Pelvic Floor Physical Therapy
contributions from Annemarie Everett, PT, DPT, WCS, pelvic floor physical therapist, co-founder of PopUplift, @popuplift
Even with an “easy” birth, your body still experienced huge changes — and it’s important to address the needs of your postpartum body. Whether it’s recovering from a difficult delivery, navigating sex, or returning to exercise, a pelvic floor physical therapist who understands your goals can help you get there.
What kind of physical therapy (PT)? What is the pelvic floor?
Though the name calls to mind a flat surface, the pelvic ‘floor’ is actually a bowl-like network of musculature and connective tissue between the hip bones, pubic bone and tailbone. It functions as a part of the “core” for postural support and stability, supports the pelvic organs (bladder, uterus, bowels, and cervix), maintains bowel and bladder control, and is the opening through which your baby passes in a vaginal delivery. A pelvic floor PT is specially trained in addressing the function of your pelvic floor.
How can a pelvic floor PT be helpful after giving birth?
In many parts of the world, it’s common to receive some type of postpartum pelvic floor PT to support your return to normal physical activity. That is not typically the case in the US, where 88% of new parents report receiving no guidance from their healthcare provider on this transition.
Visiting a pelvic floor PT after baby arrives can be helpful regardless of your baby’s birth mode (vaginal or cesarean). If you had a difficult delivery, a pelvic PT is the provider who can evaluate your physical concerns and help you develop a plan toward recovery. If you had a smooth birth experience, they can recommend an appropriate path to a comfortable return to physical activity and sex, acknowledging the normal hormonal and mechanical changes in pregnancy that affect your body in myriad ways.
What is a postpartum appointment like?
Lots of talking! Your PT wants to hear your story—not just what physically happened, but how you feel about it. Things like mood, sleep, fears about our physical bodies, relationship concerns, and positive or negative experiences surrounding pregnancy and birth can greatly affect your symptoms and are important for your PT to understand before they develop your treatment plan. The most effective physical therapists acknowledge the need for a deep dive in this regard. What is ‘the story you’re telling yourself?’ What are your expectations, what information have you internalized, and what are your motivations? PTs give you a little bit of a sanity check.
If you didn’t visit while pregnant, your PT will give you a quick anatomy lesson on the pelvic floor and walk you through what to expect during your first postpartum visit. Then, they’ll move forward with the physical exam.
When we’re talking about postpartum recovery, it’s important to recognize that this trajectory looks different for all individuals because each body is different, each pregnancy and birth are different, and we all have different goals about what we’d like to return to or accomplish physically. That means your treatment plan will be unique to you and your specific goals.
When should I make an appointment?
If it’s possible (and you want to), we’d suggest setting up a postnatal PT appointment for soon after your six week follow-up appointment with your OB/GYN or midwife. Then, you’ll automatically have support set up for when you need it. If you have issues with delayed healing of stitches, retained placenta, or other concerns, your pelvic PT may ask that you postpone your appointment until those are resolved.
Is postnatal pelvic floor PT covered by insurance?
Some large hospital systems do have pelvic PTs on staff who are able to provide care that’s eligible for insurance benefits and will do the billing for you. Many pelvic physical therapists in private practice do not take insurance. You can usually use FSA/HSA funds, or ask for a superbill so you can submit an ‘out of network’ claim on your own.
In our experience, most of our postpartum claims we submitted via superbill were paid for (less a copay). It’s always best to check with your specific insurance provider.
What if I don’t have access to pelvic floor PT or it’s too difficult to leave my house/my baby in the early weeks?
Luckily, there are some great alternative options. You can work with a PT 1:1 via telemedicine (basically a Google Hangout/Facetime with your therapist). Annemarie provides these services. There are also several new online courses created by pelvic floor PTs — ranging in price from $49 to $200 and all online!
