10 Things That Happen at Pelvic Floor Physical Therapy

Part One: For the Mom who Leaks Pee

The idea of Pelvic Floor PT can be a little scary for people. I understand. It may seem a little crazy to have a physical therapist looking at your lady bits, but I promise, it’s even less invasive than a trip to the gynecologist! As a pelvic floor physical therapist, I want women to feel less scared of going to see a PT — we can help you! So, I figured I would write about what a typical session with me would look like, and hopefully by the end, you’ll see how not scary it really is.

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Photo by Dakota Corbin on Unsplash

To all the postpartum women who leak pee, this one is for you:

  1. You’ll tell your physical therapist how you are doing. How you’re REALLY doing. What are your symptoms today? What symptoms occurred between our sessions? What is stressing you out recently? How are you sleeping?How is pumping/breastfeeding/bottle feeding going? What was a big win for you this week? Did you do your homework? And follow up, was it helpful? Are you feeling stronger than you were before?

  2. We’ll need to measure your pelvic floor muscle strength today. You’ll get undressed from the waist down, lay on your back on the table with your knees supported, and cover yourself with a sheet while your PT goes to wash her hands.

  3. Your pelvic floor PT will measure your pelvic floor muscle strength vaginally. Yes, vaginally. Yes, it is necessary. Your pelvic floor muscles are inside your body, so you cannot accurately test them from the outside. Your PT will measure strength, endurance, coordination, and lengthening of your pelvic floor muscles with one gloved and lubed finger. This should not be painful and should only take a few minutes.

  4. Your pelvic floor muscles have gotten stronger from your last visit! You and your PT celebrate! Maybe, that homework she gives you is actually doing something…You remark that doing the kegels is feeling easier.

  5. You are given a wet wipe to clean up with and get dressed again. Internal stuff done for the day.

  6. Time for exercises! You still leak pee when you cough, sneeze, walk quickly, and jump. Your goal is to not have to wear any sort of pad anymore and feel confident enough that you won’t leak to return to the gym and exercise classes. You start with exercises to strengthen your deep core muscles — you do a few on your back, on hands and knees, and standing. You nail the exercises from last week, so we progress some of them.

  7. Next, you work on your exercises for your hips and glutes. There are bridges, squats, lunges, and jumping involved. You are also supposed to be doing kegels WHILE bridging, squatting, lunging, and jumping. Your pelvic floor muscles not only have to be strong on their own, they have to be able to contract at the right time in order to prevent leakage. It’s hard! You’re feeling more confident with these exercises than last week and you can actually feel your pelvic floor working when you squat! Good things are happening!

  8. You chat with your PT about your plans for the rest of the day while you’re exercising. You tell her about how your baby is rolling over now and show her videos. You talk about what TV shows you’re watching and what podcasts you recommend. You note that your upper back is killing you from nursing and pumping all day. Your PT shows you a quick stretch for your pecs and upper back to help.

  9. You did great with all your exercises and even the new ones we tried today. You are making great progress towards your goals! Your PT gives you new homework to do between this visit and your next visit.

  10. Your PT tells you how great you’re doing and reminds you of where you started and where you are now. You’ll soon be jogging, warrior I-ing, jump roping, squat pressing, sneezing, and everything else without a worry in the world. You go mama! Your hour is up, you say your goodbyes for this week. Until next time!