Who Can Benefit from Pelvic Floor PT?
My shortest answer is absolutely everyone can learn and benefit from a pelvic floor physiotherapy experience. Pelvic floor problems are not limited to a certain age or gender. I strongly believe that everyone can benefit from learning about the location and function of their pelvic floor muscles. Clients are able to expand their knowledge on healthy bowel and bladder habits. Through this, clients can identify what routine habits or strategies they may be doing that are not supportive to optimal function of the pelvic floor. Clients learn to incorporate novel ways to connect to an area of their body that can be voluntarily contracted or relaxed but not easily seen as these muscles lie inside our pelvis.
If I was to be more specific, anyone who is experiencing urinary or bowel incontinence, difficulty emptying their bladder, constipation, urinary urgency/frequency, deep pelvic pain, pelvic or genital pain related to sexual activity, pelvic organ prolapse, vulvar and/or vaginal pain, pregnant and/or postpartum, pre or post menopausal may benefit from pelvic floor physiotherapy. However, some of my clients are interested in a pelvic floor physiotherapy assessment as more of a proactive and preventative approach so as to minimize the risk of developing these symptoms down the road. This idea is brilliant to me and something I highly support.
When is a good time to see a pelvic floor PT – during pregnancy/before birth, postpartum?
There is no hard and fast rule here. I have seen very proactive clients who are keen to have a pelvic floor physiotherapy assessment prior to attempting conception to simply ensure their pelvic floor and bladder, bowel, and sexual health has received a healthy check up. Other clients wait to be seen until after the first trimester which is generally recommended before an internal vaginal and/or rectal assessment would be performed. The science behind this rule is not very strong but it is a general rule that I am consistent with in my practice. For pregnant clients to be seen, they do not have to have any pelvic symptoms whatosever for an assessment to still be a great idea. I like to support clients throughout their pregnancy by helping them understand more about their pelvic floor function, the anatomy of the pelvic floor, healthy bladder and bowel habits, strategies to support their mobility, flexibility and strength as their body undergoes significant changes throughout pregnancy. As delivery day gets closer, the focus transitions to guidance on pelvic floor muscle lengthening and relaxation strategies to help minimize the risks and severity of trauma to these tissues during delivery. I encourage my clients to stay connected in the early postpartum phase where I am available for virtual treatments during the first 6 weeks. At 6 weeks postpartum, most clients get the “all clear” from their OB/midwife that they can restart pelvic floor physiotherapy. This is the time in which pelvic floor function and core strength is reassessed and more specific goals for recovery are identified.
Should I be doing kegels?
“Kegels” are an umbrella term used to describe an exercise that focuses on repetitive contraction and relaxation of the pelvic floor muscles. I tend to shudder as I perouse all of the online websites that describe and direct people to “Kegel” as the answer to all things related to bladder, bowel, or sexual issues. This is absolutely NOT the answer to fix all problems. If someone asked me if they should be “kegeling”, my answer would certainly be “maybe, but certainly not without an assessment performed by a trained pelvic floor physiotherapist”. Pelvic floor physiotherapists are trained to first determine if any reported symptoms appear to correlate with a pelvic floor problem. If the symptoms appear to be related to possible pelvic floor weakness and/or tension, a thorough objective examination will then identify the strength, coordination, and endurance of a person’s pelvic floor muscles. This is the most reliable information obtained in order to determine whether someone should or would benefit from doing pelvic floor muscle exercises and more specifically, what KIND of pelvic floor muscle exercises. For some clients, they already have very tense/over contracted pelvic muscles. These muscles are weak and very difficult to relax. A lot of people don’t even know that is how their muscles are presenting and will mistakenly start to contract/tense those muscles even further by doing “kegels” thereby worsening their symptoms. The exercises for this subset of clients is very different from “kegels”. The most reliable answer is to get properly assessed by a trained Pelvic floor physiotherapist.
My last thought is more of a shout out to anyone who thinks they may have “pelvic floor dysfunction” but feel too embarrassed or are afraid of what an internal assessment may feel like. I truly believe in collaborating with my clients when it comes to their treatment. There is no black and white expectation of how each individual assessment or treatment proceeds. It is of utmost importance that my clients know that I prioritize their sense of safety at all times. I encourage and am open to the discussion of what each person is comfortable with incorporating into their care and more importantly, what they are not. Consent is never assumed and is established through open communication. I inform each client what I am able to learn with and without an internal assessment so that an informed choice and decision is made.
Leeanna Maher, Pelvic Health Physiotherapist