Any pregnancy related ache or pain can be addressed by a pelvic floor physiotherapist. This may include low back pain, sciatica, pubic symphysis dysfunction, rib pain, etc.
Another important part of pelvic floor physiotherapy in pregnancy is the preventative nature - teaching you about your core and pelvic floor, doing delivery preparation including pushing practice (surprisingly most of us don't know how to do this properly), and discussing what you can and should be doing in the early days postpartum.
It is never too late to see pelvic floor physiotherapy after having a baby. This includes both vaginal and caesarian delivery. Common complaints postpartum include urinary incontinence, pelvic organ prolapse, and painful intercourse. It is also very important to have your pelvic floor assessed postpartum before returning to specific activities such as running, that place a big demand on the pelvic floor.
Diastasis Recti (Abdominal Separation)
Diastasis recti is a natural adaptation to pregnancy, however what we do throughout pregnancy and early postpartum can aid in the recovery of these tissues.
Even if you had a baby years ago and think this might be an issue, an assessment can be done to determine the extent of separation and proper breathing and core exercises can be prescribed to aid in optimal functioning.
Pelvic Organ Prolapse (POP)
POP is when any of your organs starts to descend down the vaginal canal (bladder, uterus, rectum). Common complaints with a prolapse are the feeling of incomplete emptying, or a bulging sensation inside the vagina. Prolapses range in severity as well as symptoms felt. Although not always related to childbirth, prolapses are more common after vaginal delivery.
Sex should not hurt. Period.
Many women experience pain or discomfort with penetrative intercourse - this does not make it normal or something we should just accept. There are many factors that play into why some women may experience this, and physiotherapy can address these. Some of these include overactive or tight muscles, vaginal dryness, scar tissue, or an underlying health condition like endometriosis.
Pelvic floor physiotherapy also addresses complaints related to bowel functioning or "back door issues" - constipation, difficult evacuation, unwanted leaking of stool or gas, pain in the rectum or tailbone, etc.
Pre- and post-operatively
Any gynecological or colorectal surgery may affect your pelvic floor. Oftentimes after surgery the pelvic floor gets really tight because it is responding to the pain and tensing as a protection mechanism. Seeing a physiotherapist prior to surgery can teach you all about these muscles and proper recruitment and relaxation.
Common surgeries include hysterectomy, endometriosis excision, anal sphincter repair, etc.
With menopause comes a change in the hormones responsible for pelvic floor elasticity and lubrication. A physiotherapist can discuss different options for complaints such as vaginal dryness or painful intercourse, as well as address the pelvic floor muscles.
So what is "normal"?
Here are a few facts on "normal" pelvic floor functioning! Are you right on the mark or could there be some improvements?
As women, we are often not taught much about optimal pelvic floor function, and typically we don't even think about our pelvic floors until they become a problem.
Normal Bladder Tips
You should empty your bladder about 5-8 times in your waking hours (or about every 2-3 hours).
Getting up in the night 0-1 times is also completely normal!
Normal Bowel Tips
Normal bowel frequency can vary from three times per day to every three days. As long as this is consistent you are considered 'regular'.
Stool should be soft but formed like a banana!
I like to say that lube is mandatory when it comes to penetrative intercourse. This is often a taboo topic where women feel that it is their fault if they 'need' lube.
Just use it. EVERY TIME!
Although VERY common, it is never normal to leak urine (or stool or gas). Even if it only happens with a really full bladder and a big unexpected sneeze, this shouldn't be something you just deal with.
This doesn't have to just be with penetrative intercourse - unable to insert a tampon? Or have pain with a PAP exam?
This can mean that your pelvic floor is too tight or overactive, and can be addressed with physio.
Let's be Proactive!
Did you know that you don't necessarily need a 'reason' to see a pelvic floor physiotherapist?
It's a great idea to check in to get a baseline so you know how to avoid complaints in the future!