Pelvic Floor Physical Therapy
Pelvic Floor Physical Therapy can sound intimidating, foreign, like a saving grace, or all of the above. It is completely understandable if you don’t have much knowledge on what it truly is, or if the thought of it mostly leaves you confused on what even happens in an appointment. It is complicated topic, and a huge umbrella of information! As a result of this, I wanted your questions and confusion to be addressed by a master in the field, Dr. Sabrina Baxter.
Dr Sabrina Baxter’s slogan and the name of her podcast is literally “No Such Thing as TMI, so you know this is going to be comprehensive blog and ultimately a very safe space. Sabrina is deeply passionate about pelvic health for both women and men and this really comes through in her interview.
Before we get started on her answers, Here is a brief overview of what Pelvic Floor PT is and who can benefit:
Stabilization of your low back, hips, and pelvis. Back and abdominal pain can definitely be addressed by working with the pelvic floor
The pelvis is a line of muscles, ligaments, tissues, and nerves that stretch from the pubic bone and tail bone. They can be too tight, too loose, or a combination of both.
Bowels and bladder control! If you experience leakage when you cough, sneeze, or do jumping jacks, this can help. In addition, constipation and painful bowel movements can be eased by strengthening your pelvic floor
Circulation and movement of lymph. Working with these muscles can aid circulation, speed up wound/injury healing, and more.
Painful sex. It is common to get stuck in a cycle of vaginismus (pain with sex) that is equally mental, emotional, and physical. You can essentially remain in “flight or flight”mode just at the thought of any form of vaginal penetration, including tampon insertion. A Pelvic Floor PT can help you attack this at all angles. You don’t have to live in fear and pain
Sexual trauma. Victims of sexual assault are found to be significantly more predisposed to sexual dysfunction and pelvic floor dysfunction such as vaginismus, IBS, lower urinary tract issues, vulvodynia, and more. In addition, 22% of patients with chronic pelvic pain were assaulted before their 15th birthdays. Healing is a path towards wholeness. Not just a singular set point that you have to reach. If you have been through sexual trauma, you are left feeling very fragmented and separate from your body. Especially during sex. Your pelvis will “speak to you” after an assault whether you think you have processed the trauma or not. Sharp muscle spasms, discomfort and pain during sex are all very common and can be worked through with a specialist.
Similar to our past blog on the Psoas muscle, or “the seat of the soul”, your pelvic floor muscles are going to act like a guard dog for your body. They contract to protect us and can get stuck there, causing consistent tension and pain
Now for Our Discussion with Dr. Sabrina:
Opinion on kegels? Should everyone do them, or should you be instructed always by a professional before beginning an exercise regimen like this at home?
“I think it's super important that everyone knows HOW to do a kegel BUT not everyone needs to incorporate them as part of their exercise routine. Bringing awareness to your pelvic floor -- knowing HOW to contract (aka kegel) and HOW to relax (the release of that kegel) is very valuable, especially in situations where you need to strengthen or relax the pelvic floor. My favorite cue is telling someone to hold in a fart (squeeze your anal sphincter). You should feel your pelvic floor (a hammock of muscles) lift! And then let that contraction go, this is the release! That's how you activate and relax your pelvic floor. On the regular you want to keep your pelvic floor relaxed, no need to keep it clenched throughout the day, this can contribute to pain and dysfunction. If you are experiencing pelvic pain or tightness, I'd recommend against kegels until you get evaluated by a professional -- your pelvic floor likely needs more relaxation practices. If you are practicing kegels to strengthen your pelvic floor, don't neglect your abdominals and hips because these muscle groups contribute heavily to overall pelvic floor strength.”
If someone knows they eventually want children, how soon should they begin working with a pelvic floor PT to strengthen these muscles?
"If you are ready to have kids there is no harm in seeing a pelvic floor therapist right away! I think this can be very valuable and you can learn about your body and how to prepare your body for an optimal pregnancy and postpartum experience. The pelvic floor therapist should do a full body evaluation, checking bony alignment and identifying any muscular imbalances. With your consent, they can also evaluate the pelvic floor muscles specifically strength, endurance, coordination and identify any areas of tension or pain. And if you have any pain (literally anywhere) or experience bladder, bowel or sexual dysfunction my hope is that the pelvic floor therapist would help you resolve those so you really get to experience a painless, strong pregnancy!”
