During my first pregnancy I became aware of how a pelvic floor physiotherapist can help a pregnant and postnatal mama. But it was only because my sister-in-law is a pelvic floor physiotherapist that I knew about the work that they do and through her I learned how important their work is to helping pregnant and postpartum moms deal with aches and pains, pelvic floor discomfort, incontinence, and sexual dysfunction among many issues experienced during and after pregnancy. Read on for my interview with Tegan Vermey, pelvic floor physiotherapist,Msc.PT & owner of Willow Health Women’s Health Centre in Chatham Ontario.
Denise: Thank you for taking the time to talk to me about the importance of pelvic floor health for pre and postnatal women. Can you please first explain what a pelvic floor physiotherapist is?
Tegan: We are like normal orthopedic physiotherapists who deal with knees, shoulders, and backs, but we also have special training to look at pelvic floor muscles, dealing with pelvic pain, and pelvic floor dysfunction. There are just under twelve thousand physiotherapists in Ontario, and out of them about 460 are pelvic floor trained.
Denise: Why does pelvic floor physiotherapy seem so new for North American women when in some countries in Europe, every pregnant woman has one?
Tegan: It could be due to legislation; prior to 2011 if a client wanted to see a pelvic floor physiotherapist it needed to be signed off by a doctor. However, in 2011 legislation changed so that now the public has direct access without a doctors sign off, making us more accessible. Additionally lot of research regarding pelvic health has been coming out in the last 5-10 years which will start to become more widely disseminated to the public.
Denise: To expand on that, a lot of times a postpartum mom will go see her doctor and ask if she can resume fitness after 6 weeks postpartum, and provided there are no discernible problems the doctor will likely say yes. However doctors don’t know the pelvic floor like you do and often don’t assess pelvic floor issues like you can, thus not seeing the need to recommend that the postpartum mom see a pelvic floor physiotherapist. It seems like pelvic floor physiotherapy is also quite new to the doctors, and it’s really up to the mom to know her body and decide if she needs to see you.
“when looking at a post-partum population, 50% of women will have incontinence, prolapse, sexual dysfunction, or pelvic pain”
Tegan: You’re right, there are definitely many doctors who haven’t heard of the work that pelvic floor physiotherapists do, especially in smaller communities. It is too bad because when looking at a post-partum population, 50% of women will have incontinence, prolapse, sexual dysfunction, or pelvic pain, and it’s important to point out that although this is common it’s not normal, and shouldn’t be accepted, as all of these issues can be treated.
“it’s important to point out that although this is common it’s not normal, and shouldn’t be accepted, as all of these issues can be treated.”
Denise: Which leads me to ask, when should a pregnant woman go to see a pelvic floor physiotherapist?
Tegan: If she starts having symptoms including low back pain, hip pain, or leakage noticed when they cough or sneeze, or pressure or heaviness low down in the pelvis, any of which can present at any time during pregnancy. If there are no symptoms it’s not necessary to see a pelvic floor physiotherapist, however there is really good evidence that being able to do Kegels properly can help reduce postpartum issues like incontinence and prolapse. Many women think they are doing a Kegel, but they’re just squeezing the muscle, and not actually lifting the pelvic floor. I liken it to squeezing your bicep, which just squeezes the muscle but doesn’t functionally strengthen it. Additionally many women think they are doing Kegles correctly when they’re just doing rectal squeezes.
Another thing that we can do is teach the mom or partner how to do perineal massage. It’s a nice thing to start around week 34. Evidence shows that the first time having a baby, perineal massage lessens the risk of 3rd or 4 perineal tears, which are the tears that do damage to the pelvic floor. So it’s great to learn how to do this preventatively, and only takes 5 minutes a day for you or your partner to do.
“Many women think they are doing a Kegel, but they’re just squeezing the muscle, and not actually lifting the pelvic floor. I liken it to squeezing your bicep, which just squeezes the muscle but doesn’t functionally strengthen it.”
