Episode #03: What Happens at a Pelvic Floor Physiotherapy Appointment?
Subscribe: Apple Podcasts Spotify Google Podcasts
In this episode, Dayna talks about what it looks like to come and see a pelvic floor physiotherapist.
She talks about what conditions pelvic floor PTs help with and who they help (a.k.a. it’s NOT just for birthing people!)
She also discusses how she helps pregnant and postpartum women prepare for and recover from birth.
-
Pelvic Health and Fitness Podcast Episode #03 - What happens at a pelvic floor physio appointment
We're excited to have you join us for this episode of Pelvic Health and Fitness. I'm Dayna Morellato, Mom, Orthopedic and Pelvic Health Physiotherapist. And I'm Rhonda Chamberlain, Mom, Orthopedic Physiotherapist and Pre Postnatal Fitness Coach. On this show, we have open and honest conversations about all phases of motherhood, including fertility, pregnancy, birth, postpartum, menopause, and everything in between.
We also provide helpful education and information on fitness. The pelvic floor and many aspects of women's health, including physical, mental, and emotional wellness. Please remember as you listen to this podcast that this is not meant to treat or diagnose any medical conditions. Please contact your medical provider if you have specific questions or concerns.
Thanks so much for joining us. Grab a cup of coffee. Or wine. And enjoy!
Welcome to episode three of the pelvic health and fitness podcast. Today, we are going to be talking to Dayna about what it looks like to go see a pelvic floor physiotherapist. So, this is something that is becoming more commonplace and a lot of women are aware of what it looks like to go see a pelvic floor physio, but there still are a lot of misconceptions and a lot of myths about it.
So, I thought it would be a good idea to talk to Dayna about that and about what that looks like. So, Dayna, why don't you just give us a little bit of intro. First of all, what, what a pelvic floor physiotherapist does. and what that initial assessment might look like. Yeah, so pelvic floor physio, there's definitely a few misconceptions about it and who can come.
So firstly, pelvic floor physio really is for anybody kind of across the lifespan. And there are a number of conditions or reasons, concerns that people will seek out a pelvic floor physiotherapist, which we can touch on, um, during this episode as well. But really, I, pelvic floor physio, we're coming and we're looking at the whole person.
So a lot of times I'll have clients end up in my office and they're surprised at how thorough the kind of first initial subjective or interview portion is. And that's really because we're trying to get a good understanding of everything that could affect the pelvis and that really truly is everything.
So, so people can come to Pelvic Physio for any number of conditions and concerns. And so we start with a really good interview and really try to get a good understanding of what is going on with that person. We talk about bladder habits. Bowel habits, gynecological history, if that is relevant. Obviously pregnancies, postpartum, any surgeries that may have happened in and around the pelvis.
So if anybody's had any laparoscopic surgeries for end endometriosis or PCOS or anything like that, you can see a pelvic floor physio after gender reassignment surgery. Um, there are pediatric physiotherapy, uh, pelvic physiotherapists who will treat. Incontinence and bedwetting and constipation in children.
Um, so a number of, a number of things. So really, truly, if you have a pelvis in, that means you are human. You can see a pelvic floor physiotherapist. Primarily in my practice, I see pregnant and postpartum women. And postpartum can be... Anytime after you've had a baby. So I have seen women all the way into their 80s, and it is never too late.
Yeah. Yes. I think that's one of the biggest myths, right, is... A lot of women say, Oh, you know, I had a baby 30 years ago. It's too late for me, but that's just not true. Absolutely. There's always, always improvements that can be made. And truly when we're talking about the pelvic floor, their muscles and our muscles can learn and we can retrain them.
And the public floor muscles are no different. So when you come in for whatever. combination or a single concern, um, into see a pelvic floor physio, they will generally start with a really detailed interview. So they're going to ask you questions about all of those symptoms or what, what's the history with the bowel, the bladder, gyno history, as I said, um, get a really good understanding of where you're coming from.
And then we do an orthopedic scan. So we look from head to toe, we look at your. your back muscles, your abdominal muscles, your hip muscles, how everything moves kind of as a whole, you know, with the pelvis in mind, obviously, but we chat a lot about breathing and posture and lifting mechanics and the effects on the pelvic floor.
