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Peeing yourself after kids is NOT normal - Pelvic Floor PT with Empower Physical Therapy.

As a grown ass adult, about 6 months postpartum, I peed my pants. Not like just a little - enough that my eyes got wide when I realized what happened, and I had to change my undies. “Great” I thought “I’ve reached the “pee my pants” stage of motherhood”. I had heard my mom talk about it all the time - she was a mother of 6, and crossing her legs to sneeze or laugh had just become a "normal" reflex. “That’s the joy of having kids” she would say, sarcastically.

It wasn’t until recently (like - a few years ago) that I realized that the pelvic dysfunction (ie - peeing your pants) after having kids isn’t actually normal. And what’s cooler - there’s something you can do to prevent and heal it. There is actually a type of physical therapy you can do to fix pelvic floor issues, and we even have a dedicated clinic right here in Lincoln!

Empower Physical Therapy located in Lincoln Nebraska

I was STOKED to find out about Empower PT, a clinic that helps us fix all those fun symptoms we've all but accepted as normal. From back and pelvic pain, urinary leakage (yep - peeing our pants), pelvic organ prolapse and diastasis recti - you have a clinic right here in Lincoln that can help you heal and get back to feeling more like your truly normal, pre-pregnancy healthy pelvic state.

I visited Empower PT recently and asked them some questions for us all to learn more about what they do and how they can help. Here’s what they had to say!

Tell us more about Empower PT

Empower Physical Therapy is a clinic that solely focuses on pelvic floor health and therapy. We wanted to create a space that was welcoming, without the hustle and bustle of a traditional outpatient orthopedic PT clinic. We offer full hour-long appointments that are one-on-one the entire time with the physical therapist. We pride ourselves on a whole body, hands-on approach to treat our patients. You will be listened to, heard, and your concerns will be addressed. We understand these can sometimes be difficult issues to discuss, but trust us when we say there is no such thing as TMI at Empower.

Pelvic floor physical therapy can also include wellness and prevention! We often see patients when they are in pain or have other urinary or bowel symptoms, but we can also see you to help PREVENT these symptoms from happening. We can help keep problems and dysfunction from arising with education and addressing imbalances and dysfunction before they become symptomatic. We believe that all pregnant and postpartum women should be seen by a pelvic floor therapist. We deserve to have more than one postpartum check.

What is the most important thing someone should know about pelvic floor PT?

"Peeing, pooping, sex, breathing, sitting...these are things that should be pleasant! They are basic to life and critical to the enjoyment of life. It's incredibly sad when the basics of lie are not only not pleasurable but are now painful or embarrassing." -Dr. Sandy Hilton

Pelvic floor physical therapy is for everyone! We see a lot of pregnant and postpartum women, but women who have not had a child and men also have pelvic floors and can have dysfunction, as well. Most importantly, you don't have to suffer in silence!

What is Pelvic Floor PT?

Pelvic floor physical therapy is a non-surgical treatment approach to help address pain, weakness, and dysfunction in the pelvic floor muscles. The pelvic floor is a group of muscles that sit like a "bowl" or "hammock" at the bottom of your pelvis. When these muscles aren't working as they should, they can cause pain and other symptoms, including bladder or bowel issues, that interfere with daily functioning. Physical therapy can provide lasting relief of your pain and symptoms. While we specifically address the pelvic floor muscles, we look at the entire body and how posture, mobility, strength, breath, coordination, and intra abdominal pressure can be contributing factors to your pain or symptoms.

Why is Pelvic Floor PT important for pregnant/postpartum women?

Pelvic floor physical therapy is incredibly important for pregnant and postpartum women.

During pregnancy there are so many changes in our body to accommodate for our growing baby and these changes can often cause pain and slow down our postpartum recovery. By maintaining strength, mobility, and stability of our changing pregnant bodies we can minimize pain and set our bodies up for optimal postpartum healing. Pelvic floor physical therapy can also help you prepare for your labor and delivery by learning pelvic floor stretches, how to coordinate your pelvic floor and breath to ease delivery, and education on perineal stretching to reduce your risk of tearing. You can't predict your labor and delivery experience, but you CAN prepare.

Then, we get to talk about postpartum. Our bodies go through an incredible feat growing and subsequently delivering a baby. Whether that delivery is vaginal, cesearean, medicated, or unmedicated. Our bodies took 9 months to grow a baby and then we expect them to "bounce back" in a matter or weeks or a few months?? No! Our bodies need time to heal and recover from the demands that were placed on them throughout pregnancy and the labor/delivery process. A pelvic floor physical therapist will ensure that you are given the tools to support your body during your pregnancy, help prepare you for labor and delivery, and serve as your guide to help you return to whatever goals you have set for yourself postpartum. We believe every single pregnant person should be seen by a pelvic floor physical therapist during every pregnancy and following the birth of every baby. Just as physical therapy is recommended following knee surgery, we believe pelvic floor physical therapy should be the standard of care for every pregnant person.

How does it work?

