As a perinatal therapist, I often hear about how physical body changes related to pregnancy, delivery, and the postpartum period impact emotional well-being. My patients regularly talk about self-esteem, body image and changes in libido. But what happens when the problems feel more physical? What happens when your quality of life and emotional health is diminished due to these physical changes?

It can sometimes feel like there is void between when you “graduate” from your Obgyn and when go back to your primary care physician, especially if issues arise that feel like they are still part of your perinatal experience. Enter Katie Bayer, PT, DPT and founder of Transition Physical Therapy in Vienna, Virginia. Katie is a physical therapist whose practice specializes in women’s health to include evaluating and treating pelvic floor issues (incontinence, pelvic pain, pain during sex etc.)

Check out my Q & A with Katie below to learn more about what pelvic floor therapy is, what a session might look like, and how to find a reputable pelvic floor therapist who can become part of your perinatal support team

What is pelvic floor physical therapy? How is it different from working with a more generalized physical therapist?

Pelvic floor PT is a therapy that examines the entire body, with a focus placed on the pelvic floor. The pelvic floor is a group of muscles within the pelvis that are a part of our core, and help to stabilize us. They are also the gateway to the vagina and anus- so things like sex, pooping and peeing issues can all be pelvic floor issues.

Because of where the pelvic floor is, we generally include an internal (vaginal and/or rectal) examination to be able to actually evaluate the muscles firsthand. A lot of the things we do and discuss can feel very personal, but they are important to know in order to fully understand how to get each patient better.
Even though we are called “pelvic floor PTs”, this does not mean that we are only focusing on the pelvic floor. It is attached to the rest of the body and we need the entire system to work together!

What are some of the conditions that you evaluate and treat in women who are pregnant or postpartum?

So many! When pregnant, people can have pain in their pelvic joints or low back. We can work on these issues with posture changes, manual work to soft tissues that are tight, and with exercise. I also believe that all pregnant women should have a good understanding of what their pelvic floor is, and how to connect to it. Most women go into the delivery room having little to no understanding of their own anatomy, so how can they be expected to know what to do to prevent injury? Also allowing them to understand they have some control over their pelvic floor and in the birthing process is empowering.
In postpartum, there are many issues that can occur. Stress urinary incontinence (leaking pee when you sneeze/jump), fecal incontinence (leaking poop or gas), prolapse (when an organ starts descending towards or out of the vaginal opening), pain with sex and constipation are some of the most common diagnoses I see. But any postpartum changes in the pelvic area, abdominals and spine can be helped with pelvic floor PT.

What does a typical session of pelvic floor therapy entail?

At the evaluation we talk a lot about your medical history- including gynecological, sexual, urinary and gastrointestinal, which all affect your current pelvic floor health. We want to know how many pregnancies you’ve had and how your deliveries went (Vaginal? How long did you push? Any tearing? C-section?), along with all the details of your pooping and peeing habits. We also want to know your current and past exercise habits, and what you want to return to doing. Your goals are what drive our focus on treatment.

We focus on your breathing quite a bit because it directly impacts your pelvic floor, so that will be evaluated on the first day and revisited throughout your care. If there are any soft tissue issues, we work on those with manual techniques like massage and myofascial work. Included in the soft tissue work may be the pelvic floor, depending on your own needs. Internal work is either vaginal, or rectal and often includes both simply because it’s the best way to get to all of the pelvic floor. We test the strength (think “Kegel”) and also the ability for these muscles to relax, or lengthen. Internal work should never be painful, and you are always in charge. If you ever don’t want to do internal work, or you want to stop mid-session- that’s what we do. Period.

We also give exercises that you can do at home in order to further progress on your own and maintain any gains we make in therapy. Most of your time is spent OUT of PT, so what you do at home really matters!

How long do women need to continue pelvic floor therapy?

I know people hate this answer, but it totally depends! Obviously, the longer you have lived with an issue, or if it is more severe, then generally more visits are needed. This is why I prefer to get patients before or during pregnancy so that we can help prevent future injuries. I see some patients for as few as 1 or 2 visits, and some for many weeks or months.

How do I know if what I’m experiencing is normal or whether I need to see a pelvic floor physical therapist?

I recommend all people see a pelvic floor PT after giving birth. A lot has happened there during pregnancy and delivery and understanding your new “baseline” is important. Also, if you have any issues that are bladder, bowel or sexually related and you’ve been cleared by a medical provider but you’re still suffering, seeing a pelvic floor PT is likely a good idea. When in doubt, do it! At the very worst, you will get taught a lot about posture, breathing and other ways to prevent future injury.

How can I find a reputable pelvic floor physical therapist, especially if I’ve experienced sexual or birth trauma and am worried about feeling triggered?

Asking trusted friends or people “in the business” (doulas, postnatal fitness professionals etc), and your own midwife or OBGyn. When you get a name, be sure to look at their website and see if it looks like they would be a good fit for you and your needs. Then call them up and speak to them and ask any questions that you have. Ask specifically about how they handle past trauma, and gage if their response matches what is comfortable for YOU. You want to make sure that you feel a connection with your PT. It is a person you will be sharing a lot of personal information with, and you will ultimately do better in the hands of someone you trust.

Have more questions or want to schedule a consultation? Reach out to Katie via her website.