Let's clear up one of the biggest misconceptions about pelvic floor health:
Peeing when you sneeze after having a baby may be common. That doesn't mean you just have to live with it.
And pelvic floor physical therapy isn't only for someone who had a traumatic birth, a severe tear, or a prolapse.
You don't even have to have had a baby.
If you have a pelvic floor and you do, there are situations where pelvic floor physical therapy can be incredibly helpful.
Pregnancy, birth and postpartum simply happen to be times when we pay particularly close attention to it.
First, What Exactly Is the Pelvic Floor?
The pelvic floor is a group of muscles and connective tissues that sits at the bottom of your pelvis.
Think of it somewhat like a hammock.
These muscles help support your pelvic organs and play important roles in:
- Bladder control
- Bowel control
- Sexual function
- Core stability
- Pelvic organ support
- Pregnancy
- Birth
- Postpartum recovery
Your pelvic floor also has to do something people don't talk about nearly enough:
It has to know how to relax.
That's important because pelvic floor dysfunction isn't always caused by muscles that are too weak.
Sometimes they're too tight.
Sometimes they're poorly coordinated.
Sometimes one group of muscles is compensating for another.
And sometimes the problem isn't really about strength at all.
Pelvic Floor Therapy Is NOT Just Kegels
This deserves to be in giant letters.
Please stop assuming every pelvic floor problem needs more Kegels.
Kegels involve intentionally contracting the pelvic floor muscles.
For someone who needs to improve pelvic floor strength or coordination, contractions may be one part of treatment.
But imagine that your pelvic floor muscles are already chronically tight.
Now imagine responding by repeatedly telling them to tighten even more.
Probably not our best plan.
A pelvic floor physical therapist evaluates what your muscles are actually doing before deciding what they need.
Treatment might involve strengthening.
But it could also involve learning how to relax the pelvic floor, improving coordination, breathing mechanics, mobility, posture, core function, scar mobility or learning how to appropriately engage and release muscles during everyday activities.
That's why randomly doing 100 Kegels because someone on Instagram told you to isn't the same thing as pelvic floor therapy.
Signs of Pelvic Floor Dysfunction Aren't Always Obvious
When people hear "pelvic floor problem," they usually think:
Bladder leakage.
That's certainly one possible symptom.
But pelvic floor dysfunction can show up in ways you might not immediately connect with your pelvis.
You may benefit from an evaluation if you're experiencing things such as:
- Leaking urine when you cough, laugh, sneeze, run or jump
- Feeling like you need to urinate constantly
- Difficulty completely emptying your bladder
- Urinary urgency
- Bowel leakage
- Constipation or straining with bowel movements
- A feeling of heaviness or pressure in the vagina
- Pelvic organ prolapse
- Pain with intercourse
- Pain with tampon insertion
- Pelvic pain
- Tailbone pain
- Certain types of hip or lower back pain
- Difficulty coordinating your abdominal and pelvic floor muscles
- Persistent pain around a cesarean or perineal scar
And no… you don't need to wait until your symptoms become severe before asking for help.
"But I Just Had a Baby. Isn't Leaking Normal?"
This is where we need to distinguish common from normal and unavoidable.
Pregnancy places significant demands on the pelvic floor.
Then birth—whether vaginal or cesarean—adds another major physical event.
Some pelvic floor symptoms during pregnancy or in the early postpartum period are incredibly common.
But:
"Lots of women experience this" does not mean "nothing can be done about it."
If you're six months postpartum and still crossing your legs every time you sneeze, you don't get bonus points for suffering through it.
Talk to someone.
Pelvic Floor Therapy During Pregnancy
You don't have to wait until after your baby is born to see a pelvic floor physical therapist.
In fact, pregnancy can be an excellent time for an evaluation.
As your uterus grows, your center of gravity changes, your abdominal wall stretches, your posture adapts and your pelvic floor manages increasing pressure.
A pelvic floor PT can evaluate how your body is responding to those changes and help address symptoms before they become more disruptive.
Depending on your individual needs, pregnancy-focused pelvic floor therapy may work on:
- Pelvic floor awareness
- Breathing mechanics
- Core and pelvic floor coordination
- Hip and pelvic mobility
- Pelvic pain
- Pubic symphysis discomfort
- Sacroiliac discomfort
- Urinary leakage
- Constipation
- Positioning and movement
- Preparing the pelvic floor for birth
And here's an important one:
Learning how to relax your pelvic floor.
Your Pelvic Floor Has to Get Out of the Way for Birth
We spend so much time talking about strengthening the pelvic floor that we sometimes forget what needs to happen during a vaginal birth.
The pelvic floor needs to lengthen and allow the baby to descend through the pelvis.
Pushing isn't simply:
SQUEEZE EVERYTHING AS HARD AS POSSIBLE.
Effective pushing involves pressure, positioning, breathing and coordination.
Someone can have an incredibly "strong" pelvic floor and still have difficulty relaxing or coordinating those muscles.
Pelvic floor therapy during pregnancy can help you become more aware of what those muscles feel like when they contract and when they release.
That body awareness can be useful during labor.
Can Pelvic Floor Therapy Prevent Tearing?
This is where I would be careful with promises.
No pelvic floor exercise or therapy can guarantee that you won't tear during birth.
Perineal tearing is influenced by many factors, including fetal position, fetal size, tissue characteristics, speed of birth, maternal positioning, previous births and how the baby's head and shoulders emerge.
Pelvic floor therapy may help improve mobility, awareness, relaxation and coordination in preparation for birth.
That's worthwhile.
But we don't want to turn it into:
"Do pelvic floor therapy and you won't tear."
