April 1, 2021

What is it? When is it needed? What to expect? 

“Is it normal to still look pregnant even though I gave birth months ago?”  

“Why is sex uncomfortable after giving birth?” 

“Is it normal to pee a little when I sneeze?”  

As a pelvic floor physical therapist, these are examples of questions that I get asked daily from patients, especially postpartum moms. It’s no secret that your body goes through major changes during pregnancy and childbirth. Peeing your pants when laughing with friends, avoiding sex because of pain, feeling pressure or heaviness in your vagina does not have to be your normal.  

Pelvic floor physical therapy can help alleviate these symptoms and also give you tools to feel more confident and in control of your body at any season of life as a woman.  

What is the Pelvic Floor?  

Your pelvic floor is a group of muscles which sit like a hammock at the base of the pelvis, running from the pubic bone to the tailbone.  The pelvic floor has many important roles which rely both on its strength and on its ability to relax. Strength is needed for keeping your urinary and anal sphincters closed to hold in pee and poop and to keep your organs supported throughout the day. Relaxation is equally as important and is needed for bowel and bladder emptying, vaginal intercourse, and vaginal childbirth.   

Pelvic floor issues start for many during pregnancy. As your posture changes, ligaments soften, and your muscles relax to make room for a growing baby. Issues also can begin after either vaginal or cesarean childbirth. Many people believe that only vaginal births can lead to pelvic floor dysfunction; however, this is simply not true. In fact, a larger percent of women who have had a C-section report pain with sex following childbirth as compared to those who had a vaginal birth. Shocking, right?   

Do you Need a Pelvic Floor Therapist?  

Pelvic floor dysfunction can present as pain with sex, constipation, vaginal or tailbone pain, back pain, leakage of pee or poop, pelvic pressure or heaviness, or urgency to get to the bathroom. Symptoms, however, vary for everyone.  

You do not even need to have symptoms to see a therapist. Pelvic floor therapy can be a wonderful opportunity for education and exercises to keep your pelvic floor healthy with the goal of preventing future pelvic floor problems.  

What to Expect in a Pelvic PT Session?  

As with any medical appointment, the first session will include a thorough history-taking, providing an opportunity for you to voice your concerns and your goals for the therapy.

The therapist will then perform an assessment which includes looking at your posture, lower back, and pelvic alignment, as well as assessing your abdominal wall for scar restriction or muscle separation/diastasis recti.   

An internal pelvic floor muscle assessment through the vagina will assess strength, coordination, and tension of the pelvic floor. Based on the findings of the examination, your PT will develop an individualized treatment plan and arrange for follow up visits.  

Other Benefits 

Women receive so little education about pelvic floor health throughout their lives, yet these muscles affect such important and intimate issues of their daily lives and quality of life. Seeing a pelvic floor physical therapist can be life changing, helping you control your pain and symptoms while also guiding your return to daily activities and exercise.   

We all have busy schedules. And while it may seem you cannot possibly squeeze in one more appointment, most clinics offer flexible scheduling and online sessions, and some even encourage you to bring your kids along.

Whether you are starting your menstrual cycle, becoming sexually active, currently pregnant, entering menopause or month or years postpartum, the time to get help is now!   


Ashley Holstein PT, DPT is a Doctor of Physical Therapy and pelvic floor specialist at NOLA Pelvic Health, a pelvic floor physical therapy clinic in New Orleans.

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