What are some daily practices people can utilize to assess their pelvic floor, strengthen it, loosen it, or simply get more in touch with it? Anything we should avoid/big no-no’s?
“If you are a clencher, whether that be your jaw, stomach, or pelvic floor -- let it go! Check in throughout the day and try to release. Especially in moments of stress or anxiety, take a big inhale, then a bigger inhale and sigh it all out. Let it go! Chronic clenching is asking for pain and dysfunction! Your pelvic floor needs less of that. If you want to practice kegels, be intentional with it. I don't recommend doing it while your busy doing something else (ie. driving). Definitely do not practice WHILE urinating (this is an old recommendation people used to get) because it can confuse the signals your brain sends to your bladder and vice versa! If you are someone that just wants to be proactive with your pelvic health, stay tuned because I have programs coming out :) but also I would recommend regular yoga and pilates. I think yoga has some great poses (ie. happy baby, child’s pose, frog pose) to open up the pelvis and hips and I also love how yoga prioritizes breath work (super important to be a regular 360 breather, not a shallow breather via just the chest). Pilates focuses a lot on deep core and pelvic floor activation, so I especially love to recommend pilates-based exercises for pregnancy prep. I love strength training too so if that's your jam, don't stop! My favorite quote I've heard recently is that most people aren't overweight, they are UNDER muscled! I love that and really believe in that.”
Does PFD often coincide with any other issues such as bad PMS, dysmenorrhea, amenorrhea, endometriosis, major anxiety and/or depression, chronic pain elsewhere, etc.?
“Yes, yes, yes and yes. Remember the pelvic floor is a group of MUSCLES. Muscles are extremely responsive to stress, trauma, inflammation, infection, injury, etc. If you experience any symptoms that involve bladder, bowel or sexual dysfunction -- commonly pelvic pain, pelvic girdle or low back pain, pain with penetration (ie. tampons, gyno exam, sex), urinary frequency, urgency, leakage, constipation or incomplete emptying, muscle spasms in the pelvic area -- that is classified as PFD and you could benefit from seeing a pelvic floor therapist. Trauma can be stored in various areas of the body, including the pelvic floor. This is always something I will screen for and be mindful of when working with clients. Usually people with chronic anxiety have a degree of muscle tension and tightness so this is also something I am mindful of and help people bring awareness to. Absolutely.”
Do you view pelvic floor PT as more preventative or curative?
“Both :) Curative, of course. My entire schooling revolved around treating specific symptoms and diagnoses. Preventative is my love language. I have a special place in my heart for preventative pelvic health. I wish MORE people knew about how MUCH we can do to prevent dysfunction. Of course dysfunction is not always preventable and I never want someone to feel like they didn't do enough to prevent the symptom they are experiencing - some things are just truly not preventable. Life happens, genetics happen. But the power of education is real, and many unpleasant symptoms and situations can be avoided with more pelvic health education.”
What should someone expect in their first appointment if they are feeling nervous or apprehensive?
“Think of it as a regular PT appointment, full body evaluation (clothed!) - checking from head to toes. You can disclose as much or as little information as you want as you feel comfortable to do so. An internal exam should only be performed with your consent. Often times I do not do an internal exam on the first session because we are just getting to know each other! I will only recommend an internal exam if I feel it is appropriate based on your symptoms and goals but ultimately it is completely up to you. Remember this session is for you and your benefit, the therapist should go at your pace and walk you through the process! I also like to recommend someone look their therapist up online, get their vibe, and even call their office and have a conversation to get to know them a little better and express any concerns or questions there. We're just here to help, we love what we do. I've never met a pelvic floor therapist that wasn't super passionate about their job, and that's something really special.”
Be sure to follow Dr. Sabrina Baxter on instagram at @drsabrinabaxter and if you want additional support, you can click here to schedule a discovery call