Fed Up with Insistent Incontinence:: The Impact of Pelvic Floor Therapy

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This post is sponsored by Revitalize Physical Therapy. With locations in Wauwatosa and Hales Corners, the caring staff seeks to provide hands-on, one on one, personalized care in a private, comfortable setting that will get you better, faster. Their priority is to help you live a healthy, active life and do the things you enjoy the most!

Dr. Brenda Heinecke is the expert for prenatal and postnatal care, incontinence, low back pain and female sports injuries in the Milwaukee area.  Her comprehensive approach helps patients get better, faster and have better long term success. If you are considering pelvic floor therapy, we highly recommend her!

Why the Pelvic Floor is Kind of a Big Deal

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I know this will come as a surprise to exactly no one, but my body has not been the same since I carried and birthed three babies.

I’m not just talking about the things like a soft tummy, thighs that heroically catch my phone from a watery death, and stretch marks, but more about internal changes that have left my body forever altered that began to affect how I lived my life on a regular basis. I knew there was a real problem when, eleven years after becoming a mother, I found myself avoiding exercise out of fear I would pee my pants, contorting myself into a pretzel in the makeup aisle at Target during a sneeze, packing a pantyliner in my purse when I had tickets to a comedy show, or even skipping out on certain social situations because of the fear of a bladder accident.

For the longest time, I thought that peeing my pants was just one of the prices I had to pay to be Mom. 

As it turns out, I am not the only one who has held this false belief for far too long.  And furthermore, there were more problems I was experiencing that I had no clue were not normal until I started pelvic floor therapy with Revitalize Physical Therapy.

Not surprisingly, there are a lot of myths out there about our bodies that women have just been believing and living with, including: incontinence, weak core, painful intercourse, and back pain, among others. As it turns out, the pelvic floor is kind of a big deal, and I had no clue for more than the first DECADE of my journey as a mother. 

What is Pelvic Floor Therapy?

Pelvic floor therapy is a kind of physical therapy that is specifically targeted to encourage the relaxation and strengthening the muscles of the lower pelvis. These muscles support the pelvic organs, assist in bowel and bladder control, and contribute to healthy sexual functions. Pelvic floor health is an often overlooked area of prenatal and postpartum treatments for women that can help to prevent injury or assist women in returning to an active lifestyle without pain. 

How did I get here?

When my oldest child was born 11 years ago, I did not know that pelvic floor health was a thing. I wasn’t part of a mom group on the Internet and the extent of my birth plan was reading an old copy of What to Expect When You’re Expecting that I found at the thrift store for a quarter and binge watching A Baby Story on TLC.

During my son’s birth, I was induced, pushed for over three hours, and eventually suffered third degree tearing that had me sitting on an inflatable donut for weeks and buying Tucks pads in bulk.

This was birth trauma that had significant effects on my body, but I didn’t know it at the time — I thought this was all just part of the gig. After two more births, my body was no longer my own and I just went about motherhood for more than a decade. 

Looking back now, I can’t pinpoint when exactly I started to realize that there were issues that were affecting my daily life.

The symptoms that led me to pelvic floor therapy:

  • Significant urge incontinence – Literally every time I would come inside from being outside, my body would scream EVERYBODY MOVE OUTTA THE WAY and I would have to rush directly to the bathroom.
  • Stress incontinence – A cough, sneeze, laugh, jump, or even light jogging would lead to bladder leakage. It got to the point where I would change my social habits to avoid situations or to quit exercising because I didn’t want to leave the gym with wet pee pants. Everyone kept saying, “Wear a pad!” or “Just wear black pants!” but I was so embarrassed and uncomfortable every time that I eventually just avoided environmental stressors all together. Sneezing made me twist my body into a pretzel to avoid making an actual puddle on the floor. Several times, I had to take evasive measures in public because a sudden cough or sneeze had made me pee myself so much that it was obvious and humiliating.

The symptoms that I discovered later were actually related to my pelvic floor (that I had no idea about previously):

  • Lower Back Pain – Several times a week, I experience what I have previously described as “tailbone pain” that sends sharp shooting pains through my hips and tailbone area. I never would have imagined that this was due to overly-tight ligaments in my pelvic area!
  • Painful Intercourse – Okay, so we’re basically best friends now. For years and years, there would be times during….ummmm….intimate time with my husband that I would suddenly feel a variety of pains that I couldn’t explain, from sharp radiating pain through my thigh to muscle pain. I’ve endured it a lot and, if we’re being honest, avoided the situation more than anything else because I thought it was just the way I was now. 

