You expected your body to change a bit after pregnancy—stretch marks, saggy boobs, maybe a few extra pounds. But now you’re peeing when you laugh, sneeze or go for a run; sex is uncomfortable; or maybe there’s even something (what?!) protruding from your vagina.
There’s a problem with your pelvic floor—and it needs your attention.
Carrying a baby for nine months and then delivering that baby can often weaken the muscles that support the organs assisting in urinary and fecal continence, sex and overall stability. This can be difficult to hear if you’re knee-deep in diapers, cold coffee and books about sleep schedules: Really, something else to worry about?
But here’s the good news: You can get your pelvic floor firing again, working with its neighbouring muscles and communicating with your brain, says registered physiotherapist, orthopaedic and pelvic health floor physiotherapist, Lamiya Zaidi.
But what exactly happens at that appointment? We asked Zaidi that and more.
Is pelvic floor therapy becoming more popular? LZ: Where I live, in Toronto, there were maybe one or two practitioners five years ago. Today, the courses you take to become one are packed, and the number of pelvic floor therapists in the city is growing. People have been practising pelvic floor therapy for a long time, though; in France, it’s part of their public health system.
How are moms finding out about pelvic floor therapy? LZ: More and more women are talking to each other about their symptoms. It wasn’t always common to talk about leaking or that something is protruding out of the vaginal area, but now with the amount of support moms are giving each other to, say, get back into an exercise routine or be intimate with a partner, they are recognizing common signs and symptoms—like leaking or pain—and are telling each other about pelvic floor therapy.
Take us through what the first appointment would be like. Is it more like an exercise class or is there a physical examination? LZ: At your first appointment, we talk about what’s happening with your body and your physical activity goals, and we do both an external and an internal exam. I also give a short anatomy lesson, explaining where the pelvic floor is and why it’s important.
For the internal exam, you will be asked to undress from the waist down, lie down on your back and you will be draped. There are no instruments used—just gloves and lubrication—and it’s much gentler than a pap smear. I go very slowly and use one finger to feel for the tone of the muscles that wrap around the vaginal canal. I assess the vaginal area and ask the patient to do some funny things like cough, hold their pee, hold their gas and do a Kegel to see how the area is responding.
If a patient wants to see what's going on, I have a mirror and they can watch. The more the patient knows what is happening, the more control they have, and that’s what we want them to regain.
OK, the exam is over and now I'm dressed. What happens next? LZ: After the exam, we talk about how to get the pelvic floor activated, figure out a plan and establish some homework to get you started using the muscles again at home.
Wait, so there’s homework too? How are postpartum mamas expected to do it in between feedings, not sleeping and not sleeping some more? LZ: I’m often asked by patients if they'll have to do Kegels for the rest of their life. I tell them that pelvic floor muscles are muscles: If you don’t use them, you lose them. Between 30 to 50 percent of women are doing Kegels wrong, so we teach the correct way, and you do have to re-visit the exercises every so often to ensure pelvic floor health.
What about moms who have had C-sections? Do they ever need pelvic floor therapy? LZ: Yes! You’ve still had nine months of baby on the pelvic floor, plus you’ve had a large incision in your abdomen. A big thing a lot of patients aren’t told is to work on your scar, which gets the deep abdominal muscles underneath firing again.
How often do you recommend women go to pelvic floor therapy? LZ: We actually recommend coming in after your first trimester. The game plan is to start strengthening the pelvic floor muscles from 15-16 weeks pregnant, and at around 34 weeks we can prepare for labour and delivery. After baby arrives, if you haven’t done the prenatal work, we recommend waiting until the six-week postpartum check-up to consult your doctor.
What does pelvic floor therapy cost? LZ: The initial consultation and appointment is about $135 (for one hour), and the follow-up appointments are about $95 for half an hour. Most extended health insurance plans cover physiotherapy and at least a portion of the consultation.