What in the world is pelvic floor physical therapy?

Yesterday I had my first pelvic floor physical therapy appointment. I will have 3 or 4 of these before I give birth and at least one afterwards. It was the coolest thing ever. Let me tell you about it.

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Amber Anderson is a physical therapist who received her doctoral degree from Elon University in physical therapy and went on to do her post-doctoral work, specializing in the pelvic floor at Duke. If you have heard of pelvic floor physical therapy (PFPT) before, you probably have heard of women going to a PFPT after birth to repair trauma to the pelvic floor muscles which can cause things like incontinence or painful intercourse. But down here, Amber is seeing patients before birth too…because an ounce of prevention is worth a pound of cure.

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I first heard about PFPT while reading French parenting books. In France, all pregnant women see a PFPT 10-20 times before birth and several times afterward to restrengthen their pelvic floors. It is just a part of normal prenatal care over there. So I read about it, and it sounded interesting and I thought to myself, I am going to ask my midwives about it. 

I didn’t have to. Because at the Birth Center of Baton Rouge, they have Amber – an in-house PFPT that they refer all their patients to. So yesterday I went in for my appointment. I came from work, wearing my scrubs. I brought a set of workout clothes to change into because I had NO idea what we were going to do…

Well, let’s just say…I didn’t need any clothes for the type of exercise we were doing.

So first of all, let’s talk about the pelvic floor. Pretty much what I knew before going in is what I know from yoga. I know how to engage my pelvic floor muscles. I know that kegels strengthen them. I know that people with weak pelvic floor muscles have issues with urinary and bowel incontinence. But there is more to these little things.

This is what they look like:

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Men and women both have them, but women have a slightly different design and a lot more going on down there in life that can cause a problem. The main muscles are round, like your eye socket or mouth muscles. There are several layers of muscle which criss cross, and three holes punched out…the urethra, the vagina, and the anus.

A pelvic floor contraction stops the flow of urine, holds a bowel movement in the rectum, and tightens the opening of the vagina. When you relax the muscle, urine and feces can move out. We want nice, strong pelvic floors, right? That’s what they tell us. It protects you from incontinence, improves orgasm control, and even helps stabilize and support the spine.

But when you are having a baby, you have to push a large head through all those muscles, and it is just as important to know how to relax and stretch those muscles as it is to strengthen them.

But how do you stretch muscles sitting inside your pelvic girdle?

Manually. That’s how.

So, after an interview about my pee, poop, and sexual habits, Amber asked me to undress from the waist down. I was like, Ah, this is where we are going with this…lightbulb!

I laid down with a sheet over me on an exam bed. Amber sat in a stool next to me. First she just observed that area while I did kegels, relaxed from them, held them, and coughed. Then she inserted one finger into my vagina and used her other hand to show me what she was doing. She began gently pressing around the wall of the vagina, literally manually stretching the muscles (imagine sticking your finger into your mouth and pulling on the inside of your cheek to stretch it out). She told me to imagine my vagina as a clock face. If you push at 6 o’clock, you stimulate the rectum…so we don’t need that. But if you push at 3, 4, 5, 7, 8, 9, you can gently stretch the muscles.

She started shallow, only one knuckle deep, then went around the clock at 2 knuckles deep, then went around again at 3 knuckles deep. She pressed on the areas and demonstrated on my arm how hard she was pressing. She was barely pushing at all, and it hurt like a bitch. Like when you have tight hamstrings and you try to reach your toes…except inside your vagina. It was not pleasant.

When she pushed against my obturator internus muscles, I thought my whole hip was being ripped off.

And as she did this, she explained.

It turns out I have a wonderfully strong pelvic floor. From being young, and healthy, and a yoga teacher. I am good at contracting them, I have good endurance holding a contraction, and I am good at relaxing them. But because they are so strong, they are tight and thick, like a bicep muscles that gets worked out but never stretched.

As she gently manually stretched it, I felt like my insides were on fire. And the amount of pressure she used was minimal. She was barely touching me. In a couple months, I will have several pounds of pressure and weight bearing down on all those muscles. And that will freaking hurt. And if it hurts so bad, I will not want to push, and my pushing will be less effective as a result. (Now, pushing is going to hurt regardless…but we can help it a little in advance).

In addition the muscles are thickened from flexing so often. She showed me the obturator internus muscles on a pelvic model. If they are thick, they can obstruct the birth canal. Women with thickened, strong obturator muscles are often those who push and push and the baby’s head is right there, you can see it, but it just won’t freaking come out. And often they end up tearing.

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The good news is, it is easy to stretch these muscles yourself. 10 minutes a day every day. manually, with lubricant. Very gentle pressure, just until you feel mild discomfort (not pain). Unless you are too sore to do it from the day before, then you should take a rest day. Se also told me that I won’t be able to reach the 3 knuckle deep muscle layer myself, so (and I quote), “If your husband is not a caveman, he can help you.” Guys, I was sore when I left her office. It’s the craziest thing. It felt like my hamstrings do after a hot yoga class.

So I am to do my exercises every day. And I have a couple of follow up appointments during which she will see my progress. I also have SI joint issues, which this should help, so she will be monitoring that too.

For my last appointment with her, Brian is to come with me. They have this cool machine that monitors muscular contraction strength on a computer, using sticky electrode pads (like you have for a EKG). The stickies go between my buttcheeks. She will put me in different pushing positions and actually watch me push on a computer, coaching me to tell me if the push is working for me, or, if not, how to tweak it. I will walk away with knowledge about which positions work best for me, and how to use them to facilitate baby getting out as quickly and easily as possible.

One of her colleagues, Amber told me, is responsible for petitioning the French government to include PFPT in prenatal care. As a preventative measure, rather than just a reactive one. PFPT is not just for birth. Its for women with painful intercourse, incontinence, and so much else.

What Amber was telling me and showing me just made so much sense, it is mind-boggling to me that this is not more of a “thing” in America. The French take their physical appearance and their sexuality very seriously. Perhaps that is why they hopped on board a treatment like this. Returning to normal sex and bowel and bladder function after birth is of the utmost importance to women in their country. It should be for women here too.

This woman studied at Duke University. She has a doctoral degree in PT. She is not a crunchy granola lady who stuck her finger in my hoo-ha. She is a medical professional who helps women give birth the way they want to, and return to normal afterwards, and I love it. Why aren’t midwives and physicians everywhere referring their clients to these people prenatally? Insurance companies need to be covering this. If PFPTs can prevent a C-section with a couple hundred dollars of prenatal appointments, why wouldn’t the insurance companies want that? (Rhetorical question…I know the answer unfortunately…and the issues of birth in this country are a different problem for a different blog post).

Pelvic Floor PT is a thing, and the professionals are out there. Find them. Get your pelvic floor assessed. Like I said, an ounce of prevention is worth a pound of cure. You won’t regret it.

 

 

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