I can’t have pelvic floor issues, I’ve never had children

Actually, you sure could. A common misconception is that you have to have delivered a child to need pelvic floor (PF) therapy. But, did you know that anyone at any age can have pelvic floor dysfunction (even those who have never been sexually active)?  While PF problems are common for women who have given birth, there are many women (and men) who are struggling with things like leaking urine with sneezing or exercise, a strong sudden urge to use the restroom, pelvic pain with intercourse or your period, tailbone pain, constipation, or pelvic heaviness.

Peeing a little after having kids is just normal and wearing a daily panty liner isn’t that big of a deal.

Is it common?  Yep. Is it normal? Nope. There are so many things in the postpartum period that are considered common but aren’t healthy, and are a sign that there is a problem in the system. For example, things like leaking urine while jumping or running can be common after having children, but this is a sign that your core system is not working right. Left untreated, this can often lead to problems like hip or low back pain or worsening of your pelvic symptoms. Another example is a separation in your abdomen. Yes, a diastasis recti can be common after pregnancy, however, there are so many things we can do to address this and heal your core to allow you to be stronger, which in turn can decrease your risk for lower back pain, neck pain, or other pain in your body.

If I leak a little, I probably need to just do some more kegels?

Kegels, or pelvic floor exercises, can be helpful in some circumstances. But, more often than not, pelvic floor problems like urinary incontinence can be connected to muscles that are too tight or not coordinated correctly, not simply too weak. If this is the case, strengthening in the form of kegels can potentially make your leaking worse. There are many factors involved with leaking and pelvic floor strength is just one of those. Additionally, there are many exercises such as bridges and squats that actually engage your pelvic floor muscles much better than a kegel does and are generally more fun to do. 

Sex hurts. It’s probably just me. My doctor told me to drink some wine and just try to relax….

This advice breaks our heart. Sex should NOT be painful. End of discussion. And alcohol or antidepressants should not be required to make that happen. Pelvic pain with intercourse (or associated with other activities), is often due to tightness in the pelvic floor and deep rotator muscles or potentially related to scar tissue associated with childbirth. All of these things are treatable!

Pelvic floor therapy sounds embarrassing, I’ll just deal with the issues I have.

This one I get. I’ve been on your end of things and yes, it can feel a little weird at first. But so is getting your teeth cleaned and most of us still do that. Your pelvic floor muscles are muscles that just have a little more personal access point but ultimately, are still muscles. That being said, this is a very personal area of the body and not everyone wants or needs a pelvic floor exam. We will take the time to really discuss what you’ve been dealing with, educate you on the pelvic floor and how it is connected to your entire body, assess everything outside of the pelvic floor, and perform a pelvic floor muscle assessment only if you’re 100% comfortable with it.  We understand it is a little uncomfortable to talk about the symptoms and will make it as comfortable of an experience as possible. Peeing, pooping and sex are all normal parts of life that may not be easy to talk about, but you will be in a safe and private space during our sessions to disclose as much or as little as you’re comfortable with.

What is a Pelvic Floor Assessment Like?

A pelvic floor muscle assessment is never done in isolation, but rather we will look at many different factors such as posture, how your body moves, muscle strength and flexibility, pelvic alignment, rib movement, assessing for an abdominal separation or c-section scar if indicated, among other physical assessments. Then if you’re comfortable with it, we will do a pelvic floor muscle assessment. This will be somewhat similar to, yet different, from the type of pelvic exam you get with your OB-GYN. We are assessing muscle strength, coordination, and tone. Good news: there are no stirrups or speculums involved. An external exam of your vulvar region will be performed first to check for any skin changes, tenderness and tightness and to visually see if you are able to contract and relax your muscles. Then the internal assessment is performed using one gloved finger inserted vaginally. Your muscles will be assessed for tightness and any reproduction of pain. Then you will be asked to squeeze and relax your muscles (do a kegel) to check for strength and coordination. For most women, this is a fairly quick and painless assessment but if there is any discomfort with it, there are things we can then do through treatment that can help eliminate that discomfort (so things like sex or inserting a tampon do not cause pain).  

I have a prolapse and was under the impression surgery is the only thing that can fix this.

Being diagnosed with a prolapse (i.e. one or more of your pelvic organs start to shift downwards) can feel very scary and defeating. The great news is that surgery may only be necessary for severe cases. Most often, pelvic floor therapy can be extremely helpful for limiting or eliminating prolapse symptoms long-term without surgery. Symptoms of prolapse (pelvic heaviness, pressure, incontinence, feeling of a tampon falling out, lower back aching) are often due to core and pelvic floor instability and poor pressure management. Learning to improve all of these things can do wonders for not only eliminating your PF symptoms but also allowing for improved core and body strength overall. In the event that you end up needing a surgery to correct prolapse, the recurrence rates are high following surgery. Learning these fundamentals, ideally before surgery, is crucial to assist in preventing recurrence. However, learning the necessary fundamentals after surgery is still extremely helpful for recurrence prevention in the event that you are only able to schedule with a pelvic floor PT afterwards.