What to Expect in Pelvic Floor Physical Therapy


Does the thought of a trampoline park instill a deep sense of dread in the pit of your stomach?

Does the horror of cold season come with an extra side of never-ending leaking every time you cough or sneeze?

Do you feel a sense of heaviness in your pelvis that seems to worsen after an active day or right around the time Aunt Flo comes to town?

Pregnancy and birth are beautiful and transformative, but with that transformation can come unexpected pelvic pain and symptoms. We often make light of the leaking, back pain, and feelings of heaviness with a quick joke about how our babies ruined our bodies— but the truth is that there is help available to manage your pain and symptoms.

You do not have to resign yourself to a lifetime of adult diapers and stifled laughs just because you birthed a human being. In France and other parts of Europe, birth comes with an automatic referral to a Pelvic Floor Physical Therapist (PFPT) with 6 weeks of treatment. Here in the US, you have to know to ask for a PFPT referral, and sometimes adamantly insist that your symptoms are not a normal part of being a mother and warrant treatment.

Some things that a PFPT can help treat include:

  • Pelvic pain
  • Tailbone pain
  • Cesarean scar massage
  • Pain during sex
  • Urinary incontinence (leaking during activities and daily life counts as incontinence)
  • Diastasis Recti (separation of the abdominal muscles at the midline)
  • Pelvic Organ Prolapse
  • Urinary urgency
  • Fecal incontinence
  • Urinary frequency (going to the restroom more than once every 2 hours)
  • Back and pelvic pain during pregnancy
  • Feelings of heaviness in your vagina or rectum
  • Feeling like you are constantly sitting on an egg
  • Feeling a sensation like you are constantly wearing a tampon
  • Back and hip pain
  • Chronic constipation
  • Pelvic floor weakness/Pelvic floor tension
  • Feeling like you have a constant headache in your pelvis

Did you tick one or a few symptoms off that list? I know I do.

I battled urinary frequency and pelvic bone pain after the birth of my second child, and low back pain throughout my pregnancy with my third baby. If you are experiencing pain or discomfort, I highly recommend consulting a PFPT during and after pregnancy. Don’t accept the aches and pains as part of the process!

Now that you are armed with the knowledge that there is an alternative to accepting a life of leaking, finding a PFPT is the next step. Due to an increase in awareness of the value of PFPTs, it can be common to have a bit of a wait to get on someone’s caseload. Find a PFPT in your area by searching the directory here!

What to expect at your first appointment

Your initial assessment will involve a lot of talking. Your therapist will ask you several questions about your symptoms, your pregnancy and birth history, and additional medical information. After a nice chat, you and your therapist typically will go through a movement assessment to see how you are activating your muscles, breath patterns, alignment, muscle strength, and flexibility.

Next, you can expect to have an external and internal assessment of the muscles that attach to the pelvis. This is the part that many people can be intimidated by. The thought of an internal assessment of your pelvic muscles can be a bit worrisome or invasive. Know that this part of the assessment is optional and does not need to be performed at your initial appointment. However, I would like to arm you with some knowledge to make it a little less scary.

Pelvic Floor Physical Therapy | Central Mass Mom

What happens during an internal assessment?

An internal pelvic floor assessment with a PFPT is much more laid back than in your OB office. No stirrups, no bright lights, no speculum involved. The therapist will insert a gloved lubricated finger into your vagina and gently palpate the muscles of your pelvic floor. The reason that this assessment is so valuable is that the pelvic muscles are located internally. The only way to fully assess how they are functioning (strength, tension, ability to relax and contract, etc) is with an internal assessment.

As I like to say, if you aren’t assessing you’re guessing.

An internal assessment will give you and your therapist the full picture of what your body needs and craft a treatment plan tailored to you and your body. If you are not feeling comfortable with the internal part of the exam, you and your therapist can focus on overall movement habits and lifestyle changes until you feel ready!

Have more questions about PFPT? Check out this interview I did with local Doctor of Physical Therapy Olga Treko where she answers from pelvic floor FAQs! 

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Kara is a Perinatal Fitness Specialist and Pregnancy and Postpartum Athleticism Coach.  A momma of two amazing littles, lover of the beach, former college athlete who has never met a pizza she didn’t like. She lives in Central Massachusetts with her husband, 2 kids, 2 crazy dogs, 5 chickens, and a beta fish named Nemo 2.0. Through her online and one on one coaching, Kara helps women find joy in motherhood through movement using rehabilitative and corrective exercise strategies. She is on a mission to dispel myths that leave women fearful of movement and empower women with knowledge and confidence to help them better navigate their new role as a mother. Kara thinks all problems can be solved with either a chocolate chip cookie or the ocean, and loves checking out local small shops and breweries. Her favorite type of movement right now is hiking with her dogs and is grateful to be surrounded by so much natural beauty here in New England. 


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