The Importance Of Pelvic Floor Therapy

What Every Woman Should Know About Pelvic Floor Therapy

I’ve been working with several pelvic floor therapists over the years before I had my boys to help with my pelvic floor after having a D&C procedure, and then after having my c-section to help with postpartum recovery. I have learned so much about the importance of pelvic floor therapy so I interviewed Meghan Kasper, a pelvic floor therapist to share why every woman should have this knowledge.

How can a pelvic floor therapist help women? Is it just for new moms?

Pelvic floor therapy can help all women, whether or not they have symptoms of pelvic floor dysfunction or are postpartum. The primary functions of the pelvic floor include elimination, support, intimacy and childbirth. The pelvic floor can also serve as a lymphatic sump pump as well as a shock absorber.

Common symptoms of pelvic floor dysfunction in women include, but are not limited to: urinary incontinence, urinary frequency, urinary urgency, interstitial cystitis, pelvic pain, lower back pain, lower abdominal pain, pain with intercourse, pelvic organ prolapse, constipation, fecal incontinence, diastasis recti, and symphasis pubis dysfunction.

Women do not have wait until something feels off to consult with a pelvic floor therapist. In addition to addressing specific problems, therapists can help with overall health and wellness, body knowledge, and prevention.

It’s also wise to see one before and after any lower abdominal or pelvic surgical procedures as well as during periods of life associated with major hormonal shifts (e.g. postpartum, peri menopause and menopause).

Holistic pelvic health can help many women including those who seek a deeper connection to their inner core and pelvic floor, want to improve core strength, improve the quality of their orgasms, prevent future pelvic floor dysfunction, or just have a greater understanding of their own pelvic floor functioning.

I believe everyone can benefit from seeing a pelvic floor therapist to improve their body awareness, body literacy, and improve strength.  A holistic therapist can also assist one in releasing emotional stress or trauma that may be contributing to symptoms.

When should you get pelvic floor therapy?

Knowledge is power. Every woman has the right to basic education related to bladder, bowel, sexual function, reproductive health, and nervous system balance. This knowledge, along with understanding the importance of posture, alignment, using a variety of movement throughout the day, and how to quiet one’s nervous system is essential for overall wellness and quality of life.

Women of all ages have frequently informed me they wish they had this information sooner.  Often, pelvic floor dysfunction is a symptom of something else being out of balance rather than the primary driver.

A pelvic floor therapist will look at the whole person and provide the tools to be the detective of one’s own body. The pelvic floor is the center of our core and is influenced by everything above and below it.  Finding the limitations and blinds spots elsewhere in the body can often help alleviate pelvic floor symptoms.

Often, pregnancy and childbirth can make us more susceptible to some of these symptoms, and every postpartum mother would benefit from a pelvic health consult.  Some women are appropriate for a consult in the days after childbirth due to birth injury, birth trauma, or pain while others can wait a few weeks. A therapist will not be able to perform an internal assessment until after a 6-week checkup with your OBGYN. It’s a great idea to see a pelvic floor therapist during pregnancy for education to help one be prepared for the immediate postpartum time known as the fourth trimester.

Can pelvic floor therapy help with menstrual cramps?

Yes! Menstrual cramps are symptom where one’s lifestyle and nutrition and are extremely important to consider when trying to alleviate them. In addition, manual therapy can provide great relief. Different therapists will have different manual tools in their arsenals to treat menstrual cramps. Visceral mobilization, Mayan abdominal massage, and myofascial release are just three of the common techniques used.

The goals of these techniques are to guide the abdominal organs to their proper position, reduce muscle spasms, increase blood flow and organ function, eliminate inflammation, and decrease fascial tension and restrictions that might be contributing to pain. A pelvic floor therapist can teach you and/or your partner techniques to help carry over the treatment at home. 

I’ve heard of kegals, but are they good for most women? Tell me about how personalized movement should be.

Kegals were the named after a male gynecologist from the 1950s. Core and pelvic floor rehab have come a long way since then. Unfortunately, when most people (providers included) think of the pelvic floor, they automatically think of Kegals. Kegals are basically the tightening and squeezing of the pelvic floor musculature. There’s no other muscle in the body that we are encouraged to squeeze and tense throughout our day (or at every stop light). If we did, it would likely lead to tension and discomfort. There is also a cultural expectation that women should strive for a “tight” pelvic floor when OFTEN pelvic floor dysfunction is caused by tight or overactive muscles.