Which is cool because again, I think a lot of people just assume it's only going to be pelvic floor assessment. Right? But yes, we are not just the pelvic floor, right? We are whole people, our whole people, truly. And I, to be honest, when I first started my training as a physio, so before I was a pelvic physio, I remember some of our profs.
saying you always had to look above and below. And I thought if someone's coming in for a sprained ankle, why are you checking their hip? And, you know, as orthopedic physios, I think we probably pretty quickly figured out why that may be. Pelvis is the keystone to the body. So, so many structures attach on there are affected by it.
Um, it's the main part of the core, essentially. Yeah. And that's, that's again, something I worked in orthopedics for my whole career, same as you. And now that I'm learning more about the pelvic floor, I sometimes think back to some of my chronic low back patients and think, I wonder if that was one of the missing pieces of the puzzle.
100%. And I think, when I think back, and this is no fault of the schooling, obviously, I speak very highly of where we went to school, but I think the only cue we ever really got for the pelvic floor was to teach people to stop the flow of urine. Right, right. And if you're listening to this and that's how you're doing your kegels, please don't try this on the toilet that can actually lead to urinary retention if you're trying this on a toilet.
But yeah, we did. That's a good idea. I'm going to jot that down. Um, kegels for the myths and how to do a proper kegel. Right? So yeah, the one thing, um, the one myth I sort of hear a lot of is That women don't necessarily think that they need to see a pelvic floor physio before they start having kids.
Right. Yeah. So I would say it depends and I always think that it's good to know your body and I encourage people to take a mirror often and look at their vulva and get comfortable with their anatomy prior to having kids because one of the things I often hear or the comments I hear postpartum is, well I don't know what it looked like before.
Yeah. So it just looks, I think it looks different now, or it feels different now. And certainly people connect more with that feeling different, whether that's actually to touch or just in general in their bodies. But they often will make the comment, I don't know what it looked like before. So if you, if you're someone who would come see me, or clients who come see me before they have babies, I will say, look. Take a mirror and look at comfortable with your anatomy. It's important just for general health, right? We check our skin for differences related to sun damage and things like that. And we really should be checking our vulva for the similar for similar things. Are there any changes, right? So it is So I will say that I think it's important for just general health, especially if you're curious, you just want to have know a little bit more about how your anatomy works and what's going on before you have kids.
I have had a few clients in the recent, recent months and weeks that are coming to me younger. endometriosis, uh, being caught a little bit earlier, which is beneficial for a lot of reasons. And so just working through some pelvic abdominal work there, releasing tension a lot of times. But yeah, you can totally come really anytime in the lifespan if you're just curious or if there is a concern.
For sure. And I think I, so I, I guess I knew enough at the time I went to a pelvic floor physio. When I was pregnant, um, I didn't go before I was pregnant, but during my pregnancy, just to get sort of like that baseline assessment, right. And just sort of see where I was starting. And interestingly, during my pregnancies, I did have a hypertonic, like a tight.
pelvic floor, which often we think those issues don't necessarily happen until after we have kids. But with my history as a gymnast, I think that was my natural tendency, probably even years before even trying to have kids. So that I think it would be cool if It became more common for young women to just again, get that assessment and sort of learn their habits, learn their strategies that they naturally pick up to potentially see if that can help with like pregnancy and postpartum.
Absolutely. And, you know, I always say to clients to you assess them postpartum and maybe there's a little bit of a prolapse there or maybe there's some weakness or yeah they're hypertonic like in your case, and it's, they'll always say well. You know, I, I didn't realize this would happen with a pregnancy or a delivery.
And my answer is, it might have. Yeah. You might have always had this before and we just didn't know. Right, right. So I think it's interesting. I, I, that when we, especially prolapse, I think about this a lot when with, gymnast or, uh, competitive athletes, or even just maybe someone who runs a little bit high in anxiety.
Was there a level of prolapse there before they ever even had a baby? And now it's just symptomatic, which again, pelvic organ prolapse is a whole topic of itself. But yeah, I think it's important for women. I do think that younger women are. becoming more empowered and just wanting to learn about their bodies even before they're ready to have kids.
