Pelvic Floor Health and Physical Therapy 101 For Everyone

Being a birth neoterist means understanding that reproductive justice is in everything. It intersects with health care access, holistic care, the cultural competency of care providers, and more. One of the topics that has been getting more traction and is directly related to reproductive justice is pelvic floor health.

In many countries, pelvic floor physical therapy (PT) is a standard part of perinatal care. But in the US, this is care that many do not have access to - either because it’s often not covered by insurance or because it’s not something they necessarily think about. Why isn’t it something that the majority of us think about? Because it’s not prioritized by providers or by the medical-industrial complex.

So, for those of you who maybe haven’t thought about your pelvic floor health, I’m going to spend time in this blog discussing pelvic floor health and I’ll also leave you with resources for expanded learning. Whether you are a doula, a birthing person, a trans person, or just a supportive partner, friend, or family member, I am hopeful that this information will offer some new insights and open up discussion for you.

Our bodies carry so much. From history, trauma, energetic waves, nutrition, hormones, intuition, bones, muscles, blood, and more. Part of being in touch with our body, with it’s knowledge, is understanding the phases, tuning in and identifying where tension might be showing up, identifying ease, and identifying pleasure, all in the name of liberation and being embodied. To that end, being in touch with your pelvic floor health is one path to embodiment.

What is the “Pelvic Floor”?

The pelvic floor is made up of all of the muscles, ligaments, tissues, and nerves that support the urinary and reproductive tracts, including the functioning of your bladder, bowels, vagina, and uterus. As noted by Origin’s Pelvic Floor 101, your pelvic floor has 5 main functions: sexual function, support, stability, bladder and bowel control, and circulation. In other words, your pelvic floor supports your activities of daily living!

Pelvic floor issues or dysfunction include incontinence, painful sex or difficulty experiencing orgasm, pelvic organ prolapse, and pain anywhere in the pelvic area, including the low back and hips. These issues are caused by pelvic floor muscles that are too tight, too weak, or a combination of both. Additionally, the experiences of being pregnant, giving birth, and perimenopause and menopause increase the chances of experiencing pelvic floor dysfunction. You can read more about symptoms associated with pelvic health conditions here.

It’s Not All About Kegels

You’ve probably heard about kegels (a contraction of the pelvic floor muscles, sometimes referred to as pelvic floor exercises) in a magazine, from your doctor, or even from a friend. I’m going to call them pelvic floor exercises because “kegel” is a name adopted from a white male OBYGN by the last name of Kegel, and well, we don’t need more things named after white male doctors. While pelvic floor exercises can help with some pelvic floor challenges, in many others, they contribute to making overly-tight pelvic floor muscles even tighter. Pelvic floor PTs can assess overall pelvic health, which may include an internal and/or external exam and an interview, to determine whether kegels would be a helpful part of your treatment plan.

Pelvic Health Resources

• @the.vagina.whisperer aka Dr. Sara Reardon: Pelvic Floor Physical Therapist (IG resources; CW: gendered language)

• Gender Inclusive Pelvic Health at Body Connect Physical Therapy (telehealth PT available)

• Origin. (virtual pelvic floor PT services for all 50 US states + pelvic floor 101 and blog resources)

• The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker (podcast and transcript)

• What Every Queer Person Should Know About Their Pelvic Floor (article)

• The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality by Kimberly Ann Johnson (book; CW: gendered language)

A Note on Safety

You are ALWAYS the expert on your body. As you navigate healthcare decisions, including those related to your pelvic health, bring an advocate along as often as you need or want. This can be a more formal relationship with a doula or it can be a friend or other loved one who offers a supportive and grounding presence. Furthermore, I always suggest working with a provider that you feel safe with. This may mean meeting with a few providers before you find the right fit. 

If you are using insurance, I know that local options can be limited, and I encourage you to explore virtual options and financial assistance programs if needed. Many states will have funding assistance programs for pelvic floor health, so call a Medicaid office, explore resources from the Mayo Clinic, or ask your city council for resources. Those who are uninsured will pay out of pocket, and there may be therapists or practices that offer financial assistance programs. I’ve also known folks who have crowdfunded money for services like pelvic floor therapy and postpartum doulas, or asked for monetary support in those areas at a baby shower in lieu of receiving clothing, bottles, toys, gifts, etc.

I encourage you to trust your body, trust what feels right and what doesn't feel right. Advocate for your needs, and ask your provider to go at a pace that works for you.  

Being Embodied Matters

I am motivated to honor each person’s path to embodiment, and I want every person to have access to information and resources that bring them healing and presence. Begin an exploration of pelvic floor therapy at your own pace; it can be big work (physically and emotionally). 

The Birth Neoterist is a space for exploring the present and the future of birthwork and Reproductive Justice. I’m grateful to be in process, learning and unlearning on a daily basis, and I am inspired by you all - my community - as we create visions for the future of birthing people together. Link to any offerings, organizations, initiatives, or providers who you think we should know about in the comments below!