Pelvic Floor Q&A with Dr. Mandi Murtaugh {31 Days of Postpartum Health & Healing}

OK, so I know that October is officially over and that ends the "31 Days" series...but I'm behind on everything I wanted to talk about, so I'm keeping it going through November! I know, rule breaker.

Today I'm really excited to have my friend and physical therapist extraordinaire on the blog to discuss something incredibly important for all women: the pelvic floor! We all have one, yes, and we need to know how to take care of it. Mandi is one of my dearest friends and a super smart cookie. I'm looking forward to sharing her knowledge about our lady parts!

Hi! So, what is your specialty?

I am a Women's Health Physical Therapist and my focus is on the pelvic floor as well as pregnancy and postpartum recovery.

Ok, so what is the pelvic floor?

The pelvic floor is a group of muscles, kind of like a trampoline or sling, at the base of your pelvis. It controls and supports the bladder, rectum and uterus. It's important for an orgasm, and it helps to support the sacrum and the lumbar spine. It is a part of your deep core. It works right along with the deep abdominals - the tranverse abdominis - to help zip up a diastasis (which we talked about here).

What do you do during a visit?

The first or second visit, I typically do an internal muscle exam - no speculum, no stirrups - just one finger inside the vagina to feel you squeeze and release, and to check for any tender points. They can be tight or have knots or trigger points, just like any other muscle. I also check the position of the organs to see if any organs are migrating down (prolapse) and check for diastasis (a separation of the abdominal muscles that is common). I usually have patients do a bladder diary to look at their bladder habits.

From there, I do a lot of education. I give them an individualized program for their pelvic floor, which is why I don't give blanket advice, because everyone is different. For example, if a patient can only squeeze and hold for two seconds, I'm not going to send you home telling you to squeeze for 10 seconds, I'll send you home squeezing for two seconds. Recovery is so much more individualized and involved than just a blanket fix-all amount of exercises. For instance, some people shouldn't do Kegels! They actually need to UN-Kegel.

Fun! What are the most common complaints you see in your office from pregnant or postpartum women?

Urinary incontinence is the biggest complaint, along with back pain. Carrying and having babies is good, beautiful and healthy but it is traumatic to your undercarriage! If you damage another muscle, you're probably going to rehab it, right? A woman gives birth using this powerful muscle and then is supposed to go and lift this seven pound weight repeatedly, most often awkwardly! I think that everyone after their six week checkup should have a pelvic floor consultation, and every woman should have a consultation before returning to exercise. Your doctor or midwife may not mention physical therapy for postpartum recovery.

And how does one's pelvic floor health come into play?

The pelvic floor is important in controlling bowel and bladder, and so if it's weak or damaged by a tear or episiotomy greater than a first degree (a second degree tear or greater goes through the muscle), you may have some problems. Your vagina is a lot smaller than a baby's head. The muscles stretch, the nerves can get compressed, or if the bones are out of alignment then the muscles aren't attaching quite right and can't pull they way they're meant to.

So peeing your pants or leaking urine long term is NOT normal or healthy?

It is common, it is NOT normal. It can mean that your pelvic floor is weak or that you have altered timing. You can have a strong pelvic floor but still leak if the muscles squeeze after a cough or sneeze already pushed down on the bladder. Stress incontinence is leaking with coughing, sneezing or exercise - if there is an increase in abdominal pressure - and this is also not normal. If at six months you're still leaking, than you're most likely going to be still leaking a year later if you don't get some help. If this is happening I recommend that you see a physical therapist who specializes in women's health.

How can women maintain a healthy pelvic floor before, during, and after pregnancy?

By being able to correctly engage the pelvic floor muscles. Make sure you know how to tense your pelvic floor to stabilize the spine and when you cough, sneeze, or during exercise, you need to be able to "turn it on" and "turn it off." It's not just about Kegels, because the pelvic floor needs to relax when we have sex or poop or pee. Women who have pain with sex oftentimes have an overactive pelvic floor and they need to learn how to un-Kegel.

Can you teach us a quick exercise to find our pelvic floor and engage it?

Sure! Sit down on a hard surface or on an exercise ball and draw in your pelvic floor by squeezing around your vagina - it's the same thing you would do to stop gas or pee (do NOT practice while peeing!) - you can also think of drawing your sit bones together and your tailbone towards your pubic bone in the front. Your buns should not squeeze, and if anyone is sitting next to you they shouldn't see you move. Then, let it go.

Another good way to self-check is to put your finger in your vagina while in the shower and squeeze. You should feel it close around your finger and when you relax, it should release.

Again, the times you want to squeeze the pelvic floor are before a cough or sneeze, while going up stairs, exercising, or standing up from a seat, and any time you pick something up, whether it's a baby or the milk jug. It only takes a gentle contraction--think 25% of your strongest effort--to stabilize for most normal movements. If you're leaking with these types of things, it may be time to get it checked out!

Mandi Murtaugh, PT, DPT, WCS, is a Women's Health Certified Physical Therapist in Portland, Oregon. She practices at Element Wellness & Sports Rehabilitation and will soon be launching a New Moms exercise group in John's Landing. You can get in touch with her at [email protected] or www.mandimurtaughdpt.com.

Thanks Dr. Mandi! There is so much more to discuss and I'm looking forward to picking her brain on upcoming posts. Any questions for Dr. Mandi? Post below!