You’ve heard of kegels, but pelvic floor physical therapy covers SO much more than that. We’re answering your top 10 FAQs about pelvic floor health, including the best pelvic floor exercises before and after baby, how to deal with incontinence, and postpartum recovery.
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My personal pelvic floor physical therapy experience was so educational that I thought…ALL women need to know this stuff.
As a certified personal trainer and fitness instructor I feel like I know my body pretty well. Yet, I had so many questions about ‘what was going on down there,’ after having my babies.
If I had these questions, other women must too…
You can watch the full video interview on identifying your pelvic floor muscles and strengthening your pelvic floor muscles at the top of this post, or we’ve outlined the answers to each question in greater detail below.
I practice these three take aways during these core and ab workouts:
And I was surprised to learn that pelvic floor muscle relaxation is just as important, if not more important, than strengthening your pelvic floor muscles.
Your pelvic floor muscles sit at the bottom of your pelvis like a sling. They help with the support and function of your bladder, uterus, and rectum.
Pelvic floor dysfunction symptoms a pelvic floor therapist commonly treats are:
You may need to see a pelvic floor physical therapist if you are:
Pelvic floor physical therapy (PT) is appropriate if you are pregnant, postpartum, or if you’ve never had a baby! Anyone can experience issues with their pelvic floor.
A pelvic floor physical therapist is a physical therapist who specializes in pelvic floor health and conditions related to your pelvic floor muscles.
Oftentimes, pelvic floor PTs have undergone extensive continuing education and mentoring to gain the confidence and expert competence to treat these conditions.
The first appointment often entails:
That being said, we completely respect your comfort level and can perform an assessment completely externally if needed. During the exam, we assess your breathing pattern, sensation of the internal and external structures related to your pelvic floor (is anything painful, tight, numb, tingling?), strength, coordination, and endurance of your pelvic floor muscles.
We also test for pelvic organ prolapse. If you are postpartum, we will check for diastasis recti and/or take a look at your c-section scar. Additionally, we assess your overall movement patterns and may screen your back and/or hips to better understand your condition(s).
From there, we come together to make up a game plan as to how we will treat your symptoms and work toward your goals. For some people, this just may mean one or two sessions, while others may need a bit more. Everyone is totally unique!
You can see more about what an intro session looks like on this segment with Twin Cities Live.
To truly learn, it is best to have a formal PT assessment as everyone presents a bit differently.
However, it is common that people with tight pelvic floors often experience:
Those with weak or “loose” pelvic floors often experience:
A common misconception is that pelvic floor PT is just kegels, but it is totally possible that a person can be leaking urine and have a tight pelvic floor.
If you are having symptoms, it is best to have a formal assessment of your pelvic floor muscles to learn which exercises are appropriate for you!
Definitely not. I treat adults of ALL ages!
You are considered “postpartum” regardless if it has been 6 weeks or 16 years since you’ve had a baby.
It depends on the reason why the incontinence is occurring.
Sometimes, we are placing too much stress on our core and pelvic floor with dynamic activities like jumping, squatting, and lifting your baby.
This can occur when you do not manage pressure well between your diaphragm (muscle right underneath your rib cage), core, and pelvic floor. If we hold our breath and bear down (push through our pelvic floor) during these activities, leaking can occur.
I always cue people to “exhale on exertion” or breathe out during the hard part of an exercise. For example, you should breathe out as you lift you baby, as you come up from a squat, and as your feet hit the floor when you jump.
If your pelvic floor is too tight, learning to relax and let go of your pelvic floor is super helpful. Spend some time in a comfortable position breathing and visualizing your pelvic floor relaxing, lengthening, and melting underneath you. Check in throughout the day to make sure you are not clenching these muscles.
If you think your pelvic floor is lengthened and weak, I would start strengthening with kegels. Inhale and allow your pelvic floor and belly to relax and expand, exhale and imagine you are picking up a blueberry with your vagina. You can practice using a mirror at home to ensure your muscles are lifting up and away from the mirror as you perform your kegel.
I would recommend incorporating your pelvic floor muscles into your daily activities or workouts.
As I previously stated, during the hard part of the exercise, you will exhale and lightly contract your core and pelvic floor muscles.
Remember, being able to relax your pelvic floor is just as important as strengthening. Spend a little time performing kegels a few days a week focusing on relaxing your core and pelvic floor as you inhale and contracting your core and pelvic floor as you exhale.
I would highly recommend checking in with a physical therapist postpartum.
Regardless if you delivered vaginally or via C-section, it is great to have a formal assessment to get an idea of your strength. Additionally, we can help to assess your core muscles for diastasis recti, check for pelvic organ prolapse, and examine scar tissue from perineal tearing or c-section.
If you do not have access to a pelvic floor PT, I would recommend starting with pelvic floor relaxation to reduce any pain you may be having.
Then, slowly start to incorporate kegels once when you start to feel more comfortable. For some people, this may be right away, for others, this may take a couple of weeks.
Pelvic floor muscle relaxation with diaphragmatic breathing.
This taps into your vagus nerve and helps your entire body and mind to relax. You can practice this several times a day.
Avoid any exercise that causes you to see doming or coning of your core muscles.
This doesn’t mean you won’t ever be able to perform that exercise, it just may mean that you do not currently have the strength or you may need to improve your strategy for performing that particular movement.
One thing you can experiment with is managing your pressure system (exhaling during the hard part of the exercise) and properly engaging your transverse abdominis muscles (see below). Sometimes, this is all it takes to be able to perform the exercise optimally without coming or doming.
I always start with learning how to engage your transverse abdominis:
If you need an example of how to do TA breathing, check out the video (approximately from 0:15 to 1:50) in this post: The 5 Best Exercises for Pregnancy.
This is the most foundational exercise to learn and I always progress from there. You can slowly perform this by adding movement in your arms or legs, changing up the positioning, or adding dynamic exercises like jumping or running.
If you don’t have access to a pelvic floor physical therapist you can learn more about How To Check For Diastasis Recti At Home in this post.
Do not hesitate to ask for help!
The most common misconception is that pelvic floor issues like leaking while you cough, sneeze, or laugh or feeling like you will never be able to run again is totally normal. Not true!
With guidance and practice, we as pelvic floor physical therapists try our best to help you reach your goals no matter what those are.
A big thank you to Dr. Jennifer Joslyn PT, DPT, SFMA of Motion for sharing her knowledge and expertise with us on pelvic floor health. If you’re local to the Twin Cities area I highly suggest seeing Dr. Jennifer Joslyn PT, DPT, SFMA of Motion.
This post on pelvic floor health is a part of our Q + A series where we answer your top 10 questions about a different topic each month. You might also enjoy our posts on: