Childbirth, pelvic floor muscles, and pelvic floor physical therapy

By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles

Recently, a number of studies were published on what women do and don’t know about their pelvic floor muscles, childbirth, and longer-term pelvic health.

How much do you actually know? Take our quiz and find out! If you do not know the answers, don’t fret. You are amongst 93% of women who felt like they were insufficiently informed about their pelvic health and requested more information about pelvic floor function and childbirth. The 7% that are sufficiently informed are all pelvic floor physical therapists in the United States and all employees of PHRC. Joking aside, numerous studies are concluding better peripartum education is needed and we at PHRC want to help provide it. Let’s get to it.

PHRC Pelvic Health Quiz

What do your pelvic floor muscles do?
What do your pelvic floor muscles go around?
Should your pelvic floor muscles and abdominal muscles work together?
Why might women leak urine when they are pregnant?
If you leak urine when you are pregnant, what can you do about it?
How often should you exercise your pelvic floor muscles?
What is Pelvic Organ Prolapse and how does it occur?
True or False: Once a person has pelvic organ prolapse not much can be done to help.
True or False: Leakage of stool only occurs in older women.
True or False: If stool leakage happens related to pregnancy or birth, it is short-term in duration.
True or False: Surgery is the only treatment for stool leakage.
Do pelvic floor muscles play a role in orgasm?
Do the pelvic floor muscles play a role in painful sex?

As a pelvic floor physical therapist, I understand how underserved postpartum women are and believe they can benefit from postpartum physical therapy. Because postpartum physical therapy is not currently included as a standard of care for women they often find us on their own. In order to find us women need to know that pelvic floor physical therapy addresses urinary, bowel, and sexual problems, and here in 2017, most women don’t know this.

In one cross-sectional study¹, 633 Australian 1st-time pregnant women completed a survey. The survey showed:

17.4% of the women survey had never heard of pelvic floor muscles.
41% of women thought it was normal to leak urine while pregnant.
63% of women did not know pelvic floor muscle exercises can prevent fecal incontinence.
89% of the women were not doing pelvic floor exercises.

In another cross-sectional-study conducted in 3 antenatal clinics in London², 249 1st-time pregnant women in their third trimester completed a survey. The survey showed:

The average pelvic health knowledge score was 45%.
Women knew the least about pregnancy as a risk factor for pelvic organ prolapse, answering only 35% of the questions correctly.
Women also knew very little about fecal incontinence, answering only 36% of the questions about fecal incontinence correctly.

Finally, 212 1st-time pregnant women in Belgium were surveyed.³ Women were asked whether an episiotomy or perineal rupture would cause more damage and worse outcomes. 86% of the women believed a rupture had a more negative outcome, which is in clear contrast to current research on the topic.⁴ Additionally, this survey showed:

76% of the women in this study thought that childbirth would negatively affect their sexuality.
The majority of women thought stress urinary incontinence and dyspareunia following childbirth was normal.
93% of women felt insufficiently informed about pelvic floor muscles and childbirth.

Astounding, right? The message to take home is that pregnancy and childbirth are risk factors for stress urinary incontinence, fecal incontinence, pelvic organ prolapse, painful intercourse, and aorgasmia. The reason we need better education is because pelvic floor physical therapy significantly reduces these risk factors and all postpartum women can benefit from pelvic floor physical therapy. Leaking urine or stool, painful sex, aorgasmia and pelvic pain are common and treatable but never normal!

PHRC is committed to raising everyone’s pelvic health IQ. We want women to feel empowered and prepared for labor and delivery, we want women armed with the information they need for an efficient postpartum recovery, and we want women informed on what they need to do to optimize their pelvic health for eternity. Stay tuned, next week we are going to provide the quiz answers and talk about what women can do at home to prepare themselves for labor and delivery. The subsequent posts in this series will address labor and delivery, postpartum sex, postpartum depression, and aftercare for C-section and perineal scars.

We hope you find this series helpful and please feel free to share our posts!

References:

Hill AM et al. Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J. 2017; March, DOI 10.1007/s00192-017-3309-4.
O’neill AT et al. Int Urogynecol J. (2017) 28: 125-129. DOI 10.1007/s00192-016-3087-4.
Neels H et al. Knowledge of the pelvic floor in nulliparous women. J. Phys Ther Sci. 28: 1524 – 1533, 2016.
Andrews V. Evaluation of postpartum women perineal pain and dyspareunia- a prospective study. Eur J Obstet Gyn Reprod Bio, 2008, 137: 152-156.

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.