Pelvic Floor Health: What YOU Need to Know
We are SO excited about this blog post today. The Expecting and Empowered guide includes pelvic floor workouts for EVERY SINGLE guide day! If you aren't familiar with what your pelvic floor is, what pelvic floor health means, and why it is SO darn important for all women ESPECIALLY mamas-to-be...please keep reading! Krystle and I know the focus we put on pelvic floor health is one element that makes our guide unique and valuable.
We decided to set this blog post up in a question and answer format. I'm (Amy) going to ask pelvic floor questions to two experts: Krystle and Lauren. They are both well versed women's health physical therapists with an abundance of knowledge and experience to share with us. We'll get you exactly what you need to know!
Amy: Introduce yourself for us Lauren!
Lauren: First off, I just wanted to say how great it is to reconnect with you Amy, and I thank you for being an advocate and positive voice for women as they journey through motherhood. I have really enjoyed your posts!
I work at a hospital-based outpatient physical therapy clinic called Honor Health in Scottsdale, Arizona. I have been a physical therapist for 6 years and specialize in women and men’s pelvic health. Arizona is a very active state, so outside of work I enjoy running, hiking, hot yoga and spending time with my husband and two dogs. We love to travel and explore new cities and visit friends around the country.
Amy: If you want to learn more about Krystle, head here.
Amy: Can we just start by explaining what the heck the pelvic floor is? I've found in conversation that few women actually know, yet this can be one of the KEYS to a woman's health!
Krystle: You are right! This mystery area is rarely talked about and so important in your function prior to, during, and after pregnancy. What you do for your pelvic floor during pregnancy has lifelong implications.
Our pelvic floor muscles are the muscles that span between our pubic bone and tailbone. The pelvic floor is a basin like structure, which creates stability that protects us as forces travel throughout our limbs and bodies. Our pelvic floor muscles should be the first muscles to activate when you decide to “make a move”. We are constantly asking a lot from our pelvic floors throughout the day as we lift our kids, carry things, jump during a fitness class, and even just walk.
Here is a picture of the muscles we are talking about:
Most people don’t realize that their CORE is comprised of the pelvic floor, diaphragm, abdominal muscles, and back muscles. Core exercises and abdominal exercises are not synonymous. Proper activation of your core involves much more than your abdominal muscles. The guide makes you more aware and awakens these areas that get shut down on improperly moving bodies. Well, why the heck are we moving improperly in the first place?!? Humans are creatures of habits and habits can get us into trouble. Improper posture, repetitive activities, playing on our phones/tablets, injuries, changes in our bodies during and after pregnancy can all lead to mechanical breakdowns in our bodies just like a car. A mechanical breakdown in one area certainly has impact on other areas.
Here is a picture of your CORE:
I wanted to highlight that the most important role of the pelvic floor is that it provides support to the pelvic organs and contributes to fecal and urinary continence. It also plays a LARGE role in our sexual health, more on that later!
Amy: Can you explain the role of a women’s health physical therapist before and after birth?
Lauren: I hope that it becomes standard of care for women to meet with a women’s health physical therapist before, during, and after pregnancy. Our profession strives on preventative care and women can learn about the musculoskeletal/postural changes that will occur through pregnancy. In the pre-partum phase, women can learn about proper body mechanics and posture, breathing mechanics for delivery, pelvic stabilization exercises, stretching, supportive bracing, and balance training. They also can benefit from pelvic floor muscle training in preparation for pregnancy and delivery. Often times, I treat women once they have developed symptoms and the opportunity was lost to treat them proactively.
In the postpartum phase (usually after 6 weeks of pelvic rest), a pelvic health therapist will assess the patient’s pelvic floor muscle strength, coordination, and if there are any areas of pain related to pelvic floor dysfunction. The therapist will also check diaphragmatic breathing mechanics, if the patient developed a diastasis recti, scarring from perineal tear or c-section scar, or any other pelvic dysfunction related to pain or incontinence.
Krystle: Lauren is absolutely right. I continue to be shocked and dismayed by the lack of information provided to women during pregnancy on preventative health. There is SO much that can be done for women to maintain and improve pelvic health, yet rarely does a pregnant woman get the information and plan she needs. This is one of the biggest reasons I agreed to developing the guide because I want there to be more awareness brought to preventative health, especially in this area!
