There are so many changes that happen in the body during pregnancy and birth. One of the biggest - but least talked about - is the stress that growing a baby places on the pelvic floor, an underrated and super important part of our bodies.
In some countries, care for the pelvic floor with a physical therapist is automatic following birth (looking at you, France). But in the US, it’s not very common for OBs to refer all - or even most - of their postpartum patients to a pelvic floor specialist. That means that unless parents already know about this option, many people end up with treatable conditions after birth that keep worsening because they aren’t getting the help they need.
In Orange County and Long Beach, some OBs (and many midwives) recommend pelvic floor PT, but it’s still something that’s not quite a household term.
To help bring some light to this important treatment option, we interviewed Melia Perrizo, a pelvic floor physical therapist practicing in San Clemente. Melia has such a calming presence, and we’re so glad she’s around to help our clients during and after pregnancy!
We asked Melia some of the most common questions we hear from our clients when we talk with them about pelvic floor PT. We hope you enjoy learning more about Melia and her practice - and maybe even a little something about the pelvic floor you didn’t already know!
Tell us a bit about yourself, and what led you to become a physical therapist. How did you come to specialize in pelvic floor physical therapy?
I am a mom of two, live locally in San Clemente, and have been a physical therapist for 13 years. I opened my own practice about three years ago. I knew from an early age that I wanted to be a physical therapist. In high school I fractured my leg playing competitive soccer and went through rehab. I had a great support team that pushed me towards exploring this profession.
I began my career with doing a year-long post-professional residency in orthopedics and gained my Orthopedic Clinical Specialist (OCS) title, which meant I was seeing a broad range of patients for athletic injuries, overuse injuries, and post surgery.
I began to see a similarity in the women I was treating for low back pain that included complaints about pelvic pain, leaking urine, or prolapse symptoms. And as I started to pursue the world of pelvic floor physical therapy, I realized how interconnected all of these issues were. And now more than ever, I see the importance for routine postpartum care to include pelvic floor PT.
Let’s get super basic for a minute: what exactly is the pelvic floor, and why is it so important when it comes to pregnancy, birth, and birth recovery?
The pelvic floor is a group of muscles, ligaments, and fascia that act as a sling to support your lower organs. (Fascia is the connective tissue that separates, covers, and supports muscles and organs throughout the whole body - many people can visually associate it with the white web-like stuff that you would pull off of chicken meat that you are eating.) The pelvic floor also helps with bowel and bladder control, stability for the joints of the pelvis and spine, and assists with sexual function. Basically, it sits at the bottom of your pelvis and acts as a nice bowl to support all of these things.
During pregnancy and birth the pelvic floor can become weak and overstretched, but for good reason. As your baby grows, your pelvic floor needs to make room for baby to keep developing. It also needs to allow baby to pass through the pelvis and birth canal during labor.
Issues can arise postpartum when those tissues are not given enough time to heal, or are not able to heal properly because of possible traumas that occurred during birth. The body needs to be able to have this support system “come back on” in order to have all of the above mentioned functions begin to work properly again.
How would someone know that they needed extra support for their pelvic floor with a physical therapist?
Pelvic floor dysfunction can present in many different ways. And I have to say that I have treated many young women who have never had kids, so it does not only happen to people who have been pregnant.
Listed below are some of the typical presentations of pelvic floor dysfunction. Signs and symptoms can include:
Stress incontinence: leaking urine during coughing, sneezing, laughing, intercourse, jumping, jump roping, trampoline use, running or other activities
Urinary urgency/frequency: feeling the need to go often, going frequently (4-6x/day is normal), incomplete bladder emptying, pain with urination, or increased nighttime urination (1-2x/night is normal)
Prolapse: Feeling of pelvic heaviness or feeling of something in your vaginal canal, especially during or after lifting or exercising. The bladder, uterus, or colon can prolapse down into the vaginal canal where you can sometimes feel it and/or see it
Pelvic pain: pain with intercourse, use of tampons, sitting, pelvic exams, etc.
Contributing factors include:
Separation of abdominals (diastasis recti): During pregnancy your rectus abdominis muscle (think the “six pack” abdominals) begin to separate from each other in order to make room for baby. The issue arises when the right and left side of the muscle do not come back to midline postpartum. Many people will notice that they see a “doming” or “tenting” that occurs when they do a sit up type of position. This is because the abdominal tissue in the middle (linea alba) has thinned and can not hold the abdominal contents as well.
Constipation: Continuous pressure down on the pelvic floor from bearing down during difficult bowel movements can lead to weakening of the pelvic floor. And a continuously full colon can put extra pressure on the pelvic organs as well.
Tell us more about the work you do with parents who are excited to get back to their fitness routine after birth. Are there any broad pieces of advice you want to offer on this topic?
This is one of my favorite things to address with my postpartum clients. I want to give them the knowledge that going back to their fitness routine too soon can be problematic to their pelvic floor and “core,” but that with some proper guidance they can return to activity and fitness safely.
