Ins and Outs of Pelvic Floor Therapy

Choose wisely:

Did you know pelvic floor therapy is recommended before considering surgery for uterine prolapse? I didn’t even know there was such a thing until recently. But when I searched for information online, I found plenty of articles written by health providers. I wanted to hear from a woman who actually had gone for this specialized therapy.

Now that I’ve been going for PT, here is my blog post about my experience to fill that void!

Two important factors

• If you are considering pelvic floor physical therapy, please don’t hesitate. It’s not weird or creepy, you’ll learn a lot, and the work you put into it will be worth it.
• A word of caution: When you’re looking for a physical therapist, never settle for less than you deserve or expect. Seek out the best.

The Diagnosis

My new OB/GYN diagnosed a particular kind of uterine prolapse (I’ll spare the details) and wrote a script for pelvic floor physical therapy. Of course, when I got home, I did what most people do: hopped on the internet to research (not always a good idea) pelvic floor therapy.

Very Well Health states that “Each session will take place in a private treatment room” and “The initial assessment for this type of physical therapy includes an internal exam.” Well. I didn’t know if I was ready for that.

Anyway, the doctor gave me scripts for two different therapy facilities. I was familiar with one place, having gone there for hip and shoulder issues a few years ago. The other facility (I’ll call it “Rehab Team”) was just three minutes from my house, so, what the heck, I called there first for an appointment.

I asked the receptionist, “Will the physical therapist be a female?”

“Oh, yes, of course. Absolutely. Yes,” she assured me.

Nope and nope

When it came to the internal exam and a private room, both were missing at Rehab Team. And there was also a “misunderstanding,” as the receptionist put it, about female therapists.

At the first exam, the female physical therapist talked to me for an hour or so (we were in a private room for that much), but she never touched me. At the time, I was fine not having an internal or external exam.

At the second appointment, I met with her again for some stretching on a table in the main therapy room. After ten minutes of gentle stretching, the PT passed me off to her male assistants who started me on a long list of exercises.

I was not happy. Yes, my therapist was female, but all her assistants were men. Young men, younger than my own son. Let’s call them Jason and Vince.

Ensuing Weirdness

Jason put a band around my knees while I lay on my back and said, “Exhale and contract your Kegels while you open your legs, and inhale when you release and bring your knees together.” Okay, that was weird. Then Vince instructed me on side leg lifts while I contracted my Kegels.

Neither male assistant seemed concerned whether I contracted the proper muscles or not. How would they know? They relied on my feedback, asking, “Does that feel okay?” Sure, it felt “okay,” but was it correct? How would I know?

So I worked hard, doing what I thought was right. They instructed me on other exercises while not doing Kegels, such as planks, squats and bird dogs, all to tighten my core. During one standing leg lift exercise, my back made a series of loud popping sounds. I asked Vince “Did you hear that?!” He dismissed it, saying, “We were taught there’s nothing wrong with popping.”

After my third appointment at Rehab Team, I was confused, self-conscious and unhappy. I called it quits.

Second go

I then made an appointment at Neil King, the therapy facility where I’d gone before. It had been four years since my last session, yet the PT and I recognized each other. A good sign. We talked about my symptoms and what work I’d done at Rehab Team.

Her initial assessment was hands on. She had me lie on my back and asked me to gently contract my lower abdomen. Then she asked me to contract my Kegel muscles. She pressed along my inner thighs, backside and stomach to feel the strength of all the muscles, and to see how well they worked together.

And, yes, she conducted an internal exam, too. I didn’t find it embarrassing or nearly as invasive as I’d imagined.

Having an internal exam now made sense. How else would a therapist know what part of the pelvic floor needed work? The pelvic floor is an internal basin or hammock, consisting of front, rear and side musculature, not just a single muscle around your vaginal opening. All these muscles keep the organs in your body from falling out. In my case, the front muscles are weak and the back are tight. Good to know. This means a different strategy. The rigorous routine at Rehab Team could have actually hindered progress.

Plus, the therapist will be able to tell if I’ve improved, having done an internal exam. And that’s the goal, isn’t it? To get better?

A totally different approach

At Neil King, their approach to Pelvic Floor Therapy is much different. I will not being doing twenty crunches, followed by fifteen side-leg lifts times two, followed by thirty squats and 3 minute long planks, etc. etc. and lots and lots of full-on Kegels (I’m not exaggerating) with little coaching or supervision. I will not be doing anything that makes my back pop, either.*

Now, the exercises I am being taught are extremely focused, involve coordination and fine tuning, and discussion. Believe it or not, it’s hard work, but I am progressing. My PT is encouraging, helpful and funny. Also she uses great analogies to help me understand what and how to contract my Kegels.

The best part: we are in a private room.

Another word about Kegels

I recalled reading a warning many years ago not to fatigue your Kegels. When I asked about this at Rehab Team, the PT told me you could not overwork them: “That sounds like outdated advice. It’s like any other muscle. The more you work it, the stronger it gets,” she said.

My PT at Neil King said you should not overwork them. Kegel muscles are not like your biceps or your quads. If you have exhausted them, and then need them to engage, say, when you’re lifting something heavy, good luck! Her idea of strengthening involves fine tuning the muscles.

Overdoing Kegel exercises can increase stiffness and make it harder to feel your pelvic floor muscles. Unnecessary contraction during pelvic floor exercises is not beneficial to recovering the strength and mobility of your pelvic floor muscles.

If we want things to shift in our pelvic floor, we need to also shift the habit mode of our muscles. In the case of our pelvic floors, there tends to be much confusion. Is my pelvic floor too tight? Not tight enough? How can I tell the resting tension? How can I fix it? Before we set out to resolve/fix our pelvic floor dysfunction we need to first “know” our pelvic floor. Know what engaging it feels like, what releasing it feels like, and how to control both contracting and releasing it. Only then we can discern what our tendencies are and create new movement patterns and choices. ~Restore your Core

My takeaway

Some issues that could be treated with pelvic PT include:

• Urinary or fecal incontinence or urgency or frequency
• Constipation
• Pelvic pain and/or pain with sex
• Prolapse
• Difficulty emptying bladder
• Childbirth prep and/or vaginal or cesarean postpartum recovery

Talk to your doctor. Go where you feel comfortable. Ask questions. Insist on female therapists and assistants if you want them. Insist on privacy if you want that, too. Be honest about your symptoms. Physical therapists have seen and heard it all, so don’t be bashful. I could have declined an internal exam. However, it makes sense to learn as much as you can, and to allow your therapist to put together the best program for you.

*By the way, I’ve learned that the popping in my back is due to arthritis and instability, and it is not okay, as the young dude at Rehab Team claimed. It is to be avoided.

Also, men have a pelvic floor. Obviously there are differences, but physical therapy for men is also a thing.

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Linda K. Sienkiewicz is a writer, poet, and artist.
Learn about her multi-finalist award winning novel, In the Context of Love.
Learn about her picture book, Gordy and the Ghost Crab.
Learn about her latest poetry chapbook, Sleepwalker

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