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Physical Therapy Helps Reduce Pelvic Floor Issues

Pelvic floor exercises can help with a variety of issues that arise for women immediately after pregnancy or in the years that follow. 

Expert Advice

Physical Therapy Helps Reduce Pelvic Floor Issues

A physical therapist says specific pelvic floor exercises can eliminate or help control problems like urinary leakage and pain.

Jennifer Nejman Bohonak
April 18, 2019

Physical therapy can help with bladder and bowel control issues as well as pelvic pain issues — whether they arise immediately after pregnancy or in the years that follow.

Pelvic floor physical therapy could be a game-changer if women sought it immediately postpartum.

Anna Benedix, PT, DPT, WCS, CLT, a pelvic floor physical therapist at Massachusetts General Hospital, teaches patients how to strengthen and relax their pelvic floor muscles. She also shares lifestyle strategies to fix urinary leakage and constipation, and treats muscle spasms that can make sex painful.

“I often meet people who are very stressed out and unhappy,” explains Ms. Benedix, who sees patients at Mass General Waltham. “By the time they leave physical therapy, they are smiling and feeling more relaxed and confident.”

Childbirth Affects Pelvic Floor

Many women develop urinary problems, constipation and pelvic floor pain issues after childbirth. Pregnancy and labor stretch the muscles and connective tissue that keep the pelvic organs (bladder, uterus and rectum) in place. Childbirth can also damage nerves that control bladder and bowel function.

Anna Benedix, PT, DPT, WCS, CLT
Anna Benedix, PT, DPT, WCS, CLT

In the United States, physical therapy to rehabilitate the pelvic floor following childbirth is not a standard part of treatment, so many women do not know how to heal those muscles, Ms. Benedix explains.

But pelvic floor physical therapy has become more popular in recent years, she says. It could be a big game-changer for women, if they sought it immediately postpartum, she adds. Mass General’s Center for Pelvic Floor Disorders brings together a team of specialists to treat the complex and interconnected problems that cause these disorders. In addition to physical therapy, treatments can include surgery and lifestyle changes.

“A lot of women deliver their babies and are fine until they hit menopause,” Ms. Benedix says.

Delivering a baby overstretches and weakens pelvic muscles, but women’s bodies compensate because the hormone estrogen keeps muscles and connective tissue healthy. But after menopause, when estrogen levels decrease, that muscle weakness can lead to urinary leakage or pelvic prolapse, where organs can drop into the vagina.

Benefit of Physical Therapy

Ms. Benedix says physical therapy can strengthen pelvic floor muscles to prevent urinary leakage. She begins by teaching women the proper way to do a Kegel exercise, which is a movement to tighten and relax the pelvic floor.

Many women do not know how to do a Kegel exercise properly.

Ms. Benedix says many women incorrectly think a Kegel is the same movement as using their muscles to stop the flow while urinating.

A deeper set of muscles, inside the pelvic floor, runs back to the rectum. When tightened, they close off the bladder. Ms. Benedix says one trick is to pull these muscles in closer to the back, as if trying to hold in gas. She tells patients to breathe in to relax their muscles and out to tighten into a Kegel. And to do 40 to 60 Kegels per day.

Pelvic Floor Exercises

Kegel exercises: For a Kegel you may sit, stand or lie down. Breathe in and relax your muscles. Breathe out or count out loud to 10 while you do a Kegel (tighten like you are holding in a bowel movement).

Tabletop Exercise: Once you have mastered the Kegel, learn to engage your deep abdominals. Position yourself on your hands and knees, breathe in and relax your muscles. Breathe out or count out loud to 10 while you do a Kegel and pull your lower tummy up toward the ceiling. Don’t tighten your upper tummy as this will create downward pressure, increasing risk of urinary incontinence and prolapse.

Tabletop exercise
Tabletop exercise

Trained therapists, like Ms. Benedix, offer exams, inside the pelvis, which they use to teach patients how to tighten and relax their pelvic muscles. The goal is to teach patients to exercise the right muscles.

For patients with pelvic floor pain, a different approach is used. These patients may notice pain when having sex, using a tampon or during a gynecological exam. Doing Kegel exercises could make their symptoms worse.

Ms. Benedix recommends they try pelvic floor physical therapy to relieve symptoms. A therapist can create a specific plan for each patient.

Ms. Benedix says she also talks to patients about stopping habits that give them less control over their bladder and bowel function.

Tips to Improve Bladder Function

  • Limit liquids to 48 to 64 ounces per day. Urine should be the yellow color of an office sticky note.
  • Limit caffeine.
  • Regulate bathroom use to once every two to four hours. Emptying the bladder often trains it to hold less.
  • Sit on toilet seats (even in public places) don’t hover. Hovering makes it difficult for muscles to relax.
  • For constipation, try a bathroom stool. Place your knees above your hips and lean forward.

Tips for Postpartum

  • Take it slowly, when cleared for exercise at six weeks. Wait until about 12 weeks for high intensity exercises like running. Such exercises place a lot of downward pressure on the pelvic floor.
  • If you notice urinary or fecal leakage or pain that is persistent or getting better slowly, ask your doctor about pelvic floor physical therapy.

To make a donation to support the patient care at The Center for Pelvic Floor Disorders, please contact us.