I have had a number of clients say, I just want to have a baseline. For sure. I think the one thing that I loved and was very impressed by when I had the assessment, um, with the pelvic floor physio was the paperwork and the questionnaires that were given. And a lot of, um, sort of mental health. related questions, which again, before I sort of like entered into this world, I didn't really understand that connection.
But I think that's so interesting that, yeah, there's such a tie to mental health with pelvic floor issues. 100%. I used to consider like the neck, the worry center of the body or the tension center of the body. And now I, I think it might be the neck and the pelvic floor at least, at least in an, an, and or situation.
Um, you know, at the time of this recording, we're in the middle of a global pandemic and I would have to say that primarily on my caseload is hypertonic pelvic floors. Makes sense. And yeah, that's, that's what I'm learning is that. It makes sense because in our history, so our primal organs are, you know, our pelvic floor helps to protect our primal organs.
So if we're nervous, if we're scared, if we're afraid, naturally that area is going to tense up to protect us, right? So it's, it's a very natural process. And I think this goes back to what I was saying with taking a really great detailed history, having a really good conversation with your, with clients when they come in and just understanding like what is going on in your life?
Is it a new baby and you're sleep deprived and you're trying to figure out sleep, uh, breastfeeding, all that kind of stuff. Is it your, you know, menopausal and you've got this big shift, you know, have you just had a surgery and you're a younger individual? Um, and so kind of understanding the background of what.
going on in your life outside of just your physical concerns, what is happening in your life? Yeah, totally. Yeah. So the other, the other one I often hear is, um, so this is now talking about pregnancies and, uh, after delivery. So um, yeah. I often hear mom say in between babies, I'm not going to go see a pelvic floor physio because I'm just going to wreck my pelvic floor for the second time.
So what's the point? Right. I might as well not fix it until all of the damage is done. Right. Right. Yeah. I hear this a lot too. And honestly, again, to each their own, if that's what suits you, I mean, I would highly recommend seeing pelvic floor physio between. Babies. Yeah. And the reason is and the way I always kind of think about it is in general when we, you know, do a big sporting event or like marathons, I'm always comparing to marathons, even though I am not a marathon runner.
Um, you know, people train and they see pelvic tree. Not pelvic physios, I hope they see pelvic physios, but they see physios and chiros and RMTs to prepare for their race. And then they have their injuries. They're right on top of it. They go to whoever they need to go to and then post race, you know, they're doing their recovery and they're going for their massages and they literally don't even think about it.
That's just part of it. Right. And pregnancy is a marathon. It is a 10 month marathon with a final sprint. Whatever that final sprint looks like, whether it's cesarean or vaginal, It's a lot of load and work on the body. And so when we take the time to heal and rehab from that epic sporting event, we set ourselves up better for the next.
event, whether that is another pregnancy or it's return to sport or it's just being a mom and returning to work or whatever that looks like, you're setting yourself up for success. Right. And again, I think that's the thing you and I are so passionate about is that. Birth and delivery is in our society not treated as something that we need to rehab from.
It's just not talked about that way, right? It's basically something we need to bounce back from. We need to set it aside and move on. But, it, it, yeah. Yeah, it's something that takes time to recover from. So. Why not have a team of people helping you recover, right? Absolutely. Absolutely. And um, yeah, so, and again, with that being said, if you are someone who is listening and you're like, Oh, well, I still think I'm going to wait till after I have my third baby.
There's still lots we can do, right? It's not as if you're irreparable at that point, but I would recommend if you are able. To do it between your pregnancies just to set you up for success for that next pregnancy. Pregnancy is hard work, right? It's hard on the body and delivery can be tough. So yeah, rehab, rehab, rehab.
Yep. And then the other one. So talking about different types of births. So with those cesarean births. That's another, uh, common myth I often hear is if I deliver, if I had a C section, then I don't need pelvic floor physio because the baby did not come out of my vagina. Mm hmm. Mm hmm. Very common one, right?
I hear that all the time. I've heard from a couple of cesarean moms recently, like, I didn't expect it to, expect to end up in this office because I had, I didn't have a baby come out of my vagina. And so using my Marathon. example. The marathon was the same. Yeah. The work on that pelvic floor and the body was the same.
The final sprint looked different. Absolutely. And so there's definitely, um, different concerns or maybe different outcomes effects from that birth. But when a, when a cesarean mom comes to me, the conversation is still happening. We're still talking about all those, um, things that I mentioned before.
