Like many of us, you might not have thought a lot about your pelvic floor before having kids. Pelvic floor health affects much of our daily lives, and it's hard to know where to go if it's not functioning properly and what to expect with treatment. Mara Hutton PT, DPT and Claire Kelly PT, DPT are local pelvic floor physical therapists here to help.

Q. What is the pelvic floor?

A. (Mara): The pelvic floor is a group of muscles located in the bottom of the pelvis in both men and women.

The muscles of the pelvic floor support organs such as the bowel, the bladder, and the uterus.

They have sphincteric function to control the bowel and bladder, sexual function to help with blood flow during sexual activity, and stabilizing function as the ‘floor of the core’ to control movement of the pelvis and lower back. For women, the pelvic floor also assists in childbirth.

When you contract your pelvic floor, your muscles lift the organs of the pelvis (support) and tighten the vaginal, anal and urethra openings (sphincteric). When your pelvic floor relaxes, it allows for the passage of urine and feces.

The contraction of the pelvic floor muscles (along with the deep abdominals and spine muscles) creates a ‘force closure’ of the pelvis creating a stable environment for all movement.

For both men and women, the pelvic floor assists in sexual function. For men, the muscles assist with erectile function and ejaculation, and in women, pelvic floor contractions can contribute to sexual sensation and arousal.

Q. Why should someone see a pelvic floor physical therapist?

A. (Claire): Individuals can get evaluated by a pelvic floor physical therapist for a variety of reasons, including pelvic pain, urinary or fecal urgency/incontinence, pain with intercourse, pelvic organ prolapse, tailbone pain, and pre/postnatal aches. A physical therapist is skilled in evaluation and assessment techniques that identify areas of dysfunction in a joint, muscle, or other soft tissue component. The physical therapist will develop an individualized treatment plan that will address the patient’s ultimate functional goals; pain free intercourse, birth preparation, improving core strength, or limiting incontinence. The patient will be instructed in safe and effective therapeutic exercise depending on what is identified during their evaluation.

Here is an example of why it would be important for someone to come see a physical therapist. We have all heard of a “kegel," right? A “kegel” is activation or contraction of the pelvic floor muscles. “Kegels” are important; however, they are not the end all be all. The pelvic floor muscles need to contract, just like every other muscle in the human body, but it is also vital the pelvic floor muscles relax and lengthen. “Kegels” most often are doing more harm than good for patients who are dealing with pelvic floor issues. If the pelvic floor muscles are overactive and tense, “kegels” will make symptoms worse. A pelvic floor physical therapist will be able to identify if contraction or lengthening of the pelvic floor muscle is appropriate for reducing pain and improving symptoms.

A physical therapist is here to help! Our goal is to empower women (& men) to take ownership of their body and seek the appropriate care that is available to them. Physical therapists want to educate their patients about their symptoms and provide them with the skills to function with less pain and improve their overall quality of life.

Q. What does a typical appointment look like? What do you look for as a therapist?

A. (Mara). At an initial visit, your therapist will take a medical history as well as a history of your symptoms and bladder and bowel habits. This is one of the most important parts of the visit because symptoms play a large role in directing your plan of care.

Your therapist will then conduct a physical assessment to establish where any joint, muscle or other soft tissue limitations exist. Your therapist should also look at how your hip and spine are moving and examine anything else that came up in the history.

Next, your pelvic floor therapist will likely do an external and internal assessment of your pelvic floor with your consent. This includes inserting their gloved hand into the vaginal opening in order to touch, or palpate, the pelvic floor musculature. They will have you contract your pelvic floor and palpate the muscles looking for any reproduction of symptoms, tender spots, tone differences or weakness in the muscles.

Once the assessment is concluded, your therapist should talk with you about the findings and establish a plan, including a home exercise program.

Sometimes the history and physical findings indicate that a rectal assessment is also necessary (or if you are a male, which is the only way to internally assess the pelvic floor internally). This assessment is similar to the vaginal assessment, however, the therapist can differentiate the muscles around the anus with this kind of assessment.

Q. When should someone see a pelvic floor physical therapist? Pregnancy? Postpartum? Years later?

A. (Claire): All of the above! Honestly, there is no wrong reason for seeking care from a pelvic floor physical therapist. Women (& men) seek care for a variety of reasons depending on their goals. Pelvic floor physical therapy is appropriate for all individuals, regardless if you have carried a child or given birth. Pelvic floor physical therapists can help educate patients about the anatomy and physiology of the pelvic “core” and its importance in everyday life.

During pregnancy, a pelvic floor physical therapist can instruct on safe functional movement patterns to ensure proper use of the abdominals. Therapy can help combat pelvic/low back pain, ensure proper lengthening of the pelvic floor muscles for childbirth, and instruct in helpful techniques to protect the perineum (area between vagina and anus) during delivery.

The postpartum period is an essential time to learn proper breathing patterns, regain muscle control of the deep abdominals, improve postural awareness, provide education on proper movement patterns when lifting/carrying baby, assist in cesarean scar mobilization and help decrease perineal discomfort.

Years later…of course! It is never too late to pursue help. Postpartum is forever, whether a woman is 4 weeks, 4 months, or 40 years postpartum. If you have ever thought about visiting a pelvic floor physical therapist then you most likely have something to gain from the experience.

Centre Physical Therapy offers treatment in Oak Park, Riverside, and Lincoln Park. You can find Mara in Oak Park and Claire in Riverside! For more information visit https://www.centrephysicaltherapy.com/

FIT4MOM Oak Park River Forest offers fitness classes for women in all stages of motherhood, including prenatal, stroller & moms only classes. Your first class is free! Click here to try a class.