Bodies and births aren't that predictable.
Pelvic Floor Therapy After Birth
Postpartum pelvic floor therapy doesn't have to be reserved for people who are having obvious problems.
Pregnancy and birth dramatically change the abdominal wall, pelvic floor and surrounding structures.
A postpartum evaluation can help identify what needs attention as your body recovers.
This can be especially useful if you're experiencing:
- Persistent urinary leakage
- Bowel leakage
- Pelvic pressure or heaviness
- Prolapse symptoms
- Pain with intercourse
- Perineal pain
- Pain around a tear or episiotomy scar
- Cesarean scar discomfort
- Abdominal weakness
- Difficulty returning to exercise
- Pelvic, hip or lower back pain
- A feeling that something simply isn't "right"
You don't have to diagnose yourself before making the appointment.
That's the therapist's job.
What Happens at a Pelvic Floor PT Appointment?
This is another reason people sometimes put off making an appointment.
They aren't exactly sure what they've signed themselves up for.
A pelvic floor physical therapist will typically start by talking with you about your symptoms, medical history, pregnancies and births, bladder and bowel function, pain, activity level and goals.
They may assess things such as posture, breathing, abdominal muscles, hips, spine, movement and core function.
An internal vaginal examination may sometimes be recommended because it allows the therapist to directly assess pelvic floor muscle tone, strength, coordination and areas of tenderness.
But an internal exam should be explained to you first and performed only with your consent.
You can ask questions.
You can decline.
You can ask to stop.
And depending on your situation, useful evaluation and treatment may still be possible without an internal examination.
What If I've Had a Cesarean?
You still have a pelvic floor.
Pregnancy itself places months of increasing pressure on the pelvic floor, regardless of how your baby is ultimately born.
Cesarean birth also involves abdominal surgery and subsequent healing, scar formation and changes in how the abdominal wall functions.
So yes:
People who have cesarean births can absolutely benefit from pelvic floor physical therapy.
Your pelvic floor didn't disappear because your baby came through your abdomen.
When Should I Start Postpartum Pelvic Floor Therapy?
There isn't one magic postpartum date that applies to everyone.
The right timing depends on how you're healing, your symptoms, your birth and what kind of evaluation or treatment you need.
You also don't necessarily need to wait until some arbitrary point postpartum to even have the conversation.
If you're experiencing significant pain, difficulty urinating or having bowel movements, concerning pressure or bulging, worsening symptoms, or something simply doesn't seem right, tell your midwife or other healthcare provider.
Some symptoms need medical evaluation rather than an exercise program.
Can I Just Do Pelvic Floor Exercises at Home?
There are absolutely exercises that can support pelvic health.
But here's the problem:
You need to know what you're treating.
If your pelvic floor is weak, your needs may be different from someone whose pelvic floor is overactive and unable to relax.
If your problem is primarily coordination, endlessly strengthening the muscles may not solve it.
If you're experiencing pain, prolapse symptoms, significant leakage or persistent dysfunction, an individualized evaluation is much more useful than trying random exercises from the internet.
You wouldn't assume every shoulder injury needs the same five exercises.
Your pelvic floor deserves the same consideration.
Pelvic Floor Health Should Be Part of Routine Maternity Care
We'd love to see pelvic floor health become a much more routine part of pregnancy and postpartum conversations.
Not:
"Are you leaking urine?"
"No."
"Great. Moving on."
There is so much more to pelvic health than continence.
We should be talking about comfort.
Sexual function.
Bowel function.
Pressure and heaviness.
Pain.
Core stability.
Returning to exercise.
Birth preparation.
Postpartum recovery.
And whether you feel like your body is functioning the way you want it to.
You Don't Have to Wait Until Something Is "Really Wrong"
One of the biggest misconceptions about pelvic floor physical therapy is that you need a major problem before you're allowed to go.
You don't.
You don't need a fourth-degree tear.
You don't need severe prolapse.
You don't need to be peeing your pants every day.
You don't even need to have had a baby.
Sometimes the goal of physical therapy isn't fixing a disaster.
It's improving function.
And pregnancy and postpartum are pretty reasonable times to give the muscles supporting your pelvis, bladder, bowels and reproductive organs a little attention.
Finding a Pelvic Floor Physical Therapist in DFW
Pelvic floor therapy is provided by physical therapists with additional education and experience in pelvic health.
There are a growing number of pelvic health providers throughout the Dallas–Fort Worth area.
Some accept insurance.
Some are private-pay.
Some provide treatment in an office, while others offer mobile or in-home appointments.
If you plan to use insurance, it's worth checking your benefits and asking your insurance company which pelvic floor physical therapists are in network.
And don't be afraid to shop around.
Pelvic floor therapy is personal. You should feel comfortable asking questions, understanding what your therapist recommends and participating in decisions about your treatment.
The Bottom Line
Pelvic floor physical therapy isn't just postpartum rehab.
It isn't just for bladder leakage.
And it definitely isn't just doing Kegels.
Your pelvic floor has to strengthen, relax, coordinate, support and respond to changing pressure throughout your daily life.
Pregnancy and birth ask a lot of those muscles.
Giving them some attention during pregnancy, after birth, or years later, isn't an admission that something went wrong.
Sometimes it's simply good healthcare.
At DFW Community Birth & Wellness, we encourage our clients to talk with their midwives about pelvic floor symptoms during pregnancy and postpartum. If something you're experiencing could benefit from pelvic floor physical therapy, we can help you determine the next step and provide a referral when needed.
Because "that's just what happens after you have babies" isn't a treatment plan.