4 Things I Learned At My First Pelvic Floor Course

Hey there! I apologize for falling off the grid for a little bit. Life has been pretty exciting and crazy lately. I have accepted a position as a Women's Health Resident in FL and I will be moving in less than 2 months! Over the last few weekends I've traveled down to FL to apartment hunt, taken a pelvic floor course in NJ, and been studying for FL licensure. Good news: I found a cute apartment, got licensed in FL, and LOVED the pelvic floor course! 

So it was a no brainer that this week's post is based off of my experience at Herman & Wallace's Pelvic Floor 1 class. I spent a weekend with 40+ other practitioners (physical therapists, physical therapy assistants, and a nurse practitioner) learning about how to assess and treat urinary incontinence, pelvic organ prolapse, diastasis recti, and female pelvic pain. 

#1 The pelvic floor is incredible

Okay, well I’ve been pretty “pro pelvic floor” for a while now, but this course really fired up my passion! The pelvic floor continues to amaze me. When it’s working perfectly we take it for granted - when it goes wrong, it can affect every facet of your life. Without a pelvic floor:

* Your organs would literally fall out of your body every time you tried to sit or stand up
* You wouldn’t be able to have (or enjoy) sex
* Your body wouldn't be able to support the weight of a growing baby, and forget about any chance at natural birth
* You would never pass the diaper stage of potty training and decide when YOU want to go to the bathroom

Those are all pretty important functions and you can see how a problem in any one of them could wreak mayhem in your life. You can read more about pelvic floor function with these posts. 

#2 Kegels are tough


Kegels have been all the rage for a while now, but they actually aren't appropriate for everyone and this post goes more into that. During this course we talked a LOT about kegels, when they are an appropriate exercise in rehab, and how to instruct each other in performing kegels. And guess what? It’s pretty tough to a) voluntarily contract and relax your pelvic floor muscles and b) know that you are doing it correctly.

Many women have a difficult time understanding how to activate their pelvic floor muscles on command. I can’t tell you how many times something along the lines of “Am I doing it? I’m trying to do it.” was said. Why is it so tough? Well these aren’t muscles which we get “taught” to use. There aren’t workout plans that you can find on the internet and start doing. No gym teacher ever says, “Alrighty, let’s make sure those pelvic floor muscles are working as you jump for hopscotch!” The mind-body connection between the brain and pelvic floor can be very weak. It’s tough to know whether you are doing anything and whether you are doing it correctly! 

While you can feel a strong pelvic floor contraction over clothes, it’s much easier to see it happen. Think about it this way, if you wanted to see if your bicep worked, then you would bend your elbow right? Well if you want to see your pelvic floor work, you can visualize it! At home you can use a handheld mirror to see whether you are doing them correctly. In the clinic, your pelvic floor therapist may also want to visually assess that you are doing it correctly. And for those of you curious about what you'd see: your perineum should lift up and in when you contract and move down when you relax.

#3 There is such a thing as a comfortable exam

I’ve had my fair share of pelvic exams (shout out to my gyno) and let’s be real for a minute. They don’t feel great. Not only is it uncomfortable to lay there naked in a frigid room, but the speculum sure doesn't help. If you’ve had a similar experience, then you probably don’t want to repeat it with another healthcare practitioner. But I’m here to tell you that an examination of your pelvic floor muscles by a pelvic PT is much more comfortable than an internal exam by your MD! 

What pelvic floor physical therapists do is different than a gynecological exam. Your ob/gyn is checking your cervix, ovaries, and trying to feel for any bumps or lumps which may be a more serious disease. Pelvic floor therapists are assessing the skin, connective tissues, and muscles of your pelvic floor. The key difference is that your doctor has to assess tissues which are much farther and deeper into your body, thus requiring additional equipment (i.e. speculums) and more pressure to feel those structures (i.e. ovaries). Pelvic floor therapists focus on the superficial structures which means we don't have to use speculums or push quite as hard to feel the structures we are trying to assess. In fact, we can modify our exam based on your pain level and hold the internal muscle evaluation until you are more comfortable. 

TMI (too much info) alert! 

Another reason that we perform more comfortable exams is that we have had them done on us. Nope, not talking about the gyno exam here. During the course each participant performed an exam on a partner; many of us served as patients too. And we ended up doing multiple exams that weekend with different partners in the labs. So we actually know what you are about to experience! Everyone I worked with did a great job of asking for feedback and checking in with the "patient" about how she was feeling. In med school, the doctors practice on actors and not on each other. While it was awkward the first time, it was an invaluable learning experience. 

#4 Find your tribe

This is not a popular field of physical therapy (or medical practice) yet. When I talk to people about pelvic floor rehabiliation, usually the first 10 minutes are spent explaining what it is. It was great to be surrounded by 40-50 professionals who were just as excited to learn more and help patients with pelvic floor dysfunction. It was that moment of "wow these people are really speaking my language!" I am so excited to see that this field is growing and how supportive and open each practitioner was to the course. Each person I talked to had something different to offer, their own tidbits of experience and information. 

My key takeaway from the course? Whatever your interests are, don't stop until you find your tribe! Whether it's professional or personal, there are other people out there who you can learn from/with as you pursue your passion.