I believe they’re the most under-rated asset in your pregnancy and postpartum comfort toolkit.
But until they’re pregnant or postpartum, most people have never even heard of these veritable miracle workers.
So, what do they do? Who’s it for? Why would you go? What happens during your first appointment? And how the heck do you find one?
Let’s get you sorted. Starting from basics:
What does a pelvic floor physical therapist do? Who do they treat?
Pelvic floor physical therapists (sometimes called ‘women’s health physical therapists”, but let’s just call them PFPTs from here out- k?) treat conditions of the core and pelvic floor such as pelvic pain, pressure, prolapse, abdominal separation, painful sex and more. They can assist with c-section or perineal scar management. They help folks manage leaks. And they work with folks proactively in pregnancy and help them rehab postpartum.
PFPTs use a combination of education, exercise prescription and manual therapy to deliver treatment.
They treat conditions of the core and pelvic floor such as pelvic pain, pressure, prolapse, abdominal separation, painful sex and more. They can assist with c-section or perineal scar management. And they can work with you proactively in pregnancy and through rehab postpartum.
PFPTs work with men and women throughout the lifespan. Some specialize in working with pregnant and postpartum clients. Some specialize in working with more athletic clientle. Like any profession, there’s a lot of room to niche down.
It’s important to find a PFPT who is skilled in treating your specific concern and has experience rehabilitating people engaged in the sports or activities you are interested in returning to.
What should I expect at my first pelvic floor physical therapy appointment?
During a first visit, you’ll do a lot of talking. The PFPT will take your medical and lifestyle history and talk with you about any symptoms you are experiencing. There should be a significant educational component. Your provider should educate you on basic anatomy and breathing mechanics.
They’ll perform an external exam, during which they’ll observe your posture, breathing patterns, look for any restrictions in mobility or movement anywhere in your body.
If you are comfortable, they’ll likely perform an internal exam during which they are able to palpate (feel) your pelvic floor muscles, connective tissue and nerves. They will assess your muscles for tone, strength, coordination and endurance. They’ll also evaluate the position of your pelvic organs.
The internal exam is optional, but highly recommended. While a PFPT can get some good information from the external exam, it’s not nearly as comprehensive as an internal exam.
It might be comforting to know, the internal exam is quite different from what you might experience during an OB-GYN appointment. You’ll wear a drape, there are no stirrups or speculums, and your provider will talk you through everything they do. Most of the time, they’ll be looking you in the face, rather than at your bits. In my experience, it’s much more conversational and relaxed than a typical GYN exam.
A good PFPT will ask you about YOUR goals and use those as the target for treatment. They will also work to increase your independence and self-efficacy, training you to be an active partner in your own rehabilitation and presenting you with a roadmap that ends in independence from PT treatments.
How do you find a pelvic floor physical therapist?
I recommend searching through these two credentialling organizatins:
You can also find a wide range of pelvic health professionals at Pelvic Guru. This directory will include people who perform internal and exeternal work and have a more diverse set of experinece eand credentials. So just make sure to ask good questions.
Here are a few questions you can ask as you research PFPTs:
1) What is your educational background in pelvic floor PT? Do you have specific training to perform internal work?
2) How long have you been working in this field?
3) Do you have experience working with folks with my specific concern? What kind of track record do you have treating poeple with my concern?
4) What will we do in our sessions?
5) How frequently might you anticipate I’ll need to see you? For how long?
6) If you are an athlete: Do you have experience working with athletes like me?
How does a perinatal personal training complement PFPT?
The scope of a perinatal personal trainer and a PFPT are quite different, but highly complimentary. We’ve talked a lot at this point about what a PFPT does. A perinatal personal trainer (with sufficient training and experience) is qualified to provide exercise programs throughout the childbearing experience. During pregnancy and postpartum, they may teach breath-reeducation and core and pelvic floor exercises, but they do not diagnose or treat pelvic floor conditions. Recommendations are made on a more general basis and their work benefits from collaboration with a client’s PFPT.
While PFPTs have a wider scope in some capacities, they are only granted limited sessions with their patients. They are often not as experienced in the transition from rehab to higher level activities.
The fitness professional has the ability to support and progress the work that is initiated with your PFPT. They often have more contact with their clients and are skilled in supporting the progression from rehab back to sports or higher level activities.
I believe that where accessible, pregnant and postpartum people benefit from having both a PFPT and skilled perinatal fitness pro on their team.
Does it work?
Yup. For many many poeple. It’s gold-standard, evidence-based therapy with proven results. But, like any type of therapy, it’s only going to be as effective as the effort you put back into it.
If you are ready to take charge of your pelvic health, during your childbearing year or at any time in your life, I strongly encourage you to explore the potential of pelvic floor physical therapy.
Take a deep dive into HOW to dial in a breathing strategy that will make you feel stronger and more supported in your exercise, kick-start your postpartum recovery and manage pelvic health symptoms. Download a copy of The No B.S. Guide to Breathing for a STRONG Pregnancy and Postpartum.
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (doula services) within the greater Seattle-Metro Area.