Along with the joys of pregnancy, as anyone who has gone through the experience knows, are many pains. If not pains, then aches, discomforts, and "I just peed when I sneezed" moments (the medical term for this being urinary incontinence). One area of the body that needs some TLC and is often overlooked is the pelvic floor.
The pelvic floor is a group of muscles and tissue that supports vital organs in your pelvis, like your bladder, bowel, and internal reproductive organs. These muscles form the base of your core, along with your diaphragm, abdominal muscles, and back muscles. Knowing this, can you see how many of those pregnancy aches and pains are connected?
What does pelvic floor therapy do?
You may be thinking, "Oh, I know about this; I do Kegels!" And while, sure, Kegels — which are exercises to tighten the pelvic floor — are commonly recommended, they are one tiny piece of the PT puzzle. Pelvic floor therapy treats pain, weakness, and dysfunction in the pelvic floor muscles.
"Kegels are kind of a gateway term [to pelvic floor physical therapy]. A big misconception in pelvic floor PT is that everybody needs to be doing Kegels because most women, in the opposite way, actually have a really tight pelvic floor," Allison Oswald, physical therapist and board-certified pelvic specialist, explains to Scary Mommy. "Any muscle in our body we want to be able to stretch it and contract it. So most women, I find, have a tight pelvic floor muscle, so they really need release, and then they strengthen them."
This was the case for Greene, who gave birth to daughter Kingsley in September. "It turns out that my pelvic floor was tighter than it needed to be, so I focused first on loosening things up to allow for a smooth labor and then tightening back up after," she explained.
Greene, who is also the co-founder of a reproductive health company, Hummingway, shares that through her work there, she was introduced to Carine, the founder of Origin — a women's led startup focused on pelvic floor physical therapy — and learned the importance of caring for her pelvic floor, especially around pregnancy. "Your body goes through a significant amount of trauma during pregnancy and labor — and in most situations, a trauma to the body means rehabilitation — so why wouldn't that be the same for our pelvic floors?"
Both Greene and Glazer visited Origin, whose mission is to make pelvic floor physical therapy part of the standard of care across the U.S. for every woman and individual with vaginal anatomy.
Is it covered by insurance?
Coverage for pelvic floor physical therapy at this time depends on the state you live in — unlike in other countries, like France, where all women get a prescription for 10 free physical therapy sessions to "re-educate" the pelvic floor after birth. Origin is a pioneer in this field, accepting insurance at their five in-person clinics in California and Texas and through virtual PT in California, Texas, and New York. Additionally, they offer pelvic floor coaching in all 50 states.
Is pelvic floor therapy painful?
Depending on your type of pelvic floor issues, therapy could be uncomfortable at first. That’s the goal of therapy, though — to address the cause of any pain and discomfort. The general consensus? Any brief discomfort in the beginning is worth it to get to the end results, which many patients call “life-changing.” Also, as is always the case, pain is subjective. All bodies are different, so every person will have a unique bodily response.
"I personally did not find it uncomfortable at all," Greene shares of her experience with pelvic floor therapy at Origin. "My therapist was warm, engaging, and informative. She walked me through each exercise and gave me a very in-depth explanation of how it was working and why I would benefit from it."
While it was incontinence that motivated Greene to work on her pelvic floor as early as possible in her pregnancy, Glazer has had pelvic floor pain throughout her life. She shared on her Instagram how pelvic floor therapy helped with one of the "deepest sources of pain in her life."
In an interview with Vogue, Glazer says, "I started experiencing pelvic pain at a very young age, which is four. That's when I remember first experiencing it, and it was chronic pain from ages four to 24." For those women who have this pain early on, many have experienced years of being misdiagnosed or dismissed. Glazer was one of them.
We spoke with reproductive psychiatrist Dr. Sarah Oreck, who explained the connection between mental health and pelvic pain. She shares that early in her training, she noticed this subset of women being bounced around in the medical system. The few studies on chronic pelvic pain do show there is a significant psychological component, but they are far and few and not widely acknowledged. She does note that studies show that "chronic pelvic pain is associated with about 60-70% of depression and anxiety."
This was true for Glazer, who told Vogue, "I look back at my pelvic floor as where I held my anxiety and depression." Glazer finally found a doctor who took her pain seriously, and along with an antidepressant and talk therapy, she attributes a large part of her recovery to pelvic floor therapy.
What happens during pelvic floor therapy?
So, what does this type of therapy look like? Naturally, it’s tailored to the specific needs of the person receiving the therapy.
According to Vogue, “[Glazer’s] Brooklyn-based pelvic floor physical therapist, Dr. Kristi Latham, would do internal massage working out knots in her labia, massage through her bellybutton, do biofeedback (where a practitioner uses various instruments to monitor bodily functions then makes suggestions based on the feedback), and offer her a toolkit for how to deal with the pain at home.” Glazer then shares that her pelvic floor physical therapy practice allowed her to approach her pregnancy and the birth of her son with joy. "There was something about the empowering engagement with my physical journey with pregnancy that allowed the disempowering part of it to feel lighter," she says.
While chronic pain is a different subset of pelvic floor PT, it is never a bad idea during pregnancy to seek it out as a preventative measure. Oswald shares that during pregnancy, a lot of pelvic floor PT involves education. So much so that many physical therapists, like Oswald, as well as those at Origin, offer virtual appointments. There is, however, an internal in-person component as well. "We go vaginally or rectally if consented by the patient so women can feel where these muscles are."
"During pregnancy, sometimes it's just teaching women. Sometimes, hip pain, back pain, rib pain… the pelvic floor could be connected to all of those as well," says Oswald. Toward the end of pregnancy, the focus shifts to preparing for labor and delivery. When you have a baby vaginally, the pelvic floor muscles need to stretch, and PT can help. Perineal massage (to potentially prevent tearing), as well as breathing techniques, are also taught.
After a vaginal delivery, that hammock that holds all those pelvic floor muscles is likely weakened. Postpartum, Pelvic floor PT is very useful in strengthening those muscles and getting you back to a baseline. Even those who have C-sections can benefit since they still have the effects of carrying a child for nine months.
Oswald says her postpartum PT focuses on allowing the muscles to heal and come back into a good position. The abdomen is part of our core, so that is also part of it. Diastasis recti, when the ab muscles separate during pregnancy from being stretched, is also addressed if needed. But wait… there's more. Postpartum PT also focuses on how to care for your baby in regard to the best ways to lift and hold your baby. "The big message is pelvic floor is a huge part of our whole being."
In what other ways is this type of therapy beneficial?
From a mental health perspective, Oreck believes any kind of support, like physical therapy, can be a form of self-care for new moms: "Postpartum for women who experience issues as a result of the trauma from delivery — like incontinence, prolapse (where the walls are so weak, internal organs start to come out), and painful sex — with those issues, you do get a lot of self-esteem and depression issues. If we can prevent these things from happening, they can definitely decrease depression and anxiety."
While pelvic floor therapy is becoming more and more part of the pregnancy journey, it's still not often suggested by OB-GYNs until an issue arises. Be your own advocate: ask your doctor about it. For those who don't have pelvic floor specialists in their area, there are a ton of videos and educational components online. The more you know, the better you can tackle pregnancy and all the "fun" that comes during and afterward.