Ideally, our pelvic floor is able to move through a full range of motion, is coordinated, and is responsive to our whole body movements throughout the day. Core and pelvic floor healing are much more individualized and comprehensive than just performing Kegals.

Our inner core is a system made up of a collection of four muscles (or groups of muscles), including the diaphragm, the transversus abdominus muscle, the multifidi muscles, and the pelvic floor muscles. A pelvic floor therapist will look closely at all aspects of the core system, making sure each muscle or muscle group is not only participating, but pulling its weight.

In order for the CORE SYSTEM to be successful, each muscle group has to be working properly. It’s all about balance.  Our individual movement patterns, lifestyles, the way we manage stress, and our alignment are major contributing factors to our core and pelvic floor function. The body-mind connection also plays an important role.

I have never prescribed the same movement sequence for healing twice, because it is so individualized. 

Moving one’s pelvic floor musculature through the full range of motion may be a part of that movement prescription, but it is never a one size fits all approach. Also, we often see that people are not performing Kegals correctly, in the proper direction, or are compensating with other muscle groups. It’s a good idea to be evaluated by a pelvic floor therapist before making Kegals a part of your routine.

What does a pelvic floor therapist do?

A pelvic floor therapist will perform an evaluation that includes an interview, physical assessment, education, and goal setting. During the interview process your therapist will ask you questions about your experience with your symptoms, goals, lifestyle, as well as more intimate questions surrounding bowel, bladder, and sexual function. You only have to share what is comfortable for you.

The physical assessment will be dependent on the individual symptoms you present with but often include assessments of one’s strength and range of motion, posture, breathing, and the function of the pelvic floor.

Pelvic floor therapists have the knowledge and ability to perform both internal and external pelvic floor assessments. While this gives them helpful information about the fascial integrity of the pelvic floor so they are able to design individualized treatment plans, it is not an absolute necessity and should be performed based entirely on the patient’s comfort level. Many patients prefer to wait for a few sessions prior to participating in a pelvic floor assessment, while others prefer to defer it all together. Initially a pelvic floor internal assessment is done through the vagina. However, depending on the symptoms and individual characteristics, a rectal assessment is also an option.

What types of suggestions, movements/lifestyle shifts would a pelvic floor therapist recommend and how long does it take once new things are implemented to notice any changes?

This is truly different for each individual client. More often than not, clients either present with a myriad of symptoms or discover through the initial discussion that they are experiencing more than one. What is most meaningful for the client plays a big part in the treatment plan.

The most common lifestyle shifts I often prescribe are taking time to quiet the nervous system, adding a variety of movement into one’s daily life or functional activities, prioritizing sleep, increasing postural and breath awareness and staying hydrated.

Having an understanding of the clients’ roles, habits, and routines is important when making these suggestions. For example, the time and energy that a sleep-deprived, postpartum, working mom of four has for lifestyle changes is often very different than a woman who is post-menopausal and retired.

At the same time, you can never assume someone’s circumstances.  It is important to work with each client and their individual time and energy allowances for theses changes. Some women see changes right away, and others take more time. It’s also important to remember that to effect successful habit changes, one shouldn’t try to change too many things at once.

Some women prefer a certain set of exercises and want to be told how many and how often. Other women find this overwhelming and need their movement strategies incorporated into their activities of daily living.

The most important consideration for success with pelvic floor therapy is to have an understanding that the therapist’s role is not to fix you. You don’t need to be fixed; you’re perfect as you are. Your therapist’s role is to provide you with the perfect collection of tools to help you make the shifts and changes to alleviate your symptoms and improve your quality of life. Yes, manual techniques  and exercise can help, but what you do off of the therapy table (the other 23 hours of the day), is what matters most when it comes to healing.

How does someone find a pelvic floor therapist?

You can search for local pelvic floor therapists in your area on the internet. Pelvic floor therapists can be either physical or occupational therapists. There are also many pelvic health directories. Directories that come to mind are Herman and Wallace, Pelvic Guru, and the Institute of Birth Healing. Pelvic floor therapists can also be found in hospital-based programs, outpatient therapy clinics, and private practice.

If you live in a rural area with less access to a pelvic floor therapist, you may be able to find one licensed in your state that will do a telehealth visit with you. I also recommend the following online programs for core and pelvic floor issues: Lauren Ohayon’s Restore your Core and Lindsey Vestal’s Kegals that Work program. For expecting mothers the One Strong Mama program by Lauren Ohayon and Lindsey McCoy is excellent as well.

