Ask the Expert: Why Should I See a Pelvic Floor Specialist?

Childbirth takes its toll on your body, especially your pelvic floor. Childbirth takes its toll on your body, especially your pelvic floor. Physical therapists who specialize in pelvic health, can help you kegel correctly, fix your diastasis recti, and prevent problems from escalating.

Raise your hand if your mom pees when she laughs or has made a joke about not being able to use a trampoline. Raise both hands if things down there just aren’t the same since you had a baby. Now ball up your fists if you’ve been told to get used to it because that’s just how it is.

Dr. Samantha DuFlo, PT, DPT, is the owner of Indigo Physiotherapy, a practice specializing in pelvic physical therapy. She sees moms at all stages of life and helps them address pelvic issues that arise from childbearing.

As a childbirth educator, I’ve seen a lot couples pre and postpartum, and I think everyone deserves a midwife, a doula, and pelvic physical therapist. Caring for our bodies is not selfish and not ‘extra’ and not really optional if you want to maintain strength and feel good, especially in the core.

Pelvic health means sex is fun, you don’t pee yourself, your muscles and organs are where they’re supposed to be, and you have a solid foundation for core strength. There’s probably more, and Dr. Samantha is here to tell us all about how she helps with the issues everyone tells us are “not fixable” or “just part of being a mom.”

I got more education from my two visits with Dr. Samantha than I have from any doctor I’ve visited. We also closed my diastasis — in two visits.

Q. Why did you get into this field?

A. Becoming a pelvic physical therapist was a winding, ‘choose your own adventure’ sort of path. After many years and volunteer visits to physical therapy practices in developing countries, I had cultivated an interest in the public health aspect of physical therapy. This led me to a position performing research in Malawi, where I worked in mother to child transmission and HIV/AIDS community research, after which I was drawn to maternal health, more specifically.

Following that experience, I did an internship in pelvic health, and my heart was locked in. Continence and sexuality link so deeply to our core function, our ability to work or move outside of our home, to lift our babies, to exercise, and in our ability to develop relationships and intimacy — helping someone regain those functions is deeply intrinsically satisfying. And I like a challenge!

Q. Give us a brief run-down of what you do to help childbearing women.

A. Pelvic physical therapists have roles throughout the lifespan and changes that a woman’s body takes, from pre-conception through pregnancy to postpartum to post-menopausal, whether or not a woman carries a child.

During preconception, pelvic physical therapists can help address pelvic pain, making penetration tolerable and enjoyable, as well as address questions regarding sexual function. We can treat women how to correctly recruit, activate, and contract the different pelvic floor and core muscles in order to strengthen and prevent hip and low back pain as well as pelvic floor dysfunction during pregnancy.

During pregnancy, pelvic physical therapists can treat pelvic floor dysfunction such as incontinence, low back and hip pain, symphysis pubis dysfunction, and much more.

In a nut shell, postpartum, we treat pain during intercourse, scar tissue from tearing, an episiotomy, or a C-section, incontinence, diastasis recti, and much more. I love to see mamas before they conceive, so I can teach them how to use all of these fun muscles to help prevent dysfunction post delivery.

Q. Alright, so what would I learn about my body from having an assessment in your practice?

A.Where do I start? It all depends on your body, how you present, and any symptoms you have. I am an educator, so my clients leave having seen a pelvic model and understanding all the pelvic floor muscles, as well as other fun learning tools and tricks.

I feel the more my clients know, the more in charge and autonomous they can be with their own health and wellness. I discuss my clients’ goals for their care and session, and those steer the direction of the appointment and the plan of care that we develop together.

For a ‘typical’ postpartum visit, I will look at everything from posture, core and abdominal strength, hip strength, diastasis recti, pelvic floor strength, breathing- but again, this can vary.

For a client that has been having constipation issues, we may talk more about defecation dynamics (how you poop) and toileting positions, versus a mom breastfeeding twins, we may talk more about the muscle strength between your shoulder blades, posture, and chest wall stretching.

