll know how to do it.”
2. You’re pregnant and you’re experiencing leaking or have a history of symptoms
Many women find themselves peeing their pants a little during pregnancy. In fact, it’s so common that we’re taught that it’s normal, but it’s not. We just haven’t normalized education around how to strengthen these “invisible” muscles so that we don’t end up leaking. More importantly, there are strengthening skills that a PT can teach you so you can hold your pee in until you get to the restroom, even if you have a full bladder and you sneeze.
The load of the baby and your organs on your pelvic floor can exacerbate past issues and make them resurface.
3. You had a baby!
How many of us have moms who are dealing with incontinence 30 years after they gave birth? That’s because the pelvic floor does not heal on its own after birth. It requires some TLC after going through what is probably the biggest event(s) of its existence. Whether you had your baby vaginally or via C-section, now is the time to see a pelvic floor physical therapist. In fact, in France, you are assigned a pelvic floor PT after delivery.
If you delivered vaginally, you likely have tiny or large tears, granulated tissue, and muscles that need strengthening. If you had a C-section, your pelvic floor still needs love — it got quite the workout during pregnancy from carrying the load of your baby, placenta and uterus.
Pelvic floor work can start virtually as soon as a week after birth (think breathing and working on finding those core muscles again) or once you’ve been cleared by your doctor at your six-week check-up.
If you’re still pregnant, Dr. Clampett suggests pulling a mirror out and looking at your vulva and pelvic floor to get a good glimpse of your baseline. “We can help arm you with the tool of knowing what it looked like before you had a baby,” says Dr. Clampett. “That way you’ll know if something looks different after delivery.”
The work you put in now will serve you now and for decades to come.
4. You had a C-section, an episiotomy, or any tearing
If you had a C-section, an episiotomy or tearing during labor, it’s very important to see a physical therapist. They’ll help with scar mobility. Scars left to heal on their own can lead to pelvic floor dysfunction, such as incontinence, painful sex, an inability to move fluidly through your core and more. A pelvic floor PT will help your scar heal in a way that won’t later impair your life.
“Anytime there is trauma to any part of the body, the natural response is to tighten,” says Dr. Clampett. “The good news is that within three visits, we see 90% recovery.”
6. Sex is painful (in postpartum or anytime)
No matter what you’ve heard, pain in sex is not acceptable. Whenever you’re experiencing it — with penetration, orgasm, external stimulation, or after sex — it’s something that can be resolved.
Hormones play a factor in why sex might not feel good. If you’re breastfeeding or perimenopausal, you may have a lack of estrogen in your body, which can make it hard to lubricate enough. A physical therapist can help here.
If your PT finds that your muscles are particularly tight or spasming, they’ll work with you to lengthen and relax your pelvic floor so that it can go through the full range of motion required for rewarding sex. They may also make product recommendations like certain lubes or dilators, which can be helpful tools in re-training your brain not to perceive pain before penetration so that sex can become enjoyable.
7. You’re perimenopausal
Just like so many things we experience as women — puberty, pregnancy — heading into menopause is a transition through which you should be supported. If you’re at this stage, you may be having hot flashes, a loss of your period, mood swings and hormonal shifts. This shift can feel a lot smoother if you have a physical therapist to help you through it.
That’s because your pelvic floor is undergoing a lot of changes with this shift. A decrease in estrogen leads to dryness, a weakening and atrophy of your pelvic floor muscles, and less elasticity of the tissues.
Between physical therapy and lube recommendations, you should be good on incontinence or painful sex.
8. You frequently feel like you have to pee
If you’ve often got an urge to pee but there isn’t much in there, you’re likely experiencing an over-activity of the pelvic floor.
“There is a neural pathway between your bladder and your brain that when your pelvic floor is really tight, it puts pressure on your bladder sooner than you actually have to go,” says Dr. Clampett. “The stretch receptors will start to be trained to think you have to go.”
Dr. Clampett explains that a pelvic floor PT will work with you on relaxing your pelvic floor and help you practice deferring the need to void as a way to retrain your muscles. “You should be able to hold it for 3-5 hours,” says Dr. Clampett. “Going every 45 minutes creates this unhealthy cycle.” A PT can help you break this loop.
9. If you feel heaviness or pressure “down there”
Maybe it feels like there’s a tampon in there. Or may you’ve been washing yourself in the shower and it felt like something was coming out. This is the pelvic organ pushing on your vaginal wall and it’s called prolapse. This can happen if you’ve had chronic constipation or your pelvic floor muscles are weak from having a baby or for other reasons. Strengthening and building support back into the pelvic floor can resolve these issues. A pelvic floor PT will work with you to build that strength in an effective way.
What’s the 10th reason for seeing a pelvic floor PT? “Because you have one,” says Dr. Clampett. “We see a lot of patients who say ‘I feel fine’ who have a weak floor or muscle spasms. They’ve learned to accept their symptoms as ‘just the way it is’ but the reality is no symptoms – pain, incontinence, prolapse, painful sex, etc — aren’t normal.”