I would love if every new mom was able to see a pelvic floor physical therapist before resuming fitness activities. This way guidance can be offered for a safe return.
Does pelvic floor physical therapy benefit only parents who give birth vaginally, or can parents who birth by cesarean benefit too?
Absolutely, parents who birth by cesarean can definitely benefit from pelvic floor physical therapy! The low abdominal incision that is performed can be disruptive to the fascial tension system and ability to recruit the core muscles correctly. This can lead to pelvic floor dysfunction such as incontinence and urgency/frequency.
It is very common to see scar tissue that impedes the body’s ability to recruit the lower abdominal muscles correctly. Receiving scar tissue mobilization and soft tissue mobilization with a pelvic floor physical therapist is very important for parents who birthed by cesarean.
Is pelvic floor physical therapy something people should turn to when they’re experiencing symptoms, or is it more valuable to receive regular care?
If someone is currently experiencing symptoms I would definitely recommend seeing a pelvic floor specialist. But I also highly recommend that women who are trying to conceive, are currently pregnant, or are newly postpartum should be receiving pelvic floor physical therapy. If they are not experiencing symptoms during these times, then 3-6 visits would be appropriate for them. Or during pregnancy once a month visits can also be very helpful. This allows clients to gain valuable knowledge for the next stage that’s approaching in regards to the pelvic floor.
Are there any common misconceptions about pelvic floor PT that you want to clear up?
So one of the biggest misconceptions about pelvic floor PT is that our only treatment technique is to give 1000 Kegel’s to make everything better. We have so much more to offer than just squeeze every time you stop at a red light! And one of the big problems is that not everyone should even be doing Kegel’s! Every person has a different body, birth story, and medical history, and to broadly prescribe these exercises to everyone is very misguided. Some of the women I see actually have too much tone in their pelvic floor and doing more Kegel’s is just adding to the problem. So instead, I am guiding them through relaxation techniques and having them down-regulate their pelvic floor. This is why it is important to be assessed by a pelvic floor PT before you start doing something you read online or heard from a friend, because everyone has a different story and different needs.
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"Every person has a different body, birth story, and medical history, and to broadly prescribe Kegels to everyone is very misguided.”
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Walk us through a typical visit with you. What can a new client expect for their first session? Is it different for pregnancy versus postpartum care?
An initial evaluation from me would include finding out about your medical history, pregnancy/birth history, voiding habits, diet, lifestyle and goals. An exam would be performed in order to assess your posture, body mechanics, range of motion, strength, flexibility, recruitment, and breathing patterns. I also perform an internal exam to determine exactly what is happening at your pelvic floor, such as if there are prolapse signs, how well you can turn on and off your pelvic floor, and if there is pain associated with the exam.
A typical visit would include a reassessment of symptoms, breath work, reeducating faulty movement patterns, core and trunk stabilization, visceral (organ) mobilization, and perhaps some internal work. I will rarely perform any internal work on a pregnant person unless I have clearance from their physician, otherwise the session would look very similar.
Do you also treat people who aren’t pregnant or postpartum?
Yes! I mentioned this earlier as well, but there are many people who experience pelvic floor symptoms that have never been pregnant or given birth. Typically it is a pressure management problem, meaning that they are using compensatory movement patterns in their core muscles causing increased pressure to their pelvic floor.
And I do still treat men, women and children for orthopedic conditions as well, though I’m always asking about pelvic floor symptoms from them too!
Is it ever too late for someone to see a pelvic floor PT for pregnancy or birth related issues?
No, postpartum is forever! I have clients going through menopause that I am treating for prior pelvic floor issues. You can still make positive changes no matter how far postpartum you are.
Does insurance cover this treatment?
Health insurance will cover pelvic floor physical therapy, though many of us pelvic floor PTs have chosen to go out of network with most insurance companies because we need more than 15-20 minutes to spend with you (which is all that a typical in-network PT visit would allow). You’ll find that most pelvic floor PT appointments are an hour long because we really do need that kind of time to make changes. Many PTs will give a superbill to the patient for them to turn into their insurance company to get reimbursed.
Call your insurance company if you want to learn more about what they will cover. You should also be able to get reimbursement from an FSA/HSA if you have one and if your health insurance won’t cover the cost. You can learn more about insurance coverage and pricing for my services here.
What is your favorite part of your job?
My favorite part of the job is seeing my clients get back to their lives with so much more confidence! Whether that is returning to fitness without leaking or having intimacy with their partner without pain, it’s such a rewarding part of the job to hear the joy they have found again in their lives.
Oh, and to get to cuddle with some of the newborns that my newly postpartum clients bring in!
Melia’s contact information
Melia Perrizo Physical Therapy
33161 Camino Capistrano Ste C
San Juan Capistrano, CA 92675
(Melia’s studio is located within her new business KOR Physical Therapy and Wellness in the Esplanade building)
Follow Melia on Instagram and Facebook