We're still doing a really good orthopedic exam. We're adding in what's happening with that scar, right? How is it healing? How are, how is the tissue moving above and below? How is your abdominal wall healing in terms of that diastasis? Is it pulling or tugging on that cesarean scar? A lot of moms need a lot of desensitization.
So before you can even get to scar massage, we have to desensitize the scar a little bit if it's really sensitive or maybe it's even just a mom who's fearful of touching it or just doesn't like the idea of touching it. So we're working through some of that with her. Right. Um, and then, so that all looks similar, right?
With that extra piece with the scar. And then the exercise piece would look similar. We're reconnecting with our core. And we're trying to return them to whatever they want to do. I do recommend an internal assessment. So that's a piece I think we kind of skipped that. That's the, it's not a mandatory piece of the, um, of the assessment.
But pelvic floor physiotherapists are trained in doing internal exams. And so what we are doing with an internal exam is assessing the tone or the tension that, that may be lingering from pregnancy or from the workout of that final sprint of birth, whatever way it looked, right? Um, we're assessing where those organs are sitting.
Have we changed or prolapsed? I say that gently, any of those organs, um, that we need to work to support. Um, we're seeing with the cesarean mum. Is any of that scar tissue from the cesarean scar kind of creeping down and affecting some of that pelvic floor and that's something a lot of people don't know is that that scar tissue can come down.
It's very closely associated with the pelvic floor. Yeah. So can have effects on the bladder. Um, can you activate your pelvic floor? So just because you didn't have a baby come out of your vagina, maybe you never knew how to do a Kegel prior too, right? So we're making sure that you can activate that pelvic floor and relax that pelvic floor.
And so a very similar assessment between, there's obviously little caveats for both, but Yeah, when we're reconnecting the core, it's important to look at all aspects of it for sure. Yeah, I think again, that's the thing is that even symptom wise Cesarean section moms can still deal with similar symptoms to those of us that had vaginal deliveries, right?
You're not exempt from you know, pelvic organ prolapse or incontinence that can still be a factor in your recovery Pain with intercourse. A lot of people think that pain with intercourse is coming just if you had stitches in your perineum. Yeah, but it can come most often from just tension in the pelvic floor, and so mom, you know, cesarean moms, vaginal delivery moms are both susceptible to that.
Yeah, yeah. So in that first assessment, so you do, again, very thorough orthopedic exam, and if they, um, are interested in a pelvic exam, you do that. So, what are some things that you're, so you look for, like prolapse? Um, do you check for, um, if the tearing, if they had any tearing and whether, how that's healing?
Do you want to talk about that? Yeah. So I, I definitely, especially if they're, um, concerned about it, I often get asked if they have any stitches left. I always, always tell them to double check with their midwife or their OB, um, but yeah, my main. assessment when it comes to those perineal scars is what happens when you lift and connect to that pelvic floor?
Does it cause any tugging tension through there? What happens when you relax? We, I actually assess the scar itself just like you would a scar anywhere else in your body. Does it feel thick? Does it have any tenderness or, you know, um, tone to it? Yeah. What happens, what do you feel when I touch it, right?
Does it cause any sort of, you know, feeling for you in any way? And then, if they're comfortable or, you know, whatever, teaching them how to do a little bit of scar massage themselves. Yep. So that those tissues... When the timing is appropriate often I'll wait a little bit longer than even just that six weeks depending on how it's feeling Yeah, I tend to be pretty conservative with with stitches um Doing a little bit of scar massage on your perineum so that that there there isn't any scar tissue or adhesions that build up again Coming back to our previous example for a subsequent pregnancy We want to make sure that that tear doesn't have any adhesions or scar tissue in there and that it's mobilized and moving quite well right Yeah, I'm thinking back to rewinding back to pregnancy.
And this was something that again, going into it, I had no idea about, um, just teaching moms like perineal massage to and that I think that's shown in the research that it can potentially, um, change outcomes with hearings that Is that true? Is that what you? Yeah, absolutely. It's something that can be beneficial for sure.