Amy: Why should we be so concerned about our pelvic floors during pregnancy?
Krystle: Women’s pelvises are designed to have less stability allowing for bony separation during delivery. This is great because we need to fit the baby out, but this also leaves women more vulnerable to injury leading up to the main event. This is one of the causes of muscle and joint aches and pains during pregnancy. Also, throughout pregnancy the pelvic floor muscles must withstand a greater degree of pressure due to weight gain and continuous growth of the baby.
Amy: There can be a lot of medical jargon thrown around, but can you break it down simply for mamas?
Krystle: To be quite frank pregnancy especially multiple pregnancies, carrying multiples, a difficult labor and delivery...leaves a mama exposed to possible incontinence. Which means that women are leaking urine. Unfortunately instead of dealing with this problem most women opt for black leggings and pads.
Poor pelvic floor health and awareness also means an increased risk for pelvic organ prolapse later in life. You may have heard of “sling surgeries”, which repair pelvic organ prolapse and unfortunately have a low success rate. We want to help you avoid any female health issues, keeping your confidence and dignity high and not letting your organs get low.
The other main role of your pelvic floor is sexual function. Often not discussed is that 36% of women have trouble returning to their normal sex life after delivery. Sexual health is a big part of our overall health and lives, and is something that CAN and SHOULD be enjoyed after babes. Taking care of your pelvic floor while carrying your baby will aid YOU in this.
We want to make you aware of this issues, so that you realize the important of preventative care!
Amy: What if a women is thinking "Well...I maintain a regular exercise routine, so I'm activating my pelvic floor and I'm good to go...right?"
Krystle: Ideally you are activating your pelvic floor correctly but OFTEN people are NOT. In females, we like to squeeze our tummies in because it looks better, we like to wear compressive garments, we sit for hours at a computer at work. Squeezing your stomach tight places unnecessary forces on your pelvic floor. Wearing compressive garments can sometimes cause decrease use of the diaphragm. Sitting for long periods causes poor movement of your low back.
It is a common misconception that if you are fit your pelvic floor is in great “shape” too. Unfortunately, you are not excluded and this is a common misconception. Active women are exposed to more physical stresses, which makes their pelvic floor MORE vulnerable. A stunning 52% of female athletes experience urine loss during sport or daily activities.
Amy: You had me doing all sorts of different movements and positions for the pelvic floor portion of the E and E guide. Was there a method to the madness?
Krystle: The guide is designed to take women from having NO awareness of their pelvic floor to being experts in this area. We first teach you how to activate this area which is only the tip of the iceberg. The guide is written as a progression. To heighten awareness we allow you to cheat, yes cheat. We ask you to use muscles you are not supposed to be using to aid in your learning and pelvic floor awareness. Examples including using your inner thigh muscles and hip rotator muscles to aid you in identification and activation. Next, we leave these muscle by the wayside once you've had practice. As you can see in the picture above of the pelvic floor it is a figure 8 like structure. In patients especially active individuals, there is often weakness side to side and front to back. There are exercises such as the ski jumps that train the front side of the pelvic floor. When we have guide users doing a pelvic floor exercise with one of their legs being used, we are working on strength training one side of the pelvic floor.
I know this sounds confusing, but it is very well explained and set up well for you in the guide. A women's health PT could also assess your imbalances and teach you these exercises. I will caution: if you are an E and E user (or we are currently convincing you to become one)... to do the pelvic floor part of the guide right, you need to use the appendices!
Another very specific guide detail is that early on we put guide users in positions that are easier to activate the pelvic floor in. Gravity minimized positions. Later in the guide, we add more challenging and functional positions. Toward the end of the guide and the end of the pregnancy we try to decrease the weight of the baby on the pelvic floor so you can get some meaningful repetitions in.
Amy: I know we focus a lot on the PREGNANCY side of things. But, what are signs and symptoms that it is time to see a women’s health physical therapist after birth?