Pelvic floor physical therapy works by helping patients better understand how their everyday habits can affect their core and pelvic floor. We spend a lot of time talking about the importance of coordinating breath with the pelvic floor, how to properly manage intra-abdominal pressures during everyday activities and with exercise, educating on the importance of proper toileting habits, and teaching exercises specific to each of our patients' individual goals and abilities.

Pelvic floor physical therapy takes a look at the whole body and how the entire system is working. This includes an assessment of posture, flexibility, strength, and pelvic floor muscle strength. We believe an examination of the pelvic floor needs to be done internally to properly assess and address any dysfunction that may be present. With consideration to any prior trauma, and patient consent, this is done intravaginally or intrarectally depending on the patient's symptom presentation. This comprehensive examination gives us all of the information we need to create a treatment plan that gives each of our patients the keys to managing their individual dysfunction and symptoms.

What can someone expect from a PT session at Empower?

You can expect to have your story heard and your concerns addressed. You will have a full hour with your physical therapist who has been specially trained in the evaluation, examination, and treatment of pelvic floor dysfunction. We spend a large amount of time going over your subjective history and your individual symptom presentation before we begin our examination. One of the most important parts of our job is to spend time actually listening to your concerns so we can properly address every issue.

After we have reviewed your personal pelvic floor history, we take a look at your whole body. We will educate you on proper toileting habits, observe how your body moves while you walk, sit, and stand, observe your resting posture, test your flexibility and muscle strength, and then move to an internal assessment of your pelvic floor musculature. As previously mentioned, this is done with consideration of any prior trauma and with patient consent. Before moving internally, an external inspection is performed to observe how the pelvic floor muscles are functioning with voluntary control, to check for external muscle tightness, and to observe the integrity of the skin. The intravaginal or intrarectal assessment is then completed with one gloved finger working through all three layers of pelvic floor musculature checking for any increased muscle tension, observing your ability to voluntarily contract/relax the muscles, and educating you on how to properly coordinate your pelvic floor muscle contraction with your breath.

Who should seek pelvic floor PT?

We feel that every pregnant and postpartum person should seek pelvic floor physical therapy during each pregnancy and following every single delivery. Along with our pregnant and postpartum population, anyone who is experiencing chronic low back, SI, hip, abdominal, or pelvic pain is also a great candidate for pelvic floor PT. We also see patients who are experiencing painful intercourse, chronic constipation, pelvic organ prolapse, urinary/fecal leakage, and so much more. Pelvic floor PT is for every body - young and old, male or female, babies or no babies - we all have a pelvic floor and we all pee, poop, and some of us even have intercourse. We believe all of these things deserve a safe place to be discussed and should not just be easy to perform, but pain-free, to boot.

Some of the most common issues we address at Empower Physical Therapy include:

- low back, SI, hip, abdominal or pelvic pain

- pain with intercourse

- urinary leakage

- pelvic floor heaviness or pressure

- pelvic organ prolapse

- bowel leakage

- constipation

- diastasis recti (abdominal separation)

How much does it cost? Do you take insurance?

The state of Nebraska is a direct access state, meaning you can see a physical therapist without a referral from your doctor. That being said, some insurance companies require a doctor's referral for reimbursement. It is best to call your individual insurance provider to find out if you require a referral for outpatient physical therapy services, or not. Depending on your policy and your individual physical therapy benefits, insurance may cover your pelvic floor physical therapy visits.

At Empower Physical Therapy, we have decided to make a contract with our patients and not with the insurance company. Again, based on your individual insurance policy, our physical therapy services fall under the umbrella of your out-of-network physical therapy benefits. We require payment day of service. Following each visit, we provide our patients with a superbill (receipt) that they can submit to their insurance company. Based on the patient's individual out-of-network physical therapy benefits, their insurance company will reimburse them directly (except for Medicare and Medicaid - Medicaid does not have out-of-network benefits. They would be required to pay out of pocket without any reimbursement). Patients are able to use their HSA/FSA, debit or credit card or check/cash for payment.

Our initial evaluation is $160 and each follow-up visit is $130. Every visit is a full-hour appointment with the physical therapist the entire visit. *prices subject to change

How did you get started in this field and why are you so passionate about it?

We both came out of school with a general orthopedic-based treatment approach, but over the course of treating quite a few patients, we found that something was missing, and we found that the missing piece was addressing their pelvic floor dysfunction. We quickly realized that we can't look at the whole body without addressing the pelvic floor.

Our passion for pelvic floor and pregnancy/postpartum really catapulted once we both became mothers ourselves. We became frustrated with the unsolicited and often harmful information we were given regarding our bodies and our healing process. Whether we've heard or been told that it is "normal" to have pain with sex, or to leak when coughing or sneezing, or to not be able to return to exercise as we knew it after having babies. We know that these “norms”, no matter how common, do not have to be our new normal. It is our mission to dispel these myths and to empower our patients with the knowledge and skills to take control of their bodies. We know the importance of rehabilitating the core and pelvic floor after each pregnancy and we will continue to strive to spread the word.

Go ahead and visit the Empower PT website to learn more, and give them a follow on Facebook and Instagram @empowerpt_lnk. And for some awesome birth stories, come hang out with me on IG @novitabirthstories.

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