Um, I think the benefit is definitely there. There's certainly no harm. I think the actual, like, difference in tearing versus not tearing is relatively small, but it's certainly not harmful. And I personally believe that the biggest, when we're talking about getting ready for birth, I chat a lot about Practicing that and then using your breath to, to kind of relax and relax into that stretch that you would feel that.
So it's preparing you for your delivery. Right. Right. Instead of tensing up, which could maybe lead to more tearing, we're practicing letting go and using our breath so that when it comes time to give birth, and that is a crowning event, we have practiced that letting go of tension as babies coming through.
Yeah, and again, that's that's something I think I learned after having kids that I sort of wish I someone had sort of really hammered that home to me before having because again, it's In my head, I thought the stronger the pelvic floor, the easier I'm going to have to push that baby out, but that's, that's not the case.
It's more of the relaxation piece that's important. Yeah. And I would say that's probably the biggest misconception with related to birth and the pelvic floor is that we want really strong muscles to help push baby out. Our pelvic floor is not pushing baby out. Our uteruses, maybe a little bit of our abdominal wall.
our pelvic floor muscles. We want them to glide gently out of the way so that baby can come down. So working mainly with reverse Kegels during pregnancy and letting go of tension during pregnancy. Um, and interestingly, often I'll have people continue that postpartum. If I, if I find when we do that internal assessment, that they're still doing a lot of guarding or it's very tensiony because Postpartum is an interesting time, right?
We, we go through this delivery, whatever, it ends up looking like we're sleep deprived, we're trying to figure out how to feed this infant. They don't come with manuals. No. And this is all on a healing body, and you're lifting and picking up and bouncing. And, um, so a lot of times that tension is still quite high kind of postpartum.
And so I'll, I'll have women stick with their reverse Kegels for a little bit. Yeah, I know. That was my, my thing. Early postpartum. Yeah. A lot of my symptoms were because again of that hypertonic tension. So for me, it was the relaxation piece that was very important to work on. Yes. And, and it's kind of a hard sell sometimes because if there's any leaking happening, leaking can happen from weakness or tightness in the pelvic floor.
And it's often a hard sell for me. For, to have clients let go of tension, if they are experiencing leaking and they're usually pretty shocked when they leave with just these reverse kegels and some down training exercises and they come back and they're leaking is better. Yeah. I think that's the biggest thing too, is that there's no one size fits all.
Right. We're all unique bodies. So, so I'm not an internal therapist, so I work closely with internal therapists for that reason. So I can, you know, get sort of a thorough history and figure out maybe what their habits are, what their background is. But at the end of the day, I don't, I don't know what's happening internally.
So, and again, sometimes people might not want to go that route and that's okay. There's still so much that can be done without the internal assessment. But it's just one more sort of piece of the puzzle that might help with recovery. Absolutely. And yes, it's never mandatory, right? And I say that to clients.
And if you're coming to see a pelvic floor physio and it's six weeks and you're just not sure you're ready to go there, it's totally fine. There's lots that we can get started on. There's lots of education about the pelvic floor. I usually have my model. Um, of my pelvis and that's how I start every assessment, regardless of what you're there for, whether it is postpartum, whether it is during pregnancy, whether you're an 18 year old with endometriosis or, um, I deal primarily with women in my practice, um, or somebody in your late 20s.
70s who's come to see me, I start with my pelvis. This is what you look like and this is why we are talking about these muscles and these organs and this is what those muscles would do. So they've got a visual representation. Yeah, that's so cool. And then so I'm just curious to see you do your assessment.
And then how often typically do people come back to see you or that just varies depending on the person? It definitely varies depending on the person. For a pelvic physio, if I see somebody...
For whatever reason, let's, let's pick incontinence because we've chatted about leaking the most recently. Usually I do a two week follow up because I like to just check in quickly if my schedule allows, but certainly within a month. I don't want to leave them too long if they, um, are having struggles with the exercises or certainly if anything's gone.
Array. We want to catch that early, but usually anywhere between that two to four week mark, and then I leave them for another month. And so they're, they're longer stages between, because we're waiting for muscle strength and muscle or muscle tone to change. Right. And so we need longer between those lots of exercises, lots of education, lots of tips.
