Incontinence, constipation, pain during sex…those may sound like typical late pregnancy and postpartum symptoms you’ve heard of. While it’s true that they can crop up before and after you’ve given birth, there’s nothing “typical” about them. These symptoms are often caused by weak or tense pelvic floor muscles, but that doesn’t mean there’s nothing you can do about these symptoms.
Read on to learn more about dysfunctional pelvic floor muscles, what causes them and how pelvic floor physical therapy (yes, it’s a real thing) can help. (PS: You can also watch our Instagram Live with Dr. Sara Reardon, board-certified pelvic floor physical therapist and the voice behind @the.vagina.whisperer, as she talks about all things related to pelvic floor health.)
What Is a Pelvic Floor?
“The pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs when growing a baby during pregnancy,” Dr. Reardon says. Alongside helping with sexual function and childbirth, they also hold urine and fecal matter inside your body until they’re released.
Unlike your biceps or abs, which can be visible when toned, the pelvic floor muscles aren’t ones you can see—so how can you tell where they are and what kind of shape they’re in? Ever had a super-full bladder with no bathroom in sight, so you forced yourself to hold your pee in? Those muscles you clenched1 were your pelvic floor muscles. And you can tell if they’re in good shape or not based on how well you can hold in your urine and bowel movements or if you experience any pain while the muscles are in use.
What Is Pelvic Floor Dysfunction?
Pelvic floor dysfunction can be either weakness or tension in your pelvic floor muscles, leading them to not function as they should.
“Tense pelvic floor muscles can contribute to painful sex, tailbone pain, vaginal pain, rectal pain, incomplete bladder emptying, incomplete bowel movements or constipation,” Dr. Reardon says. On the other hand, “symptoms of pelvic floor muscle weakness often include urinary incontinence (leaking pee), anal incontinence (leaking poop or gas), pelvic organ prolapse or heaviness and pressure in the pelvis.”
If you’re experiencing any of these symptoms, it’s possible it may be due to an issue with your pelvic floor. The best way to find out for sure is to talk to your doctor and/or a physical therapist who specializes in treating pelvic floor muscles. (More on what a pelvic floor physical therapist does in a moment.)
How to Strengthen Your Pelvic Floor
Pelvic floor weakness is typically caused by repeatedly straining your pelvic floor muscles. Here are some things Dr. Reardon says, if you do them often, may contribute to straining those muscles:
Straining and pushing too much during bowel movements
If you favor workouts that are high-impact, like running or CrossFit, or if you’re consistently lifting heavy weights, it can be a good idea to tone things down a bit or try wearing a support band to help from over-straining your pelvic floor muscles.
You can also weaken those muscles by overdoing it with basic bodily functions like coughing or having bowel movements. If you suffer from a chronic cough while pregnant, it’s a good idea to talk to your doctor about treating the cough, since the pelvic floor muscles get contracted and can potentially be strained2 the longer the cough continues. And if you experience constipation, it’s important not to strain or push too hard, as your muscles can overstretch and become weakened3 . Instead, prop your feet up on a small stool so your knees are slightly elevated, and allow your pelvic floor to fully relax without bracing down.
Sometimes, though, pelvic floor weakness happens simply from being pregnant. Your body is going through a lot of changes, and with all the extra weight bearing down on your loosened joints, muscles and ligaments (you have the hormone relaxin to thank for that), it’s no wonder your pelvic floor muscles can get overstretched.
So how do you get a weak pelvic floor strong again? One word: kegels. “Kegels are contractions of your pelvic floor muscles,” Dr. Reardon says, “and are commonly touted as the best way to strengthen your pelvic floor.” Remember how we said before that holding your pee in is the function of clenching your pelvic floor muscles? That clenching = doing kegels, and it works your pelvic floor muscles just like a dumbbell curl works your biceps or a crunch works your abs.
How do you know if you’re doing kegels properly? Dr. Reardon says to go to an expert. “I would absolutely encourage working with a pelvic floor therapist for a thorough assessment to ensure kegels are appropriate for you and that you are performing them properly.”
While kegel exercises are beneficial for a weak pelvic floor, they’re not beneficial for a tight or tense pelvic floor (kegels can actually make tense muscles worse).
What Is Pelvic Floor Tightness?
It’s important to have a strong pelvic floor both during and after pregnancy, but you can’t strengthen muscles that are too tight. That could damage of your pelvic floor. “There are some signs and symptoms that may indicate your pelvic floor muscles are tight,” Dr. Reardon says, “and you need to work on relaxation first before strengthening.”
According to Dr. Reardon, symptoms of pelvic floor tightness can include:
Weak urine stream
Constipation or feeling the need to strain during bowel movements
A sensation of incomplete bladder and/or bowel emptying (feeling like you need to go again after you just went)
Hard poops that are difficult to pass
Painful bowel movements
Burning during urination
Pain with sexual intercourse, including a feeling of tightness or tearing during sex
Pain or throbbing after intercourse
Burning or rawness at the vaginal opening
Difficulty having orgasms
Painful pelvic examinations
Difficulty inserting tampons
Experience labor and childbirth
Regularly push too hard when using the bathroom
Regularly hold in urine or bowel movements, especially to the point of feeling strain
What Is Pelvic Floor Therapy?
“I didn’t know there was physical therapy for that!” you might be saying right now (don’t worry, Dr. Reardon says she hears this often).
“If you have a pelvic floor, you would benefit from pelvic floor physical therapy,” Dr. Reardon says. “Yes, even men, but especially anyone who is pregnant or postpartum.”
Pelvic floor physical therapy is, as you might guess, physical therapy for your pelvic floor muscles. Just as regular physical therapy is aimed at treating and restoring muscular or joint functions for the rest of the body, pelvic floor physical therapy does exactly the same for a very targeted muscle group. So if you’re experiencing any of the symptoms of either pelvic floor weakness or tension listed above, targeted physical therapy can help.
“Pelvic health physical therapy can not only help manage weakness,” Dr. Reardon says, “but also pelvic pain, painful sex, pregnancy-related low back pain, pubic bone pain, and also help prepare your body for childbirth.”
So what might an appointment for pelvic floor physical therapy look like? “The first session is a lot of information gathering,” Dr. Reardon says. “We first sit and discuss what brings you in, concerns, and ask all the questions about pooping, peeing, sexual health, day-to-day activities, etc.” And try not to worry about personal privacy; all pelvic floor physical therapy appointments take place in a private, one-on-one treatment room.
Your therapist will then check your posture, pelvic alignment, abdominal wall for tenderness or signs of diastasis recti or a C-section scar before moving on to an internal examination (with your consent, of course).
“An internal pelvic floor muscle assessment through the vagina allows your pelvic floor therapist to check strength, tone and tension of your muscles to determine if your muscles are weak, tense or uncoordinated,” Dr. Reardon says.
Once they’ve gathered all the information they need, your physical therapist will provide any education, stretches, exercises or massages that will help you in your rehabilitation.
Wondering if pelvic floor physical therapy might be right for you? Talk to your doctor or contact a pelvic floor-specialized physical therapist to see about getting your symptoms treated.