Lauren: It is common to give yourself 6 weeks of pelvic rest following delivery. It is never normal to leak or have pelvic floor pain that is lingering in the post-partum phase. I often hear patients say they leak urine when they return to running, crossfit, or high-impact activities and are told that this is “normal” or “that’s the way it’s going to be and just deal with it.” THIS IS NOT TRUE. Leaking is a symptom of pelvic floor dysfunction. If you leak, stop the offending activity and see a therapist. Pelvic/perineal pain is also not normal and can be a sign of hypertonicity (spasm) of the pelvic floor, which can be addressed with PT. I have treated many women who have leaking, pain with intercourse or prolapse (falling out feeling) after delivery, which are common complaints.
Amy: Explain for us pelvic floor dysfunction in regard to the postpartum period. What increases a women’s chances of experiencing these problems?
Lauren: This is directly from one of my patient handouts: Pelvic Floor Dysfunction (PFD) is an umbrella term used to encompass several different bowel, bladder, and sexual disorders, and chronic pelvic pain syndromes, that affect or are caused by the pelvic floor muscles inability to contract, relax, and/or bulge effectively. These conditions may or may not have pain associated with them.
Typically, we find that most women have some sort of dysfunction, especially after being awesome and carrying a baby for 9 months! Everything is so thrown off mechanically, and it takes time to heal to resume prior activities. Women who tend to be at risk for PFD had theses issues with previous pregnancies, had any of the above issues in the pre-partum period, or return to prior activities too quickly and don’t allow enough time for healing.
Amy: Is urinary incontinence ever normal after birth? What about pain during sex?
Lauren: As I mentioned above, there will be a period of time (usually within the first 6-12 weeks) where you may experience incontinence and discomfort while you are healing. I never want to suggest that it is “normal,” but “expected” might be a better word. If these symptoms linger, then it’s time to see your therapist. Many patients report that sex is different after baby and it will take time to regain strength and muscle function to find sex pleasurable. Persistent pain during arousal, penetration, or that lingers after sex is not normal and is a sign of dysfunction.
Amy: What issues are you most commonly seeing women for?
Lauren: Incontinence is the most common followed by pelvic pain.
Amy: As with many new mamas, I was super excited to get back to exercise. How long do you recommend waiting after baby to get back into exercise? What should women stay away from early on?
Lauren: When your pelvic PT says it’s okay! (haha, just kidding!) Pregnancy followed by delivery is like recovering from a sports injury or surgery, it is crucial to give yourself enough time to heal. You don’t want to cheat yourself. I typically tell my patients when they consistently don’t have symptoms of pain or leaking during exercise, then it’s safe to gradually get back into their workout routine. Before getting back into any core strengthening, get assessed for diastasis recti (splitting/gapping of the rectus abdominis muscle). I would make sure that you never hold your breath during a high impact activity such as lifting, as this will place unnecessary pressure on your pelvic floor. The timeline differs patient to patient. Bottom line: listen to your body, it will tell you what it needs.
Krystle: You don't have to display symptoms to have weakness or dysfuction. It is important to get checked after baby to see if return to activity is OK.
Amy: How can I find a women's health physical therapist in my area?
Krystle: You can locate someone that specializes in women’s health by using this link: http://www.womenshealthapta.org/ pt-locator/. There is a tab that allows you to locate someone that specializes in pregnancy/postpartum, urinary incontinence, or pelvic pain. This group of women that work in this area are the nicest people. Call and ask them questions and ask if they have worked with your condition. They would be more than happy to help.
You would want to contact a women’s health therapist if you are a women experiencing pelvic floor issues may need more extensive training than is provided in the guide. This may include individuals that continue to have poor awareness of this area coupled with leakage and especially those that have pain during intercourse, have experienced pain with tampon insertion, and prolonged pelvic pain.
It is also a great idea to prepare this area for the stretching experienced during birth if you are planning a vaginal or vbac which is called perineum stretching. A women’s health physical therapist can help you with this starting at 32 weeks of pregnancy.
Also, if you suffer from pelvic pain, Amy Stein’s book Heal Pelvic Pain is a great resource. She has a wealth of knowledge.
We KNOW that post was jam packed! There is more to come on this subject! I want to say a HUGE thank you to Lauren for taking the time to help us out and spread the word about this mystery issue.
Hope this helped and have a great day!
Amy and Krystle (+Lauren)