by Tulsi Desai (Physical Therapist)
A lot of birth workers have heard about pelvic floor. They know it’s important. Some are very well aware about what it exactly means either because they have been in the birthing profession for a long time, or have friends who are pelvic PT, or some have personally gone through pelvic floor rehabilitation after their babies. But there are so many others who think they kind of know what pelvic floor is? But not really. And they are not sure who to ask for more accurate answer.
My name is Tulsi Desai. I am a pelvic floor physical therapist. You would ask why is pelvic floor physical therapy any different from regular physical therapy? Hope I can answer this as accurately as possible. Every physical therapist has to go through basic physical therapy degree either Bachelors, Masters (common degrees for more experienced therapists who graduated long time ago) and/or Doctorate in physical therapy/DPT (I won’t go into too much detail about the degree itself). Regardless of the designation, everyone has to take a board exam and get a PT license to practice in United States. Pelvic Floor or Women’s Health Physical Therapy is a super-specialization where a physical therapist has to go through advanced training in pregnancy, postpartum, menstruation, menopause and anything related to women’s health that includes reproductive system, urogenital system, gastrointestinal system, hormones and their effects on every tissue in the female body which is very different than the male. We get trained in unique needs of pregnant and high risk pregnant patients in order to provide them safe physical therapy treatment for back pain or any musculoskeletal problems they have.
Human body is a complex structure and human pelvis accommodates a lot of organs mainly bladder, uterus, ovaries, fallopian tube, and colon as well as various nerves, blood vessels and lymphatic system. It also accommodates the growing baby during pregnancy. Pelvic floor is a termed used for a group of pelvic muscles that support all the above mentioned structures inside the pelvis and keep them in place. Pelvic floor plays a huge role in maintaining bladder and bowel continence. It also plays a role in sex and orgasm. Pelvic floor muscle problems or dysfunctions can lead to complications like urinary or bowel incontinence (varying from a few drop leakage to full incontinence), urinary urgency, urinary frequency, multiple chronic UTIs (urinary track infections), possibly infertility or miscarriage, acute or chronic constipation, painful urination or defecation, painful penetration during sex (superficial or deep), and chronic pelvic pain to mention a few.
We are trained in internal pelvic floor evaluation where we can evaluate pelvic muscles, nerves, myofascial structures, bone alignment, nervous system, and some of the hip muscles that are inside the pelvis. All of these deeper structures are very difficult to assess without internal examination. Regular physical therapists are not trained thoroughly in these delicate structures and they do not have the evaluation or treatment skills specifically needed to address the need of women who have complex pelvic/low back/hip problems. They definitely do not have any training in internal pelvic floor evaluation.
Why does this matter to birth workers? How does this affect your clinical practice?
I am sure you have so many patients who tell you at their follow up postpartum appointment :“I pee when I sneeze” , “I have tailbone pain” , “I have to keep wiping my backside after finishing bowel movement” , “sex is suddenly extremely painful especially at the entrance during penetration or deep inside during thrusting”.
If your patients complain of any of the above mentioned problems beyond 4 weeks postpartum, they need a thorough pelvic floor evaluation. If they have had any perineal tearing beyond a simple laceration, they should get pelvic floor evaluated 4 weeks postpartum in a non-complicated patient. If there are any complications with scar healing or postpartum healing then the midwife or OBGYN doctor’s clearance will be advisable before considering pelvic floor evaluation and treatment.
We focus on so much more than just muscle strengthening or stretching. There is a reason why Kegel exercises don’t work for everyone and in some cases they make the problem worse. Most of the time, patients aren’t even doing them correctly or have no awareness on how to locate or activate the correct muscle. There are times their breathing pattern is exaggerating and complicating their organ prolapse. We look at the whole body and biomechanical chain when we evaluate our patients and then come up with the plan to address everything that is leading to the problem that the patient has.
I hope I was able to provide some insight into the importance of pelvic floor, it’s role and the huge need for pelvic rehabilitation especially postpartum. I hope the readers will be able to screen their patients for potential early signs of pelvic floor dysfunctions and guide their patients to the appropriate provider for optimal care.
If anyone has any questions, I would love to answer them or provide appropriate guidance.
Tulsi Desai is a physical therapist who can be reached at ACTIVE BODY ACTIVE LIFE (Physical Therapy & Wellness) via phone/text @ (214) 210-0715 or via email @ firstname.lastname@example.org. Facebook: @activebodyactivelife