When I went to my first pelvic floor physical therapy appointment in 2013, newborn son in tow, I didn’t know what to expect.
As a journalist covering women’s health, I’d interviewed countless physical therapists and gynecologists on different topics. But information on pelvic floor strength seemed to revolve around tips for squeezing in more Kegel contractions — while waiting at stoplights, washing dishes or watching TV.
When my own PT worked like a charm, alleviating my pelvic pain in just a few quick visits with nary a Kegel, I was — wait for it — floored. Why hadn’t I heard about this after kids one and two? Why weren’t more people talking about it?
What is pelvic floor pain?
With pelvic floor pain affecting half of women (yes, half!) and more than 10 percent opting for surgery, why aren’t more people taking advantage of a low-intervention, surgery-free option that’s usually covered by insurance? I had to know.
Turns out, lots of reasons. For starters, U.S. healthcare providers don’t routinely check new moms for POP (pelvic organ prolapse) after childbirth, so many women don’t know they have a problem or hear about potential solutions until much later in life, says Sherrie Palm, founder and executive director of the Association for Pelvic Organ Prolapse Support.
On average, women suffer with symptoms of pelvic floor dysfunction, including pelvic pain, bladder pain, urinary leaks, constipation and pain during sex, for six years before seeking medical help.
Fortunately, more healthcare providers are recommending pelvic floor physical therapy before, or as an alternative to, surgery.
If you’re thinking about it, women’s health specialist and physical therapist Peg Maas of Seattle’s Swedish Medical Center, DPT, board-certified pelvic health/women's health specialist, has some guidance on what to know before you go — so you’ll be more prepared than I was.
It’s not just for new moms.
Stronger, more coordinated pelvic floor muscles are a boon to everyone, so new mothers aren’t the only ones who benefit from pelvic floor physical therapy, says Maas.
“I also work with men, trans women, teenagers, people who have had sexual trauma and people healing from surgeries, including gender affirming surgeries.”*
It’s not invasive.
Anything called “pelvic” sounds clinical and conjures up images of hospital gowns and feet in stirrups. But I never had a pelvic exam for my pelvic floor PT, and you may not, either.
“I take a lot of information before I ever do a pelvic exam,” says Maas. “I ask about water intake, how often they pee, bowel habits, sexual pain, and look at their back and range of motion. So patients have a chance to meet me and get comfortable with me before we do a pelvic exam, if they consent to that.”
It's not all about Kegels.
First, your therapist may not use the term “Kegel” for the famed pelvic floor contractions named after the late gynecologist Arnold Henry Kegel.
“I don’t like that we have an exercise for women that’s named after a male gynecologist. I say ‘pelvic floor strengthening’ because that seems like a clean slate for people,” says Maas.
And you may need to re-learn how to perform pelvic floor contractions — or learn how to “uncontract” or relax overly tight pelvic muscles.
“I’ve met women who’ve been doing Kegels for decades — sometimes up to 400 a day,” Maas says. More contractions aren’t always better, though.
“When you have your pelvic floor muscles constantly tensed, it’s like having your shoulders in a perpetual shrug. It’s really about learning to operate your pelvic floor muscles the right way,” she says.
It can help you poop.
Pelvic floor PT can help with toilet troubles; bowel dysfunction and constipation are increasingly common and an underappreciated cause of sexual pain and urinary leaks, says Maas.
“One reason is that our toilets are getting higher and higher to accommodate an aging population, and we’re really designed to eliminate in a squatting position. I work with children and adults to learn how to relax the appropriate muscles, so the body can do what it needs to do on the toilet.”
It's about strength, not weakness.
A pelvic floor PT referral doesn’t mean you’re weak. Often, PT is about learning to coordinate pelvic floor muscles so they can fire up at the correct time.
“Some people have pelvic floor weakness, and we can work on strengthening,” says Maas. “But some of my patients are very fit — runners, for example. For those people it’s more about learning to recruit and activate the right pelvic floor muscles and get them to fire up at the right time, and relax at other times.”
Pelvic pain is the norm for too many people, but it doesn’t have to be yours. Take it from me: Fixing your floor is the most worthwhile reno project you’ll ever take on — no contractor required.
*Editor's note: An earlier version of this article misquoted Peg Maas. The quote has been updated to replace "sex reassignment surgery" with "gender affirming surgery."
Ms. Maas' title has also been updated to include the following information: "DPT, board-certified pelvic health/women's health specialist."