Different pelvic floor therapists will have different approaches. Lindsey Vestal of the Functional Pelvis has an excellent list of questions you should ask a pelvic floor therapist in order to determine if they are the right fit for you.

Here are some sample questions to ask when researching a pelvic floor therapist courtesy of Lindsey Vestal 

1. Do you specialize in women’s health? You may need to call therapy clinic to see if they have someone on staff who specializes in this area. Check to see if they are a “specialist,” or a therapist who has done extra training in this area. You can even ask what special training they have done.
2. Do you work with pregnant women? Pregnancy presents its own set of challenges, so it is best to find a therapist who is comfortable with prenatal clients. While most therapists do not do internal work during pregnancy, there are still ways to address pelvic floor concerns while pregnant.
3.  Is your facility set up for private assessments? This may seem like an obvious question, but you’d be surprised how many clinics are not set up for private care.
4. Do you do internal pelvic floor muscle work? It is important to understand their approach and training prior to your appointment. Ask specifically if they use biofeedback, manual work, or a combination in their approach.
5. What kind of equipment do you use? Would I need to be purchasing any extra equipment or devices? This helps you further understand their approach, as well as what to expect during your treatment.
6. Do you have experience with ____________ (insert specific concerns)? You can also ask: What are the most common diagnosis/issues you see in your clinic? (Prolapse, pelvic pain, incontinence, sexual dysfunction, pregnancy-related pelvic dysfunctions, diastasis recti). This will help determine the scope of their training and treatment.
7. What kind of success rate do you have with treating _________ (insert specific concern)? What you are looking to see is if they optimistic that they can help you.
8. What would I be doing in a therapy session? You may want to ask if they will be doing a pelvic exam in the first session. Many do not as there are several other areas to address before internal work. **If you have prolapse, ask if they do standing pelvic floor assessments. Often, pelvic prolapse symptoms present differently in standing, so this is important to get a proper assessment.
9. How often would I be expected to see you? And for how long? This isn’t always exact since they haven’t assessed you yet. But you’ll want to know the investment of time and money now so you can make the arrangements needed.
10. How will this treatment affect my fitness routine? Understanding the changes in your daily life due to rehab helps you be more compliant and successful.

Are you a new mom? Be sure to read top foods for postpartum recovery, the first blog in my postpartum series. 

ABOUT MEGHAN KASPER

Meghan Kasper began her journey in women’s health shortly after the birth of her first child. Her own experiences, along with the shared stories of many of the women in her life enlightened her to an area of practice underserved in our current health care system, pelvic health.

In addition to her training in myofascial release Meghan is also a certified Restore Your Core instructor, and is pursuing her certification through the Institute for Birth Healing. She has experience working in pelvic health at an outpatient therapy clinic and is currently in the process of starting her own practice. Meghan has supported women with her holistic approach experiencing symptoms of pelvic dysfunction, as well as through transitional times such as pregnancy, postpartum, and menopause.

Meghan Kasper has been a practicing occupational therapist for 18 years, massage therapist for 14 years, and myofascial release practitioner for nine years. Meghan worked in a variety of rehab settings specializing in adults with hemiplegia due to stroke or brain injury, spinal cord injury, and oncology rehab prior to shifting her practice to pelvic health supporting women in New Hampshire and Massachusetts.

In her spare time, Meghan enjoys being with her two sons, playing soccer, gardening, yoga, spending time on a lake, and being outdoors. She believes that receiving therapeutic touch and body work is one of the most important aspects of self care and healing, and is passionate about normalizing conversation around pelvic and sexual health, and educating and empowering women. You can follow Meghan on Instagram and Facebook.

I’d love to hear your thoughts!

• Was this post helpful for you? Or, do you have any additional questions? Comment below and let me know!
• Share with your friends, forward this along or post on social. You can also join me on Instagram and in my private
• FB groupWant a deeper look into your hormones? Take my quiz to see what foods might be helpful to add into your diet
• Sign up for my newsletter full of women’s health tips and get your FREE guide, the five steps to take today to help balance your hormones 

Medical Disclaimer

Information in this post and on this web site is provided for informational purposes only. The information is a result of practice experience and research by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained on or in any product label or packaging. Do not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem.