What's Up With Pelvic Floor Therapy?

What's Up With Pelvic Floor Therapy?

Around this time of my 1st pregnancy, I had been hearing a little bit about pelvic floor health in my birth education classes. Whenever pelvic floors were mentioned around me prior to being pregnant, I immediately thought of 2 things - 1. Only people who pee when they laugh have to work on their pelvic floor, and 2. You have to do Kegel exercises to prevent the first thing from happening. I quickly learned that this was not really the case at all and how important pelvic floor health was for pregnancy, postpartum and just in general!

pelvic floor muscles during pregnancyBecause they have to support the weight of your growing baby, pelvic floor muscles work harder during pregnancy than they normally do. Along with everything else in your body, pelvic floor muscles also soften during pregnancy because of ALL the pregnancy hormones that our bodies have to deal with! So whether you’re giving birth vaginally or through a cesarean, your pelvic floor muscles will definitely be affected during pregnancy. This is why even though I was feeling healthy in this area of my body, and even though I was not peeing when I coughed or laughed, I went to see a pelvic floor therapist just to get a baseline assessment. I’m really happy I did this as I now know that I was setting myself up for a better recovery!

I’ve really enjoyed working with my current pelvic floor therapist, Dr. Kat Castro, and I thought I would do a little Q & A with her to help you with any questions you might be having about this area of health!

Hi Kat! Thanks for doing this with me! What brought you to pelvic floor therapy?

I was introduced to this field in PT school - I have a history of midwifery in my family so working with women in their childbearing stages was of interest to me. This, along with my own experiences being in fitness, working with pregnant and postpartum women really drew me in. I also have experienced and worked through my own pelvic floor issues and really believe that everyone needs access to this type of therapy!

At which point in pregnancy is the best time to start pelvic floor therapy? Do you need to start working on pelvic floor before you give birth?

Any time! Actually, even before pregnancy would be great, just to get a sense of where you’re at and to learn exercises/ strategies to keep your personal pelvic floor healthy! I would recommend working on your pelvic floor before giving birth. You can do a lot of manual release work such as perineal massage, breathing techniques, exercises and stretches to help prepare this area for birth. It will help with recovery and can minimize tearing, making your birth experience more positive and empowered.

pelvic floor postpartum

When and how long do you need to work on the pelvic floor postpartum?

It depends on what kind of birth and delivery you experienced. You can start working on your pelvic floor as early as the week you come home. For how long, again it depends. Women typically work on it for their first year postpartum, ranging from beginner to more advanced strengthening exercises. Pelvic floor health and strength is life long!

How is the work you do different with c sections vs. vaginal births?

In terms of the work and rehab program, the timeline is different in general. A c-section is a major abdominal surgery so we need to allow time for the scar to heal, which is usually 8-10 weeks and with OB clearance. With vaginal births, you can start exercise after being cleared by an OB at 6 weeks.

What would the 1st session with you look like?

We would get to know your birth and medical history, evaluate your posture, check for diastasis recti, check your hip mobility, hip strength, functional movement and pelvic floor. We would then work on simple and gentle pelvic floor and core re-training exercises. For c-section patients, you may receive scar massage.

What sort of advice would you give this mama?

When she was pregnant, she was peeing her pants during pregnancy as well as 6 months postpartum. It has since subsided but she would like to know how to prevent this from happening next time!

I would recommend that she see a pelvic floor therapist and be evaluated to learn what her baseline is in terms of her pelvic floor and core function, mobility and general strength. She could start on some pelvic floor and core centered workouts as well as progressive strength training. If she is planning on having another child, it would be important to treat this period as “pre-hab” where she can focus on getting body strong and build pelvic floor awareness . The stronger you are going into it, the more positive recovery will be.

Kegel exercises while pregnantAre there any common misconceptions or myths about pelvic floor therapy that you find yourself addressing regularly?

That everyone has to do Kegels! The fact is not everyone is a candidate or may need to do Kegel exercises because it depends on the state of your pelvic floor - which is why it’s recommended to see a pelvic floor therapist at pretty much any point in your life. It’s good to get a sense of how your muscles are functioning - some people can be more tight in their muscles vs. others who may struggle with pelvic floor strength.

What are some of the most asked questions you get from patients?

The biggest one I get is ‘when can I go back to running?’ Right now, it’s recommended by the research that women can start running again once they are 12 weeks postpartum. Again and as always, it depends on the person, what kind of birth they have experienced and their recovery process. However, in order to prepare, I would recommend women to do a strength training program that is focused on restoring their pelvic floor, core and hip strength and overall posture before they start a running program.

Are there alternative therapies that complement pelvic floor therapy/ prenatal/ postpartum that you love that people may not have heard about?

As you know I’m always interested in this!

Yes! I love Visceral Manipulation & Craniosacral Therapy. Both are really gentle therapies to get your body back in balance. Also - acupuncture! It really helps with the emotional side of recovery as well as digestion, fertility and hormones. Lastly, The Arvigo Techniques of Maya Abdominal Massage - this is an ancient technique that works on rebalancing the womb - good for fertility, pregnancy and postpartum.

Any pelvic floor therapy related products that you have tried, tested and love?

Yes! For lubricants, Slippery Stuff and Maude. You use the lubricant with a pelvic floor wand. I like Intimate Rose for pelvic floor wands as it was developed by a physical therapist and is made of medical grade silicone. For pregnancy, I like the belly band from Bao Bei Maternity because it relieves pressure from pelvic floor. I also always recommend getting any pilates ball for exercises!

Are there any apps that people can use that you recommend?

I was recommended the Every Mother app by my wonderful OBs and really liked it… it was especially helpful in the first few weeks of recovering at the height of the pandemic!

Yes, I also recommend the Every Mother App! This is a great intro to all the things you would do in PT, and they have programs for pregnancy and postpartum. The app starts super slow and gentle with easy things you can do like breathing (which is really very important!). Moms are busy and you’re probably not thinking about leaving the house for the 1st 6 weeks. The app is safe enough that you can do it on your own, although you may get to a point where you want to see someone in person. But we get it, you just had a baby!

Where can people go to for more information or to connect with you?

You can find out more info at our website and feel free to follow me on Instagram!


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Meet Christine Han-Rutledge!


Christine is a mother of two with a Master’s in Early Years Education. She has always been passionate about teaching and working with the tiniest humans. Her goal is to provide her family with healthy and sustainable choices at all times, and to share those tips with you!

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