Expert advice from Pelvic Floor Physical Therapist: Megan Craig, DPT
There are many things to think about in those final days of pregnancy. I had lists on top of lists of final to-dos: hospital bag, birth plan, birth playlist. I was also recommended to research pelvic floor physical therapy options. Why? Medical care and pregnancy classes only focus on pregnancy and birth, with very little information ever shared on postpartum care. You need to prepare in advance how to best take care of yourself, not just your baby.
Waiting to search for the best support team to help you through your postpartum period after birth is stressful (check out 5 Unexpected Postpartum Experiences). Layer on little sleep, pain and you know, learning this whole new mom thing, the last thing you’ll want to do is research providers and make the calls to see if they take your insurance. So do yourself a favor and do the work ahead of time to prepare to address any pelvic floor dysfunction. And if you are already postpartum, its never too late to get care!
But if you're like me and already have pelvic pain during pregnancy, guess what? That’s not necessarily just “normal pregnancy” discomfort you have to live with. There are ways to help alleviate the pain through Pelvic Floor Physical Therapy! I SO wish I had known that pelvic floor physical therapy isn’t just for after birth.
Pelvic pain and dysfunction during and following pregnancy is more common than most women realize! So without further ado, I’m excited to interview another expert, Megan Craig, a pelvic floor physical therapist at Renew Physical Therapy in San Francisco and Mill Valley who helps women during pregnancy and postpartum get back to doing what they love!
Expert Q&A with Pelvic Floor Physical Therapist Megan Craig, DPT
Intro
Q: To start off, can you tell us a bit about your background?
I grew up in Michigan and received my Doctorate of Physical Therapy from Oakland University before moving to San Francisco a few years ago. I started practicing in outpatient orthopedics and realized I really enjoyed working with pregnant and postpartum patients but didn’t feel I had a thorough knowledge on how best to treat their symptoms… which is why I decided to further my education and become a Women’s Health/pelvic floor physical therapist!
My background in orthopedics helps me to best address the safe progression of returning to activities including exercise and running in regards to both pelvic floor support and good mechanics of the rest of the body.
Q: Let’s start with the basics…what are the pelvic floor muscles and why are they important?
A: The pelvic floor muscles function to support your reproductive and urinary tract. They control the emptying of your bowel and bladder and have a roll in sexual function. These muscles attach to your pelvis and sacrum. When they aren’t properly functioning, it can have a large impact on your quality of life!
Pregnancy Discomfort
Q: When I was pregnant, I had terrible pelvic pain. I just thought it was normal pregnancy discomfort, but recently found out there is a name for it: symphsis pubis dysfunction (SPD). What causes this? Any tips for alleviating the pain?
Symphysis pubis dysfunction or pelvic girdle pain (PGP) is usually caused by the ligaments becoming more relaxed due to hormone changes that your body uses to help prepare for birth. When the ligaments relax, the pelvis is less stable which leads to the pain.
It can be helpful to keep your knees together with movements such as rolling over in bed and getting in/out of the car. Also, try to avoid single leg stance (standing on one leg). Pelvic floor physical therapy can help address symptoms beyond these simple modifications!
My take: If I had known pelvic floor physical therapy wasn't just for after birth, I 100% would have done it. Like I said, I had terrible pelvic pain as well as back pain in my third trimester. Here are some at-home things that helped me –
If you are stuck sitting at your desk working all day like I was, try this back massager. Other remedies I tried included a pregnancy back support band that helped alleviate heaviness leading to pelvic pain. I’m obsessed with Saje’s Peppermint Halo Essential Oil Roll-on (click here to get 10% off your purchase).
Q: Great tips! I always thought pelvic floor therapy was for after birth for postpartum women, not before. What does pelvic floor physical therapy address?
During pregnancy, this can include addressing pain and limitations that come up, optimizing mobility and strengthening, and preparing your body and more specifically, your pelvic floor, for birth.
Postpartum treatment usually focuses on restoring pelvic floor function, addressing incontinence, painful intercourse, diastasis recti, prolapse and pelvic floor heaviness, scar mobility, body mechanics and posture for caring for your infant, and safe progression to return to your pre-pregnancy activities and exercise, whatever that means to you!
Postpartum Pelvic Dysfunction
Q: Probably one of your most common questions… When can I exercise following birth?
I hate to say it, but… it depends! Listen to your body and take your time. Regardless of how you deliver, it is a major process for your body to re-adjust to your “new normal.” In general, returning to low-impact exercise such as walking and yoga is a great place to start. If you plan to return to more active exercise or running, it’s best to check in with a pelvic floor physical therapy.
Postpartum rehabilitation is individualized based on a lot of different factors. Most importantly, we need to make sure your body is properly managing the transfer of forces with exercise so your pelvic floor can properly support you without compensations or injuries.
Q: Let’s talk about some of those “taboo” postpartum discomforts most women are embarrassed to ask about. First, is urine leakage normal?
Since it can be common after delivery, a lot of women think incontinence (urinary leakage) is normal and they “just deal with it.” However, this is something that should be addressed and is often completely resolved with pelvic floor physical therapy.
Q: How about another common concern: is pain with intercourse following birth normal?
Similar to leakage, this can be common. In fact, according to a research study by Odal et al, 62% of women resuming sex after birth report pain at 6 months. If this is you, see a pelvic floor physical therapy to help address this and improve your quality of life!
This is something that I have become very passionate about! I am often told by patients that they didn’t know pelvic physical therapy existed and that they have been silently struggling with these concerns for months or years. Since incontinence and painful intercourse are sometimes sensitive topics, it is not usually something women bring up to their provider if they aren’t directly asked about it. In my opinion, all women should be given the option for physical therapy during pregnancy and post-partum to help address these common concerns as well as to prevent future complications from popping up.
Getting pelvic floor help
Q: So how does pelvic floor rehabilitation help me recover from these postpartum discomforts?
You can expect an evaluation and appropriate hands-on manual therapy and exercises to address your specific areas of concern. Evaluations usually include an internal vaginal assessment to give us a better idea of how your pelvic floor muscles are functioning, but this is always optional! My ultimate goal is helping you to return to your daily life and activities.
Q: For my readers in the San Francisco Bay Area, how can we book an appointment?
I currently see patients in our San Francisco and Mill Valley office locations, as well as Telehealth sessions over video. For more information regarding our Women’s Health Program please contact Renew Physical Therapy at (415) 381-8707 or email me at megan@ptrenew.com. We accept most major health insurance plans including Medicare, Blue Cross and Blue Shield. You can also follow us on Instagram @PT.renew
I want to thank Megan along with Nicole Sabes, DPT for spending the time talking with me! Just because you hear lower back pain, pelvic dysfunction, incontinence, pain with intercourse, and diastasis recti are common, doesn’t mean it's normal. Take the time to take care of yourself Mama!
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