So when you're going to come back to see me sooner if you need to, um, and then typically really for most clients, I'm going to say, see me anywhere from like three to five visits on average, kind of spread over a six month period, right? If there's pelvic pain or a pain of any kind, I usually have them come a little bit more frequently until we get on top of that only because I don't want them to be left.
with that pain and there's lots that we can do for pain to settle it pretty like in the clinic and give them some relief in it, you know, kind of right away. Yeah, that's pretty cool. Yeah, so it is definitely different because as an orthopedic physio, yeah, we definitely see people a bit more often than that.
So just a different approach and a lot of sort of homework People go home. A lot of work. Yeah. A lot of work. Was that your experience with pelvic physio? Did you go kind of? Yeah. It was. Yeah. Yeah. So throughout the pregnancy, yeah, I think I checked in with her every couple months and she did a bit of like perineal massage for me.
Um, I struggled to do it on my own, just accountability wise. So. It was nice to just have someone sort of do it. It can also be a bit of a logistical issue, right? Depending on like how long your arms are, how big your tummy is. Yeah. It's a bit of a logistical issue. You can also have your partners do it.
There's lots of cool tools out there, like Kegel curves and stuff that can help as well. But yeah, so many cool things. Awesome. And then you also do birth prep, right? Through Rebirth. Yeah. Which is so cool. So tell us about that. I love birth prep. I love birth prep. Yeah. Um, really the way I look at it is just giving women options.
Um, I know for myself the first time and I had a lovely labour delivery. I wouldn't say I had a bad experience. I was fortunate. Um, but I didn't know I had options. Yeah. I really truly didn't, um, and so I really just use those sessions to give people options. Options for breathing, options for laboring, options for pushing, um, options for their partner to, to, to provide some support for them, whether that's like tactile or little reminders that they can give them during labor is a big piece of feedback I often hear from partners is I just want to know how I can help.
Yeah. Yeah. Yeah. Especially if it's second time or third time dads, um, or partners in the office, and they're thinking, Man, I just sat there last time. Like, they usually, they usually have questions if it's a subsequent, uh, parent, um, about how they can support better, so that's cool. That is cool. Uh, yeah, so I talk about a lot of that, and, you know, sometimes just little things.
Like, if you're giving birth in a hospital, you can ask them to dim the lights. Yeah. And set, set the tone, right? Those fluorescent lights aren't helping anybody's tension. Yeah. So just little things like that and just letting them know, really trying to empower them to be advocates. I always encourage just conversations with their OBs and their midwives.
And you know, if you like, if you think that you like to push on your side, let your medical team know beforehand. So it doesn't feel like it's something that you're kind of fighting for in the moment. It can feel a lot more peaceful that way. Yeah, I found, I think I was lucky, um, so I had midwives, both of mine, and we talked a lot about that.
So my, my sister, for example, um, labored and delivered on all fours. And I, I delivered on my back because I chose to, like that's, my body wanted to be there. But I labored on my side for the most part. Yeah, so, so I think that's, that was the cool thing about having the midwife is that I learned a lot of probably the similar things that you teach.
Yeah. Um, in your birth prep. Yeah, I think it's so important just to give women options. Yeah. Options, and, and I really try not to guide them any way, like sometimes on that back, in that back position gets a little bit of a bad reputation, I always say. Whatever position you feel the strongest, most comfortable and supported in is your position.
Right. So yeah, I'm not here to provide anything other than options. It truly is a time, I don't know if you felt this, that your body just takes over. Yes. Yeah. And then I think that's the cool thing about birth prep is just sort of like giving you those options in the moment of just having the freedom to do what your body wants to do and not having to follow this like rigid plan.
Absolutely. Absolutely. Perfect. Birth has a plan. It's not always the plan that we have, right? So, um, if you can have little tips and tricks, I kind of often joke with my clients, like, if my little voice appears in the back of your head for, like, one little tip that makes you more comfortable, then I've succeeded here.
Yeah, that's so cool. I love it. Awesome, Dayna. Did we miss anything that you wanted to chat about with... No, I don't think so. I think... I think that's good. Yeah, that's a pretty thorough introduction. And if, again, if you're listening to this and you have never seen a pelvic floor physio, I hope this gives you sort of the confidence and, um, now, you know, a little bit more to book that appointment.
Yes, absolutely. Awesome. Thanks, Dayna. Yes. See you next time. Yep.
