Pelvic floor disorders are more common than you'd think and many women shy away from seeking help.
We recently interviewed our friend, Dr. Danielle Corapi of Empowered Physical Therapy to learn more about what it's like working with a physical therapist for a happier, healthier pelvic floor.
Tell me more about you-how did you get drawn to this work?
My name is Danielle and I am a pelvic floor physical therapist, owner of Empowered Physical Therapy. First and foremost, I am a wife, mama to my daughter Rylee, and dog mom to our goldendoodle Graham! I graduated from SUNY Upstate and received my Doctorate of Physical Therapy in 2014. After graduation, I began working in outpatient orthopedics and then worked at multiple travel contracts across the country with my husband, who is also a physical therapist. Throughout the years, I had a handful of women's health patients either pregnant, early postpartum or many years postpartum. My patients were dealing with either pelvic pain, incontinence or other issues that can be found during pregnancy or postpartum. I loved working with these women but I always felt like I was missing a huge component when trying to rehab these patients, I knew I needed to learn more. This is when I started my training for pelvic floor physical therapy-and have continued to do so ever since!
What exactly does the pelvic floor do?
Your pelvic floor is a group of muscles that sit like a bowl within the pelvis and have three main functions: sexual, sphincteric- control bowel and bladder, and support- help to support all of the pelvic organs, intestines, bowel, bladder, (and baby when pregnant). The pelvic floor is also one part of four that makes up the “core”. The pelvic floor, diaphragm, abdominal muscles, and back muscles work together and form the “core”, they operate as a pressure system and allow all of us to move properly and provide stability. Although most think of the abdominals as the core, the pelvic floor muscles are an integral component.
Why might I need pelvic floor therapy?
There are SO many reasons why seeing a pelvic floor physical therapist may be useful. If your experiencing bladder and/or bowel incontinence, bladder and/or bowel urgency/frequency, pelvic pain which may include pain with sex, use of tampons, or with a gynecological exam. Many women seek out pelvic floor physical therapy while pregnant or postpartum due to the many issues that arise. Common reasons women seek out pelvic floor physical therapy during pregnancy and postpartum include all of the reasons above in addition to diastasis recti, c-section scarring, low back pain, mid back pain, and issues when returning to exercise/fitness. It may also be useful to seek out a pelvic floor PT preventatively before these issues come up, this is what I wish became more of the norm.
Why don’t we hear more about the pelvic floor during pregnancy and birth?
I wish I knew the exact reason so I could solve this! I think the biggest reason is that a lot of the focus gets put on having a healthy baby-which is obviously VERY important. However, there is not a lot of focus on having a healthy mama! Women's bodies go through SO many changes during pregnancy, birth and postpartum recovery. The pelvic floor alone can stretch up to 200% the amount during a vaginal delivery and there is significant trauma to the pelvic floor with a c-section.
Every health care professional involved in the care of mama and baby has their own area of concern and specialty, I can only hope physical therapists can start being thought of as a crucial component of the team during this time!
Are there some things that you recommend all women do to maintain healthy pelvic floors during pregnancy, and in the first year postpartum?
Yes! I think one of the most important things is to improve awareness of the pelvic floor. Many women have no idea that they have a pelvic floor let alone how it functions. One exercise that I start everyone with is diaphragmatic breathing or belly breathing. The relationship between the diaphragm and the pelvic floor is crucial for proper function. As you inhale and take a deep belly breath in your pelvic floor relaxes and as you exhale the pelvic floor contracts. By performing proper breathing, the pelvic floor will move through its full range of motion which is crucial for proper function.
To Kegel or not to Kegel?
Kegels are not always the answer! The pelvic floor muscles, just like any other muscle, can be weak however they can also be shortened or tight. If the pelvic floor muscles are tight doing a kegel (contracting the pelvic floor) would not be helpful! It would be like doing a heel raise while having a calf cramp-ouch! Research also shows that most people are unable to perform a kegel with verbal instruction alone. The bottom line is that the pelvic floor is very complex and everyone deserves an individualized evaluation to determine what is really going on.
For women who have experienced some pelvic floor weakening after giving birth, where do you recommend they even start?
I would recommend that every woman start with learning how to perform a proper diaphragmatic breath and then adding a kegel (pelvic floor contraction) in coordination with the breath. As mentioned before, as you breathe in the pelvic floor relaxes and as you exhale the pelvic floor contracts. To perform this exercise, take a belly breath in and then on the exhale draw the pelvic floor up and in to contract the pelvic floor. As mentioned above, a proper kegel is hard to perform with verbal instruction alone, having proper cues from a pelvic floor PT can help to make sure you are activating the pelvic floor correctly and not compensating with other muscles.
What can you expect from a pelvic floor therapy session with you?
An initial evaluation includes review of your medical history, a functional movement examination, an internal pelvic floor examination performed intravaginally or intrarectally to see how the pelvic floor muscles are functioning, a conversation about your goals for physical therapy, answer any questions you have, and develop a treatment plan that is evidence-based, holistic, and individualized to address your goals. I really aim to make all of my patients feel comfortable, this is why I offer visits in your own home or in the office setting. I want to tailor my treatments to help you achieve your individualized goals.
Thinking physical therapy would benefit you? Connect with Danielle and get started!
Check out more from Danielle here Empowerdpt.com