If you’re reading this, chances are you’re vaguely – or incredibly -interested in what happens in a pelvic floor physical therapy session. I know I sure was when I scheduled my first session way back in July 2013. Now, my list is by no means exhaustive or representative of every pelvic floor physical therapist so take it with a grain of whatever.
The Skinny on your Poop
One of the first things your PT will have you do is take a gander at the Bristol Stool Chart and point to your typical poo. It gives them an idea of what they’re up against in terms of constipation and free flowing unpleasantness – all of which can have an impact on your prolapse(s) and could possibly contribute to fecal incontinence (if you’re saddled with that fun bit of awful.)
You can buy your very own Bristol Stool Chart on a mug and keep the memory alive while your morning cuppa gets things moving along.
Or on a shirt if you like parading around with poop pictures on your clothes. It’s probably overkill if you’ve got small kids at home because you’re likely, on any given day, moderately covered in new human excrement. You don’t want to make the haters any more jealous than they already are.
Either way, Christmas is only 179 days away and this is definitely a gift to get for the person who has everything.
You’ll talk about the birth of your kid(s) and the healing from them. How you’re feeling, what’s been going on. Pretty typical stuff but in more detail than you’d do in a quick GP’s diagnose-and-dash 15 minute exam.
Your PT will want to know:
- If you’re experiencing incontinence in any way whatsoever (fecal and/or urinary)
- Do you have to push on your perineum or on the posterior wall of your vagina when you’re pooping to help get it out
- Heaviness in your vagina, sore back, pelvic pain
- What degrees of tearing you had with your kid(s). If you (think you) were repaired incorrectly then this is the time to bring it up.
- Are you on medications, vitamins, recreational substances? Write down all brands and doses to take in just in case you’re asked.
- How much caffeine you drink in a day (coffee, tea, soda, chocolate, etc)
This is your time, this will help your PT come up with a game plan to heal your busted vagina. Get brutally honest about where you are and what’s going on. Be descriptive.
Lady Parts Looky-loo: Part 1
Sorry, loves, but your lady parts are going to be prodded by your pelvic floor PT. The pelvic floor is a muscle, just like any other in your body except that it’s in a different neighbourhood.
My pelvic floor PT is a super chill and professional. I never feel uncomfortable or awkward because I trust her when she says that she has seen it all. With my first baby I had fecal incontinence (inability to stop from passing gas and pooping near misses), stress incontinence, and my core was incredibly weak. Well, during one session I farted during the lady parts looky-loo portion of the appointment. Oh HELL yes, if that isn’t the mother of all embarrassment then I for sure do not know what is. I wanted to die quickly but ended up apologizing, and my PT took it in stride and handled it like the boss she is. Because she’s awesome.
Along with assessing where your insides are weak, your PT may do a manual release of tight muscles. It sounds dirty but it actually hurts like a big fat swear word. But it helps. A lot. I had sustained a tailbone injury that was still causing issues for my pelvic floor, and a manual release of some hostile muscles helped out enormously.
Lady Parts Looky-loo: Part 2
Once the weaknesses have been assessed you’ll get to practice pelvic floor strengthening exercises with your PT’s hand inside of your vagina. Woo!
You will be asked to remove all clothing on your lower half, including underpants, and you’ll be given a sheet to cover yourself with. Drape yourself however is comfortable, your PT isn’t likely to look at your vagina unless you ask because you think your perineum is messed up from a bad stitch job or s/he needs to look at the healed scar tissue from where you tore during labour. Some PTs can help with scar tissue but I don’t know about this since my perineum was stitched apart after both of my births, and I currently don’t have one.
S/he will use one or two fingers to conduct the examination, while sitting slightly off to the side of you. It will almost be like you’re out for coffee with a new friend – only that they have your vagina instead of a cup of coffee in their hand and you’re half naked on a table. So pretty much nothing at all like going for a cup of coffee with a new friend. Unless you go for naked coffee . . . no judgement.
Your PT will likely NOT use a speculum because they’re not doing a gyno-style pelvic and swabbing your insides. They want to figure out where your muscles are weak by having you focus on contracting muscles that s/he is touching – yes, there are male pelvic floor PTs.
I’ve never had Part 1 & Part 2 be longer than around 5 minutes.
You might cry if, like me, you’re psychologically impacted by what’s going on with your body and/or what you’re unable to do. Between crapping your pants, peeing when you laugh, having your insides peeking out the front door, it all takes a mental toll on you. It’s okay to cry. Pelvic floor dysfunction is pretty damn depressing.
Or you might cry if you really connect with your PT. Talking about this shit takes an iron set of ovaries because it means you’re being vulnerable.
Maybe you’re just so fucking relieved that someone – possibly for the first time ever – didn’t say “oh honey, it’s because you had a baby” when you talked about peeing when you laugh.
Uh oh……your lady parts are crying red tears! You can always check with your PT if you’re feeling squicked out. It’s been my experience that PF PTs will still see you even if your lady parts are hosting a massive shark week party. They understand vaginas bleed. If you’re cool, they’re cool.
Diastasis Recti Checkti
Your PT should – not all do – check for diastasis recti (DR). DR is abdominal separation that sticks around after you’ve had your baby, and it can be relatively mild or pretty severe like with all things pelvic floor dysfunction related. I’ve been checked for DR at my initial sessions but that’s as far as it went for me. Luckily I’ve never had to deal with healing DR. But I won the prolapse lottery so……yay?
The check consists of feeling your tummy. You might have a six pack or a big old squisharoo like yours truly. Either way, do not apologize for the state of your tummy. It’s your body, your body is gorgeous and it grew a person – or people. Revel in that amazingness. REVEL. Don’t fucking apologize.
Mosey on over to Mama Lion Strong to read more about DR.
Based on your exam, you will be given pelvic floor muscle exercises to strengthen areas. If you’re struggling with urinary incontinence then you might have a lot of work focusing on the front of your pelvic floor. If fecal incontinence (and posterior prolapse) is your thing then you’ll be doing work that involves your anus and posterior muscles.
You won’t be tackling everything all at once. You’ll be scheduled for follow up appointments to make sure the exercises you’ve been given are helping, and to strengthen your pelvic floor one area at a time.
Do your exercises. Faithfully. They seem small and stupid, like yet one more thing you have to do. But these exercises are important. In 2013, at nine months post partum, I went from peeing myself, nonstop crop dusting, and almost pooping my pants to playing in an Ultimate Frisbee league with zero issues after about six sessions. This stuff works.
Enhanced Pelvic Floor PT
Some PTs work exclusively on your pelvic floor. They will do all of the stuff above and that’s about it – there’s nothing wrong with that, it’s one approach. Other PTs work on the pelvic floor within the broader context of the body. These PTs will do the pelvic floor stuff and will also:
- check your alignment for a neutral spine (Not neutral: butt tucking, pointing your nipples skyward or down toward the ground)
- activation of your abdominals
- tightness in your mid-upper back
- breath holding
- Hip and low back tightness
Depending on what your Enhanced PT finds, you could end up taping your hips (like I did) to help with pesky muscles that weren’t activating, rolling out tight quads, using a racquetball to loosen tight muscles in your upper back, transverse abdominal cueing exercises, breath expansion. All of it is designed to decrease the downward pressure on your pelvic floor that can help to cause a prolapse or make it worse – like in my case.