When you think of physical therapy (PT), what do you see? Stretching? Maybe a nice lady in a polo leaning over a young athlete, holding their ankle and knee in that iconic PT stance? Well, yes, that’s PT, but there’s more to it than that. Physical therapy uses a wide range of techniques including movement, exercise, and electrotherapy to improve or restore mobility and function.

In the case of pelvic floor physical therapy, these techniques are used to affect the muscles of the pelvic floor.

What is the pelvic floor, you ask? It’s the complex meat hammock that supports the bladder, bowel, and uterus.

Pelvic PT is a great non-surgical treatment option for people who have chronic pelvic pain, trouble with urination and bowel movements, and painful penetrative sex.

But what do they do in pelvic PT? Great question. Everybody and every body is different, so there’s no one-size-fits-all treatment. In general, PTs take a hands-on, hands-in approach (think: sports massage for your vagina). You can, however, expect a few things during your first visit: a talk with your PT, an assessment of your hip and back alignment, and a pelvic floor muscle exam. Depending on one’s needs, PTs may then incorporate techniques including:

• Education about the pelvic floor and what lifestyle choices can promote its wellbeing
• Teaching pelvic floor exercises (like kegels—although kegels are not recommended for everyone)
• Internal and/or external trigger point release and lengthening of tight muscles (this just means massaging and stretching)
• Biofeedback and electrical stimulation
• Vaginal dilation (insertion of a cylindrical object, like Soul Source dilators, to increase or restore “vaginal capacity” to make activities like sex and putting in a tampon comfier)

Image from Eugenia Loli

Pelvic floor PT is a growing field, yielding promising results and now available in many parts of the world. While pelvic floor dysfunction can affect anyone, pregnancy is a particularly common source, which is why proponents of pelvic PT and even an entire country are recognizing its importance for postpartum care. It has been demonstrated to be effective for postpartum urinary incontinence and fecal incontinence, and is showing success in reducing pelvic pain and pain during sex.

Unfortunately, pelvic PT isn’t a part of normal “4th trimester” care in most parts of the world. From the hands-off approach often seen in the United States and Canada, to traditional Chinese, Latin American, and Indian postpartum quarantine practices, the new mom experience is highly variable.

In France, however, postpartum care looks a little different—every new mom is prescribed 10 government-subsidized pelvic PT sessions (or more, if needed). After that, French mommas receive 10 abdominal PT sessions for their tummies—also on the house. A large number of mothers experience something called diastasis recti—when the two muscle bellies of rectus abdominus (the washboard abs muscle) separate— during pregnancy and postpartum. Together, these sessions are designed to prevent pelvic floor dysfunction (and prevent larger medical bills down the line—a smart economic move for France’s universal healthcare system).

Countries like the UK and the US are starting to see the light.

In 2006, the UK’s National Institute for Health and Care Excellence recommended new moms be taught pelvic floor exercises if they are experiencing symptoms of urinary incontinence. Recently in May of 2018, the American College of Obstetricians and Gynecologists (ACOG) formally acknowledged the importance of postpartum physical therapy for incontinence.

While not as preventative or broad in scope, this represents a promising shift in the way we think about postpartum care. Carrie Pagliano, president of the Women’s Section of the American Physical Therapy Association (APTA), speaks to this in an article from PT in Motion.

"Mothers have typically only had access to pelvic floor PT if they have a referring provider having prior experience with physical therapy, or it was simply left to the patient to find her own answers for her postpartum issues. Formal recognition of physical therapy in the fourth trimester not only recognizes our expertise in this area of care but provides a clearly stated standard of care for physicians providing postpartum care options for their patients."

New moms are subject an unfortunate pu pu platter of pains and pelvic floor dysfunction, but there’s hope (even if you don’t live in France). Pelvic floor PT is gaining traction, and is slowly being recognized by medical authorities as an important component of postpartum care. Plus, there is a giant directory of practitioners who are passionate about post-baby healing and are here to help.

Here are some of our industry-leading favorites:

• Pelvic Gym, an online platform (founded by The Pelvic People!) providing pelvic floor education and exercises wherever you are
• Pelvic Health and Rehabilitation Center with locations in California and New England
• Beyond Basics Physical Therapy in New York
• The Center for Pelvic Medicine in Pennsylvania

Additional reads on postpartum PT:

• For more info on postpartum practices around the world
• If you need more convincing about postpartum pelvic floor PT