What to Expect During Pelvic Floor Therapy

Office Visits

Listen, friend. I’m going to give it to you straight because I want you to feel comfortable and prepared if you decide to give pelvic floor therapy a try. You are going to get close with your care provider. As in…..VERY CLOSE. As it turns out, most of my issues were caused by the muscles in my pelvic floor being too tight, so the majority of my office visits, over the course of more than 8 weeks, involved the manual releasing of those muscles and ligaments. Yup, that means that you are making small talk with someone’s face while their hand is inside your vagina. For many, many minutes.

Was it always like this? Nope. There were several sessions where Dr. Brenda used the office visit time to work on my abdomen externally or on the areas around my diaphragm or lower back. But since the majority of my issues were centered around and caused by the ramifications from my births, I got accustomed quickly to Dr. Brenda being up close and personal. This is why it’s so important to choose a qualified, caring practitioner who you feel comfortable with. Dr. Brenda was extremely kind, caring, and always made sure I was 100% comfortable and aware of what she was doing and that was very important to me feeling like I could trust her with my care.

Homework

Only so much can happen during your office visit, so you can expect to get sent home with a series of exercises designed to help you heal your pelvic floor. For me, it started off as breathing exercises to loosen my muscles and overly tight ligaments and then gradually moved toward strengthening. As I have learned the hard way, not doing these exercises will seriously sabotage your progress, so do the homework!

Habit Changes

After keeping a detailed Bladder Diary, I found out that things like skipping breakfast (please tell me I’m not the only one who does this) and consuming bladder irritants like coffee and alcohol were not exactly helping my incontinence struggles. Rather than deprive me of my morning coffee, Dr. Brenda worked with me to create a timing strategy to dilute its effects with increased water in the morning and stopping coffee consumption after a certain time of day. I also discovered the maximum amount of water I should drink and how certain foods in my diet could also help with pelvic floor health. It was truly fascinating! 

Does Pelvic Floor Therapy Work?

The short answer? ABSOLUTELY. 

I saw Dr. Brenda for 6 weeks and I was already seeing massive changes. I wasn’t having accidents several times a week anymore and was seeing a massive decrease in the urge incontinence that had me throwing elbows to get to the bathroom every time I walked in the door. My ability to do a Kegel and hold it had improved dramatically and I found that I was even able to keep minor urge at bay using techniques Dr. Brenda taught me to train my bladder.

Now, you won’t see me in a boot camp exercise class anytime soon doing jumping jacks and burpees because 11 years of damage can’t be fully reversed in just six weeks. And, as Dr. Brenda puts it, those high-impact situations like jumping are the highest difficulty level for someone with pelvic floor struggles, so be realistic with expectations. For me, I’m excited to be able to cough or sneeze without wetting my pants and to be seeing a significant improvement in the other areas I mentioned above as well. Plus, I was able to go for long hike without making sure I wore a pad and I even was able to jog a little while without leaking! This is a huge victory for me and I am so so thrilled. 

Want to Learn More about Pelvic Floor Therapy?

As we’ve talked about, this is a very personal area of health care where feeling ultra comfortable with your provider is of the utmost importance. You’ll want to do your research and check things out a bit before you jump in!

Here’s some great ways to get started:

  1. Download a FREE copy of “5 Ways to Have a Pain-Free Pregnancy”  or “5 Ways to Jump-Start Your Postpartum Recovery.” learn what you can do to prevent and alleviate pain during and after pregnancy in order to sleep better, be more active, and be able to care for your new baby.
  2. If incontinence is your specific challenge, download your FREE copy of  “7 easy ways to END Incontinence & get your life back” to get some first steps.
  3. Schedule a FREE Consultation with the incredible staff at Revitalize Physical Therapy. Let them know you heard about them at MkeMB and this will be totally FREE! Ask your questions and get them answered in a no-pressure environment and see if this might be right for you!

Pelvic Floor Therapy FAQs

As I’ve been sharing my journey through pelvic floor therapy, I’ve been getting a lot of great questions! I brought these questions directly to Dr. Brenda at Revitalize Physical Therapy to answer. Find the answers to some of the most commonly asked questions below! 

Pelvic floor physical therapy can help fix so many different types of issues including incontinence, painful intercourse, back or hip pain, diastasis recti, overactive bladder, prolapse, and SI joint or tailbone injuries (to name a few).  We always tell our clients that these issues are common but NOT normal so if you are experiencing any of the above issues, you do not need to continue living with it.  Especially if you find yourself avoiding certain activities or not being able to be as active with your kiddos or spouse because of them.  At Revitalize PT, we offer free consultations as a way to chat more about your issues and to let you know if it is something that would benefit from pelvic floor PT or a different specialty so that is always an option if you aren’t sure if you need help.

