I’ve said it time and time again. Maybe in nicer words, but I’ve said it. If you’ve had a baby (vaginal or otherwise), you need to see a physiotherapist (PT). And not for your back or your shoulder or your knee. For your vagina. More specifically, your pelvic floor (PF), or the muscles that surround your vagina and hold up your bladder, uterus and rectum. Those muscles that are *supposed* to stop you from leaking urine when you run, and are *supposed* to help you hold in a fart, and are *supposed* to relax and contract when you have sex and reach orgasm.
That’s what they are *supposed* to do.
I am putting *supposed* in between asterisks because they don’t always do these things, in all women. And that, my friend, is why your vagina needs therapy.
If you saw my previous post about PF dysfunction, and you are maybe having some issues, you’re maybe considering going to see a PF PT (first off, yay!). But maybe you’re nervous, ‘what exactly do they do at PF PT?’ you ask? Well that’s what I am here to tell you.
First off, most physio’s will have you fill out a questionnaire, so they can get a quick grip on your symptoms, your obstetrical history, and what your goals are. Most often the start off with an initial consultation, that is longer than your regular visits, so they can get to know you and do a thorough interview to assess where you are at. They want to know how many babies you’ve had, how you had them (vaginal or c-section), whether or not you’re currently having issues with leaking, discomfort with sex, and any pain or heaviness.
Then they will most likely assess your posture or alignment, movement patterns and sometimes feel the muscles on your back or sides while you move, like squatting up and down. They may also pay attention to your breathing while you move, or have you pick something up to see how you do it. They may even just assess your movement patterns without you even realizing, they are professionals and have a keen eye, and a lot of people move differently than they usually do when they know someone is watching! Then they will assess your abs, have you lay and lift your head and feel your belly to see if you have a diastasis recti (separated abs) and have you contract your transverse abs to see how well you are able to connect with them and how strong they are.
Then comes the fun part.
Okay maybe not fun, per-say, but the meat and potatoes of the visit, so to speak.
The Internal Exam.
This is probably what most women are nervous about, but I promise you, it is nothing compared to a pelvic exam by a doctor, a PAP or, hello, giving birth. I’ve been to two different PTs and both of them made me feel so comfortable, it didn’t feel awkward at all. They assess your tissues from the outside, get you to cough and bear down before they even touch you, then they touch the outside to see if there is any tension or tenderness anywhere. Then they insert a gloved, lubricated finger into the vagina and have you cough and bear down again to see if there is any prolapsing organs. Then they feel all of the muscles in your pelvic floor from the inside if your vagina, and assess them for tension or tenderness again. Then they have you do a pelvic floor contraction (or kegel) and assess how strong your muscles are and how coordinated they are with each other. They may also use their other hand to feel your abs to see if they are coordinating properly with your pelvic floor.
At this point it varies between PTs, but some may do some myofascial release, or scar tissue release or massage. Then most will work on teaching you how to do a PF contraction properly (if you don’t already, which most women don’t if they have been to PT before). Then they will work on improving your contraction, maybe positioning their hand in different orientations to assess how all of the different muscles are contracting. Depending on where you are at in your rehab, they may have you do some minor exercises (think lifting one leg up, or lifting your hips, no jumping jacks!) while laying on the table and assess how well your PF responds to the movement.
After that, they will conclude the internal, and leave the room to give you a chance to get dressed. Then they will come back and discuss what they thought of everything, give you some exercises as homework and discuss whether or not you need to schedule another visit (or two, or more).
That’s it! It’s really not as bad as you may have thought (I hope!) but I promise you will leave with a whole new appreciation and understanding of your pelvic floor, and your body as a whole! The pelvic floor is an integral part of how your entire body functions, and supports some very important organs, I hope you plan to take care of it the same way you’d take care of any other muscle in your body if it were to go through a trauma like the PF does in bearing a child.
Don’t neglect the pelvic floor!