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When & Why to See a Pelvic Floor Physical Therapist

by Dr. Helene Darmanin, PT, DPT, CSCS

As a new parent, I know how hard it is to find time for yourself. Even while pregnant, I already felt like my time was limited, but I forced myself to make time to see a physical therapist (PT) both before and after giving birth, and I’m so glad I did. I relied on my knowledge as a physical therapist with a specialty in pelvic health (and advice from my awesome NYC Birth Village doulas, Sam and Erica!) to know when to go and what to expect. But not everyone has that luxury, so I want to empower you with this knowledge, too.

Physical Therapy? For Pregnancy?

There are two types of physical therapy that are appropriate for pregnant folks and new parents: orthopedic/musculoskeletal and pelvic health. Though these are considered distinct specializations, many pelvic health therapists also practice orthopedic physical therapy and often have more knowledge of issues specific to pregnancy and the postpartum period. An important tidbit to remember: once you give birth, you are always postpartum. This doesn’t mean that you will have the same symptoms six weeks after birth and three years after birth, only that pregnancy and birth have lasting effects on the body and mind. It is never too soon—or too late—to address bothersome and painful symptoms in order to feel your best.

Orthopedic PT

Common orthopedic issues that arise during pregnancy include (but are not limited to):

  • low back pain (almost universal)
  • carpal tunnel syndrome
  • hip pain
  • sprained ankles
  • pubic symphysis pain (pain in the front, middle of your pelvis)

Many of these issues are caused by changes in posture that pregnant people make as belly and baby grow bigger, and by hormonal changes that affect the laxity of connective tissue, cause fluid retention, and more. Anyone experiencing the above issues would benefit from seeing a PT as soon as possible. Physical therapy can not only help ease discomfort during pregnancy, but also set you up for success after giving birth by preventing recurrence of pain and optimizing your movement and posture to meet the physical demands of parenting.

Dr. Helene Darmanin, PT, DPT, CSCS during one of her pregnancy workouts.

In this situation, therapy looks similar to treating a sports injury: primarily strengthening exercises, education on strategies to decrease your discomfort, and maybe some hands-on treatment. However, there are still things that need to be taken into consideration because you’re pregnant, so make sure you see a PT who has some expertise in pregnancy.

Pelvic Health PT

You may have heard people talk about the pelvic floor, or suggest doing Kegels, but pelvic health is much more complex and nuanced. Kegels are not right for everyone!

The pelvic floor is a diamond-shaped group of muscles that span from sit bone to sit bone and from the pubic bone in the front of the pelvis to the tailbone in the back. The pelvic floor has many important functions like maintaining continence (preventing leakage of urine and feces) and contributing to breathing, orgasms, and core strength. There is a lot of strain on these muscles as they support the weight of a growing fetus, and they need to be able to relax and stretch to give birth vaginally.

A pelvic floor PT can help if you have…

  • pain in your pelvis
  • pain with sex
  • urinary incontinence (leaking urine)
  • low back pain

Or if you want to prepare your pelvic floor for birth through coordination, breathing, and relaxation.

Pelvic floor PT may consist of several different interventions. Some treatments may consist of simple strengthening exercises similar to orthopedic PT to encourage pelvic stability. If necessary, internal treatment may be performed. This consists of the therapist inserting one gloved finger into the vagina to assess the muscles for tension, “knots,” and ability to contract and relax. Internal therapy, like all PT, is only done with your consent and can be stopped at any time. Similarly to orthopedic PT, the sooner that you seek help, the faster these issues will likely resolve.

PT After Baby

In the postpartum period, you may have some of the same issues as when you were pregnant. Physical therapy would look similar, but with different precautions (again, important to see a PT with experience in this area). New issues may arise from breastfeeding, holding your baby, and recovering from birth. Physical therapy can help with anything from wrist or back pain, urinary incontinence, and diastasis recti (separation of the abdominal muscles) to scar tissue from vaginal tearing or C-sections.

The timing of postpartum PT is a somewhat contentious issue, so you should speak to your doctor or midwife about when the right time is for you to seek this care. If you are having severe back, neck, shoulder, leg, or pelvic pain, you should see a PT as soon as possible—a good therapist will be able to give you exercises to decrease your pain that are less strenuous than some of the activities that you are already doing as a new parent. For other, less severe issues many doctors will prefer that you wait until your 6-8 week check-up to start physical therapy. It is a difficult period to find time for yourself, but the better you feel, the better you can care for your little one. And you deserve to be as strong and well as possible!

And yes, you can get virtual PT!

During the COVID-19 pandemic, many therapists are providing telehealth visits or virtual PT. All orthopedic and many pelvic floor issues can be treated effectively by video chatting with a therapist. We are experienced in watching and coaching movement with visual and verbal cues, and in empowering our clients with strategies to care for themselves. In fact, most research shows that exercise and knowledge are the two of the only treatments that have profound, long-lasting effects.

Don’t know where to start? Talk to your care team. Doulas, midwives and OBGYNs will likely have trusted recommendations for physical therapists that specialize in care during and after your pregnancy.

Dr. Helene Darmanin, PT, DPT, CSCS is a physical therapist who specializes in pelvic health, especially pregnancy and postpartum care, and orthopedic rehabilitation. She is also a group fitness instructor. Helene sees herself as a facilitator, empowering clients on their healing journey with knowledge, body positivity, and agency in their process.

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