Denise: Can you explain what postpartum prolapse is as experienced by a mom after having her baby.
Tegan: Postpartum prolapse can look different in everyone. It could involve a falling out feeling in the vagina, or pressure or a bulging sensation. If having sex, it might feel like there is something different down there, or inserting a tampon might feel a little bit different than it usually does. Again all reasons to see a pelvic floor physiotherapist after having a baby to help correct any of these symptoms.
A mom will also come to see me if she has diastasis recti which is the separation of the abs and results in the belly sticking out because the space between your left and right abdominal muscles has widened.
Denise: We discussed how you can help a mom postnatally if she has prolapse, painful sex, diastasis recti, but if she displays no symptoms, is it necessary to see a pelvic floor physiotherapist?
Tegan: It’s wise to listen to your body. If you feel good, nothing is separated, there are no feelings of pressure, sex isn’t painful, no leakage or prolapse then it’s not necessary to come in. I think the main thing is awareness, and if you do have any of these symptoms just know that it’s all fixable and you don’t have to put up with it.
“just know that it’s all fixable and you don’t have to put up with it.”
Denise: For myself, I know it took me longer than 6 weeks to have sex again. It just didn’t feel comfortable, and I had been cleared by my pelvic floor physio therapist, what’s that all about?
Tegan: Most of the perineal tissue is done healing by about 6-12 weeks after having a baby. Painful sex after 3 month mark isn’t because you haven’t healed, it’s because you’ve healed too well. A lot of times the scar tissue doesn’t have the same elastic properties as the rest of your skin does and as a result can have a ripping, burning, tearing, sharp sensation during sex, which makes us feel that something hasn’t healed down there, making moms think they should stay away from sex because they aren’t healed. There is a lot that we can do in that regard to help moms feel normal again during sex.
“There is a lot that we can do in that regard to help moms feel normal again during sex.”
Denise: Are you covered by OHIP? (Ontario Health Insurance Plan)
Tegan: No, this kind of physiotherapy is not usually covered under OHIP. It is only covered for those who are under the age of 18, over 65, or if you’ve had an overnight hospital stay, however many employee benefits plans do cover physiotherapy.
Denise: So tell me how moms can go about finding a pelvic floor physiotherapist near them.
Tegan: You can go to the College of Physiotherapists of Ontario , click on “find a physiotherapist” link you can enter criteria like city or postal code, and make sure to check off the box that says “Pelvic Floor/Incontinence” In other provinces you can go directly to your provincial College of Physiotherapists.
Denise: Is there anything else that you think is important for moms to know?
“in a childbearing population 50% of woman will experience prolapse, and 1 in 3 will experience incontinence”
Tegan: We try to convey that a lot of these symptoms are common; in a childbearing population 50% of woman will experience prolapse, and 1 in 3 will experience incontinence. When looking at a pregnancy population, 1 in 2 women will have incontinence. So although it is common, it’s not normal, and is fixable. It’s really important to fix it in the postpartum stages. Even if you experience these problems, and it doesn’t change your quality of life, it’s still a good idea to get it fixed earlier than later, because what can happen is we can lose the density in our pelvic floor once we hit menopause, so what we notice in our thirties might not be a big deal or change our life, but by the time we hit 50 years old it may likely change your quality of life. Not that we want to scare people, but it’s so nice to be able to fix these issues when we’re young now, and then be able to be able to head into our later stages of life being nice and strong.
“it’s so nice to be able to fix these issues when we’re young now, and then be able to be able to head into our later stages of life being nice and strong.”
Denise: Thanks for all this information. It’s my hope from all of this information that pre and postnatal moms will understand what is happening with their bodies and know who to see to fix it.
You can find more information about Tegan and her clinic at www.willowhealthcentre.com
I wanna know; is this the first time you’ve heard of a pelvic floor physiotherapist, or have you been to one before?
In fitness & nutrition
xoxox Denise