To Perineum Massage or Not to Perineum Massage?

To Perineum Massage or Not to Perineum Massage? 

That is the question. 

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Hey, Tranquility Tribe!  If you’ve ever wondered about your pelvic floor health and whether or not you should see a pelvic floor physical therapist, this episode is for you!  Today, Hehe talks to Mandy Rempfer-Kuncio, a pelvic health physical therapist and a doula from Canada, all about the ins and outs of pelvic health.

Why pelvic health physical therapy?

As Mandy explains, physical therapists are dedicated to the science of human movement and function.  The pelvis plays a very important role at all times during a person’s life, and especially during the pregnancy, birth, and postpartum periods for women.  Did you know that by the age of 60, one in two women who have had a baby will have bladder leakage or develop some degree of pelvic prolapse?  These pelvic issues are common, but that doesn’t mean they are normal or optimal!  It is very important to prepare your pelvis for birth and maintain good pelvic health throughout your life, and a pelvic floor physical therapist is a great tool to help you do so. 

You may find that the support of PFPTs by other providers varies.  PFPTs are often a controversial subject because the majority of the existing scientific studies that have been conducted do not show obvious benefits for seeing a PFPT.  However, much of the research is focused on the prevalence of perineal injury during birth, rather than many of the other potential benefits that seeing a PFPT can offer, and studies have indicated very little risk from receiving perineal massages and doing other pelvic floor work.  At the very least, seeing a PFPT can help you get more in touch with your body, which can bring benefits to anybody, especially women who are expecting. 

According to Mandy, there are three most common types of pelvic floors that she sees when working with patients.  Some patients have normal pelvic floors and just need to work on maintaining the balance of strength and relaxation in their pelvis.  Others have weak pelvic floors and often experience bladder leakage or an inability to control gas.  The third group have tight pelvic floors that hold extra tension even when they are at rest.  Mandy explains that those individuals with tight pelvic floors can benefit the most from seeing a PFPT, especially if you are pregnant, because your pelvic floor needs to be able to relax during the birthing process.  Your pelvic floor type can also influence your sex life – if your pelvic floor is too tight, sex might be uncomfortable or even painful.  Massaging and stretching your pelvic floor can help prepare you for birth and sex and enable you to maintain a healthy life in general.

Pain is not normal

In today’s society, people are often encouraged to push through pain and even ignore the fact that something may be wrong with their bodies.  As we have adopted an increasingly sedentary lifestyle, Mandy says that the number of people with tight pelvic floors has gotten higher and higher.  Society’s belief that pain makes you stronger makes it hard for you to be in touch with the natural processes that your body goes through during birth because you aren’t as used to listening to your body.  Having a tight pelvic floor can further complicate things by causing you to feel pain throughout your pregnancy, during your birth, and even in the postpartum stage, which many women feel pressured to ignore. 

But as both Mandy and Hehe point out, pain is never normal!  Pain can be natural, but regardless of its cause, it merits further investigation.  You do not need to power through pain; rather, you should see pain as an indication that something is up with your body and reach out to friends, family, or practitioners for support. 

The inside scoop on seeing a PFPT

When Mandy meets with a patient, she is focused on figuring out how their pelvis integrates with the rest of their body.  Most often, patients often come to Mandy because they have pain or functional issues such as leakage, or they are dealing with diastasis recti.  As Mandy explains, the vast majority of the exam is external – it is important to understand how parts of your body such as your spine interact with your pelvis.  However, because the pelvic floor is an internal structure, an internal exam is necessary to really see how it is working.  Many PFPTs use their fingers to do the exams rather than a speculum, which allows them to go at a pace that keeps their patient as comfortable as possible, especially for those who may not be very familiar with that area of their body. 

For those who are pregnant, Mandy recommends first seeing a PFPT around 20-24 weeks to establish your pelvic floor baseline and identify challenges that need to be addressed.  Women should visit their PFPTs again around 32-36 weeks to focus more on specific birth preparation.  Perhaps most importantly, Mandy also recommends women to check in with their PFPTs 6 weeks postpartum, even if they are not having any issues, just to see how their pelvic floor is doing after the birth.  In many women, pelvic floor symptoms that stem from giving birth may not arise until menopause, so even if you are symptom-free at 6 weeks postpartum, it is important to visit your PFPT. 

If you are going to see a PFPT for the first time, Mandy recommends going alone rather than bringing your partner.  Because it’s often a new experience for people, it is important to start physical therapy on your own so that you have a sense of the amount of pressure required to give your pelvic floor a sufficient but not painful stretch.  However, as Hehe points out, once you have a good understanding of your own pelvic floor physical therapy, having your partner help you with perineal massages and other PT can be good practice for developing communication skills that will come in handy during your birth. 

If you are thinking about seeing a PFPT but are still on the fence or feeling a little uncomfortable, you can do your own mini pelvic floor exam at home!  As Mandy explains, you can get a sense of your pelvic floor health by inserting one finger vaginally and doing a kegel.  According to Mandy, you should feel a squeeze and a lift, rather than pressure down towards your hand.  If you feel pressure, that may be an indication that you should visit your PFPT.  And even if you feel that squeeze and lift, you should still go see your PFPT to make sure that everything is in good shape (especially because PFPTs are specially trained to support pelvic health)!

Mandy’s postpartum advice

Mandy is full of pelvic floor advice, especially for those of you who just had a baby!  She points out that although incontinence can be a sign that your pelvic health needs some attention, it is entirely normal to experience some incontinence during the first 4-6 weeks postpartum.  After all, your bladder suddenly has much more space to bounce around than it did when you were pregnant!  In order to help get your bladder back to normal, Mandy stresses the importance on peeing often (every 2-3 hours), rather than holding it in.  And if you aren’t noticing that your incontinence is decreasing over time or you are still experiencing incontinence by 6 weeks, that’s a sign that you should get it checked out. 

As far as the hot topic of postpartum kegels, Mandy says they aren’t for everyone.  While some women find that their pelvic floor is weaker after birth, others may develop tightness in their pelvic floor, and doing kegels will only increase that tightness.  It’s important to check in with your practitioner before doing any sort of exercise after birth.

If you want to hear more from Mandy, visit her practice website at nurtureher.ca, where you can find her blog, online classes, and even a video explaining how to do a perineal massage!  You can also find Mandy on Facebook at Nurture Her as well as on Instagram at @core.believers.

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Written by our Guest Blogger, Kyra Shreeve. She is a Biochemistry, Health Policy, and Music student at Brandeis University.