For many, the term "pelvic floor" might be unfamiliar or even a bit intimidating. However, with increased public awareness, it's fast becoming a popular topic in the realm of perinatal health.

Back in June, we recorded the Supporting Pelvic Health Through Pregnancy and Beyond webinar, with Dr. Rebecca Maidansky, PT, DPT and owner of Lady Bird Physical Therapy. We've transcribed the 45-minutes webinar and published the most important parts of our discussion. Dr. Maidansky and her team help you get back to you, and it's something I wish I knew more about during my pregnancies and after the birth of both my children.

Understanding the Pelvic Floor

What is the Pelvic Floor?

At its core, the pelvic floor refers to a group of muscles situated at the bottom of the pelvis. Comparable to the rotator cuff around your shoulder, the pelvic floor spans from sit bone to sit bone and from pubic bone to tailbone. Encompassing your urethral, vaginal, and anal openings, these muscles play a pivotal role in many bodily functions.

Functions of the Pelvic Floor

When one is not pregnant, the pelvic floor is instrumental in numerous ways:

• Ensuring continence by keeping urine and feces in.
• Aiding in excretion by letting urine and feces out.
• Facilitating hip rotation.
• Contributing to pelvic and lumbar stability.
• For pregnant individuals, the pelvic floor's responsibilities grow even more critical. It supports the increasing weight of the growing baby, uterus, and placenta. Furthermore, during delivery, these muscles have to relax and make way for a vaginal birth.

Evaluating the Pelvic Floor: A Physical Therapist's Perspective

Strength, Tone, and Coordination:

• Strength: Many individuals equate pelvic floor health to muscle strength. While strength is indeed a part of the equation, it is not the sole determinant. We have to conduct a comprehensive evaluation by inserting a finger vaginally and gauging how powerfully one can activate these muscles.
• Coordination: Just knowing that a pelvic floor exists is not enough. To utilize it optimally, one should be able to activate these muscles correctly. This coordination is crucial for a functional pelvic floor.
• Flexibility: A lesser-known yet equally vital component is tissue flexibility. Drawing a parallel with the bicep, it's essential to have enough flexibility to perform everyday tasks seamlessly. Similarly, the pelvic floor muscles need to have flexibility in addition to strength and coordination.

Self-Evaluation:

If you're curious about your pelvic floor's condition, there's a simple self-test. Insert a finger vaginally and try to squeeze as if holding back urine or feces. What you're aiming to sense is a tightening and lift. While this won't provide an accurate measure of strength, it can offer insights into muscle activation.

Why You Should Consider Pelvic Floor PT Before Conception

Before pregnancy, addressing pelvic health is pivotal. Nearly 30% of individuals already face pelvic floor dysfunction before conceiving. Addressing these dysfunctions ahead of pregnancy ensures a smoother journey, reducing complications.

The Best Time During Pregnancy to See a PT

Visiting a PT in Pre-Conception

Dr. Maidansky encourages her patients to build their pelvic floor muscles and prepare their pelvic floor well in advance of conception.

"The stronger you go into pregnancy, the stronger you come out. Building strength and muscle mass prior to pregnancy will help support your body if and when you go through periods of low energy, decreased activity and bed rest during both pregnancy and postpartum recovery," said Dr. Maidansky.

Pelvic health evaluations during pregnancy usually start in the second trimester. While first-trimester evaluations are avoided due to misconceptions about miscarriage risks, they are essentially safe. Delaying them is mainly to prevent potential misconceptions during early pregnancy stages.

Visiting a PT During Your Pregnancy

It's recommended to consult a pelvic floor physical therapist in the early second trimester, even if symptoms aren't evident. However, for latecomers, the 25-week mark is ideal to ensure resilience during the pregnancy's later stages.

"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," said Dr. Maidansky.

Common Postpartum Pelvic Floor Symptoms

Postpartum recovery can come with various pelvic health symptoms, including urinary incontinence, pain during intercourse, pelvic pain, and symptoms of prolapse. Recognizing these signs is crucial for effective intervention.

The Underlying Need for Postpartum PT

Pregnancy puts significant stress on the body. Regardless of the delivery method, the body needs structured rehabilitation post-delivery, benefiting immediate recovery and reducing future risks.

Pelvic Floor PT as a Preventive Measure

Prevention plays a significant role in pelvic health. Pelvic floor PT can minimize the risk of birth injuries or post-delivery symptoms like incontinence or persistent pelvic pain.

When to Start Postpartum PT

Starting PT is key for postpartum recovery. Ideally, sessions should begin three weeks post-delivery. However, waiting until the six-week OB/GYN check-up is common. Referral periods for PT vary by state.

The six-week postpartum check-up is vital. However, ACOG suggests an even earlier check-in, stressing the importance of timely support for new mothers, especially given the constraints faced by many OB/GYNs.

OB/GYNs are increasingly recognizing the benefits of pelvic floor PT. To manage the growing demand and lengthy waiting times, it's advisable for patients to schedule these specialized appointments during pregnancy. This proactive approach ensures that they have a structured plan ready when their baby arrives.

Finding the Right Physical Therapist for Your Perinatal, Pelvic Floor Journey

Specialization and Expertise:

• Look for physical therapists specializing in pelvic floor dysfunction and perinatal care.
• Prioritize therapists with certifications in women's health physical therapy or pelvic floor rehabilitation.

Experience with Pregnancy and Postpartum Care:

• Seek therapists with experience in managing the unique needs and concerns during pregnancy and the postpartum period.
• Inquire about their experience in dealing with specific issues like diastasis recti, urinary incontinence, and pelvic pain.

Individualized Treatment Plan:

• Ensure the therapist creates a personalized treatment plan addressing your specific symptoms, concerns, and goals.
• Discuss the proposed treatment strategies, exercises, and progress milestones.

Insurance and Payment Options:

• Verify if the physical therapy services are covered under your health insurance plan.
• Confirm payment options, and ask about the estimated cost per session if it’s not covered by insurance.

Initial Consultation:

• Opt for an initial consultation to assess whether the therapist understands your concerns and can meet your needs.
• Use the consultation to ask questions about their approach, experience, and any concerns you might have regarding the therapy.

Remember, choosing the right physical therapist is crucial in navigating your perinatal, pelvic floor journey effectively and comfortably.

A Personal Journey of Commitment to Pelvic Health

Many PT professionals' dedication to pelvic health comes from personal experiences, like witnessing a family member's recovery or debunking pregnancy activity myths. Such professionals offer a blend of personal insight and expertise, ensuring comprehensive care.

Remember, every pregnancy is distinct, emphasizing individualized care. While general guidelines provide initial guidance, tailored recommendations ensure optimal health and well-being, catering to each body's specific needs.

Trusted Resources

1. Ladybird PT website- www.ladybirdpt.com‍
2. Pelvic floor PT locator (national and international) https://pelvicguru.com/directory/ (has international PTs)
3. Blog posts Rebecca wrote about: feel free to choose which one you like more!‍
4. Is there anything I should be doing during pregnancy to support my pelvic health?‍
5. A realistic timeframe for recovering postpartum is 6-18 months, not 6 weeks.‍
6. Free guide (email) - 10 minute guide  push preparation