One of the biggest challenges I face as a women’s health physical therapist is overcoming the confusion and misinformation as to what pelvic floor physical therapy actually is and when it is appropriate to seek care.
I choose to call new patients before the first appointment to make sure they understand why they were referred and are clear on what to expect during their first session. I find, by providing this information, that I am able to alleviate fear and clear confusion prior to the first appointment, making the first few treatment sessions even more successful.
Pelvic floor dysfunction (PFD) is a term used to describe a variety of disorders including pelvic pain and various types of incontinence or constipation. PFD can occur when the muscles lack tone, increasing symptoms of incontinence or pelvic organ prolapse. Additionally, excessive tone in pelvic floor muscles can lead to difficulty with evacuation of urine or stool, sexual dysfunction, and/or pelvic pain.
Postpartum pelvic floor dysfunction can include various types of incontinence due to the trauma inflicted on the pelvic floor during delivery. This can occur with traumatic deliveries (prolonged labor, use of forceps, large baby, etc,) as well as with those without complications. Additionally, pelvic pain is common post-delivery after undergoing an episiotomy, often due to scar tissue restrictions limiting pain-free sexual intercourse.
During an initial evaluation, the patient will work with a pelvic floor therapist to determine her type of dysfunction and help establish a treatment plan. The initial consultation will include a thorough evaluation with a detailed history, musculoskeletal examination, and postural assessment.
When indicated, the initial treatment may also include an internal exam to determine the tonicity of the pelvic floor in order to better specify each patient’s treatment goals. The goal is to treat the whole person, not just the dysfunction, in order to return the mother to her level of function prior to pregnancy and delivery.
Conditions treated in pelvic floor physical therapy include:
A typical course of care in physical therapy for standard postpartum rehabilitation is 4-6 weeks to restore both deep abdominal muscle activation and pelvic floor muscle activation. If pain is present, internal scar mobilization may be utilized in order to restore normal muscle pliability and improve pain with insertion.
Sessions include both internal and external muscle mobilization, core stabilization, postural re-education, and education on safely returning to recreational activities. Other modalities include taping techniques for improving diastasis recti, sacral or abdominal bracing, dry needling for lower back pain, and/or heat laser to improve blood flow and tissue healing. The physical therapist will assist the patient to reach her postpartum goals, giving home exercises in order to improve strength and conditioning for return to full pre-pregnancy function.
Pelvic floor physical therapy is an excellent resource for any mother postpartum, even without dysfunction, in order to regain muscle strength and resume exercise without risk of injury. Physical therapy can help both in treating injury and preventing future issues from occurring. My hope is mothers will continue to seek pelvic floor physical therapy as a standard part of postpartum care in order to give their bodies the absolute best chance to succeed.
Dr. Holly Durney is an APTA Orthopedic Certified Specialist and has pelvic floor rehabilitation training from the Herman and Wallace Pelvic Rehabilitation Institute. Her pelvic health training focuses on treating pelvic floor dysfunction and related issues in the pelvis, hip, and spine. Her pelvic floor treatments involve assessment including movement patterns, ligament structure, current activity level, and pregnancy history. She believes that treating the whole person is the key to complete health and wellness and to help her patients achieve their goals. Dr. Durney currently sees patients at Smart Athlete PT.
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