Q. Why don’t more people seek help?

A. I believe it’s a lack of information and referrals. In other countries, ie France, every single woman is referred to postpartum pelvic physical therapy for an evaluation and education on postpartum care.

Although this conversation is changing, many women are led to believe that pain during intercourse postpartum or leaking while exercising or sneezing is “just the norm” after having kids, so not everyone knows that there is treatment out there. I would say that most people that find me say things like, “I never knew this existed!” Hence, the importance of conversations like this, to spread awareness.

Q. Can my OB or midwife help me with these things?

A. There is a place for everyone on the healthcare team for collaborative pelvic care, and a pelvic physical therapist’s expertise is the pelvic floor. An OB or midwife can evaluate and refer, as well as disseminate a wealth of information, but a pelvic physical therapist has the benefit of an entire hour or more one-on-one with clients and manual treatment.

I always suggest asking your health care professional: each individual on the health care team has a slightly different perspective or niche of care, some do specialize in pelvic floor muscles, and if they don’t know or can’t help, are always happy to refer you to someone who can.

Q. How do I know it’s a good idea to see a pelvic PT? When should we be looking into this?

A. Knowledge is power. I don’t know many people that wouldn’t benefit from learning all about their pelvis, from general bowel and bladder habits, to the muscles and the organs. The more you know, the more you can educate your children as well as keep yourself healthy to prevent things like pelvic organ prolapse or incontinence as you cross the lifespan.

Q. Shouldn’t I just wait until I know I’m done having kids to fix up everything down there?

A. It is usually easier and less time consuming to correct dysfunction as it comes, versus waiting until things are much worse, when it may take more time and effort to correct. Especially when it comes to diastasis recti, the correction can be as easy as teaching exercises, and has the possibility of reducing the impact of pregnancy on the separation for future pregnancies.

Q. There’s been a lot of back and forth between the ‘kegel’ and ‘anti-kegel’ camps. Why are some health professionals in favor of them and some not?

A. The kegel versus anti-kegel camps are often misinterpreted. What most health care professionals are advocating for are strong, healthy pelvic floor muscles that perform their job in continence and sexual function.

That being said, if you have pain during intercourse, scar tissue, or adhesions, pelvic floor contractions (kegels) may be counter-indicated. Imagine if you arm was stuck bent at the elbow, and then I gave you a dumbbell and told you to perform bicep curls: you can’t! The muscle doesn’t have the right length to actually do a further contraction, it is already stuck in a shortened position.

Your pelvic floor muscles can do the same thing with pain or scar tissue, and performing repeated contractions may contribute to making this worse. Again, each person is different, and this is why I recommend that you reach out and consult or see a pelvic floor physical therapist.

I also find that many people aren’t actually performing a pelvic floor contraction correctly!

Q. How about diastasis recti? Should everyone with a separation see a professional?

A. I would stress the importance of women knowing that their abdominal separation can be addressed. Many women come to me and report that they’ve been told that the diastasis recti “just is what it is,” which is untrue.

Q. How do you recommend we look for local specialists? What credentials are we looking for?

A. The American Physical Therapy Association Section on Women’s Health (apta.org) and Herman and Wallace are two groups that provide the bulk of pelvic physical therapy training, and provide resources and information for people looking for practitioners. Here you can peruse profiles, websites, and look for someone that might meet your needs.

profile-photoAbout the Expert

Dr. Samantha DuFlo, PT, DPT earned a Doctorate degree in Physical Therapy from the University of Maryland Baltimore, after which she relocated to Chicago, IL to further her knowledge and training in pelvic pain and rehabilitation. As Chicago is home to several of the leading pelvic pain institutions, Dr. DuFlo felt privileged to be immersed in the learning, research and care environment.

Returning to the Baltimore area, Dr. DuFlo was able to bring her unique, holistic approach to treatment of pelvic and sexual dysfunction to the community through her practice Indigo Physiotherapy.  Dr. DuFlo is also adjunct faculty at the university level, is active in research and writing for the profession, and prides herself on being up-to-date on research and perinatal activism.


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