Coverage and reimbursement for pelvic floor physical therapy depends on your insurance plan, the issue you’re being seen by and the type of treatment that your therapist does. Insurance companies have become more stringent with their coverage for pelvic floor issues recently. They do not view some of these issues as “functional” (like who cares if you’re peeing your pants, you can still walk) so they limit the treatment sessions and also dictate what can and can’t be done for treatment.  For this very reason, we work a little bit differently with insurance, as an out of network provider, where our clients can get reimbursed for their visits. The benefit to this is that we are able to give our clients exactly what they need in order to get better and do this in the shortest amount of time possible (ideal for all of us busy moms).  Insurance can be so confusing so often times it’s best to ask and we can help guide you through all of it.

The frequency of your therapy depends greatly on the type of issue you have, the severity and if there is something specific we need to get you back to quickly.  On average, most pelvic floor issues may start out at 1x/week but if you are having alot of pain, we may need to see you 2x/week at first in order to get the pain under control.  After a few weeks, we typically start to space out your visits even more to 1x every other week and then to 1x/month.

YES!  Sex shouldn’t hurt, regardless of what you’ve been told about sex after baby!  Most women have pain after baby but there are also women that have had pain prior to pregnancy (or have never had children) or also have pain with tampons or pap smears.  Pelvic floor physical therapy can help all of this!  We hear so many crazy things at the office that women have been told to “just have another glass of wine” or “take a bubble bath” or “it’s all in your head” and this is so unfortunate.  If there is pain or discomfort, we can fix it quickly so don’t keep dealing with it and give us a call 🙂  

Pelvic floor physical therapy should be an integral part of pregnancy and postpartum care and it is actually pretty standard in other countries in Europe and Australia.  It can help you get through pregnancy without pain, incontinence, and better function.  It can also help prevent diastasis recti and prolapse or the worsening of these issues if you already have them.  We have also seen at the clinic that doing manual pelvic floor muscle release has helped our clients have a successful vaginal delivery with less tearing and complications and a better recovery.  Starting this fall, we are partnering with UW-Milwaukee to start a research project to more closely study these findings and are so excited for it!  We have seen it in our work over the past several years but to have concrete data will be so great to help women have a better pregnancy and delivery.  Let us know if you’d be interested in participating in the study at all since we will be looking for pregnant mamas!

Women often complain of core weakness or “loose” abdominal muscles after baby and this is extremely common.  We work with women to re-train and strengthen the deepest abdominal muscle, called your transversus abdominus (TA) because it cinches everything in like a corset and supports the pelvis and spine.  During pregnancy, this muscle shuts off and stops working for most women.  However, it doesn’t just automatically start working again after baby so we have to re-train it, which can be incredibly difficult to do on your own.  This is also why it is so important to work on stabilization exercises to strengthen the core rather than jumping back into crunches, planks and more traditional ab exercises.  

At Revitalize PT, we take a very different approach to care than the traditional physical therapy model.  We strive for providing quality, hands-on, personalized care in a comfortable setting.  And we also realize that pelvic floor PT is a sensitive topic and women can feel very nervous about starting it.  For this reason, we designed our offices to feel more inviting and comfortable than a traditional medical facility.  We also use private treatment rooms that are discreet so women don’t feel as if they are on display out in a large gym full of other people.  You are the only patient we see at that time and we give an hour of treatment to each client (so no bouncing around between patients).  We also only have Doctors of Physical Therapy here and we rely primarily on our skills rather than just hooking you up to a machine for 15 minutes.  Our clients really appreciate the extra attention that they get and also how we take the time to sit down and listen to them in order to make them feel comfortable and explain everything that we are going to do.  There shouldn’t be any surprises in your care and you should most definitely be included in the planning of your care plan.  We really feel strongly about empowering our patients and enabling them to have a say in their treatment.  Oh, and we have a fully stocked coffee bar and magazine rack in the waiting room so if you want some quiet time to yourself after your appointment, you’re more than welcome (we know how it is…)

As it turns out, a physical therapist is the care provider I never knew I needed. If I knew then what I know now, I would have been much more intentional about preparing my pelvic floor for birth to try to avoid significant damage or at the very least, been far more proactive and vocal about the symptoms I was suffering with for far too long out of a combination of misinformation, embarrassment and the false assumption that nothing could be done about it anyway.

As mothers, we have enough stressing us out…..our pelvic floor shouldn’t be one of them. Reach out to Dr. Brenda at Revitalize Physical Therapy and get your questions answered!

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