STLMom LIVE: Pelvic Floor Physical Therapy Recap


Ever wonder what a pelvic floor physical therapy appointment entails? Well, wonder no more!


Legacy Physical Therapy logo


We recently sat down with Dr. Brooke Kalisiak of Legacy Physical Therapy. Legacy Physical Therapy specializes in the overall health and strength of the pelvic floor and surrounding muscles. While pelvic floor therapy can address various issues, one of the more common reasons to see a PT is when you are a postpartum mom.  


Dr. Kalisiak broke down one of the most asked questions that she receives about her practice: 


What does an initial pelvic floor physical therapy appointment entail?


As a mom, I must admit that I am not very familiar with the concept of pelvic floor PT. In fact, until recently, I thought that many of the after-effects of pregnancy and childbirth (such as muscle weakness or leaking when you cough, sneeze, or laugh) were just things that women had to accept. Even in more severe situations, I was under the impression that surgery was the only option. Learning that simple physical therapy sessions could end some of the most bothersome postpartum issues sounded too good to be true!


But how *awkward* must a pelvic floor PT appointment be? I can only imagine. And not having the answer to that question has kept me from investigating it further. Not to mention, I have four kids, ages 8 – 18. I assumed the window to address these issues through PT must be closed by now. Guess what? I was totally wrong!


Dr. Kalisiak sat down with Rebekah Coste, owner of STL Mom, and explained in detail what women could expect from an initial assessment and assured me that women at ANY stage of their postpartum journey could find relief through PT.




What to Expect


Talk, Talk, Talk!


A first pelvic floor PT appointment involves a lot of talking. Patients talk about their symptoms, of which there is a wide range. Symptoms may cause aches and pains, bowel and bladder function issues, or sexual function concerns. As with any other health visit, patients are encouraged to fill out a medical screening form ahead of time to ensure their therapist has a complete picture of the causes bringing them into the office. 


Dr. Kalisiak broke the physical assessment down into two sections. The first one takes a generalized look at the primary muscles surrounding the abdominal/pelvic area, such as your abdominals, hips, back, and buttocks. What a therapist is looking to see is how they function. How do you perform basic movements? How do you stand, and how is your posture? Are you breathing well? This assessment also addresses abdominal muscle separation, which is common in pregnancy. This part of the assessment is done fully clothed, and your therapist will take notes as they ask questions about how you feel during specific movements and if any of them cause any leakage. How you are moving is also noted, as that can tell a lot.


Show ‘Em Your Muscles


The second, much shorter, phase of the assessment is where the therapist looks at the pelvic muscle itself. Dr. Kalisiak noted that the “gold standard” way to assess it is to do an internal exam, much like a gynecological exam, allowing the therapist to feel the muscle at rest and when it contracts. It also lets them ascertain any scarring or scar tissue and alerts them to any soreness or tenderness you may feel to the touch. Throughout this quick exam, you discuss how it feels all the way through. 


The internal exam is considered the “gold standard” because therapists understand that women come in for PT for a variety of reasons. If pain is a big issue, an internal exam may be uncomfortable. Likewise, your personal comfort is taken into account. The internal exam can wait until you are more comfortable if need be.


Once the exam is complete, you will get dressed and discuss the findings. Often the things that bring women into PT, such as weak muscles, bladder leakage, or pain with intimacy, can be pinpointed within an initial session. You may discover you have strength issues or that scar tissue is causing problems. Some of your muscles may be unable to coordinate together. Whatever your specific issues are, you will go home from that first appointment with a good idea of your needs, and you will be given some tools to get started. Your therapist will set a plan into motion.



How soon after childbirth can I visit a pelvic floor physical therapist?


Dr. Kalisiak stresses that ideally, you should have your six-week appointment with your OB/GYN or midwife before pursuing PT. Those first six weeks, your body is healing internally, and you need to give yourself the time for that healing to take place. Occasionally, a woman may have significant pain or concerns that warrant PT earlier, however, in those cases, internal exams are rare as the pelvic area is not yet ready. 


The biggest, most comforting tidbit that I took away from this discussion is that it is never too late for pelvic floor PT — even in my case, where my oldest child has already hit adulthood, and my body went through three subsequent pregnancies, after which I did not do any follow-up to address muscle strength and health. Even for me, it is not too late. So please don’t give up and assume that living with the symptoms is just part of being a mom.


And, in the wise words of Dr. Kalisiak,