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Pelvic Floor Therapy Guest Post

Today we have Katie Bacarella, PT, DPT coming on to share her knowledge about pelvic floor therapy and pregnancy.


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Pelvic floor physical therapy has become a household name over the last few years, but still a lot of people don’t know how it can help them, especially during pregnancy & postpartum. Pelvic floor physical therapy can help manage a lot of symptoms experienced during pregnancy & postpartum.


Who am I?

My name is Katie Bacarella, and I hold my doctorate of physical therapy from the University of Michigan. I’ve been working as a physical therapist for 8.5 years, and specializing in pelvic floor physical therapy for 4.5 years. I own my own clinic, MOVE Physical Therapy, and specialize in pelvic floor, pregnancy & postpartum, return to sport physical therapy and CrossFit rehab. In addition, I also provide pregnancy & postpartum personal training, consultations and coach CrossFit and fitness classes. I have three beautiful

girls with my husband, who owns Light the Fire CrossFit. I CrossFitted through all 3 of my pregnancies and postpartum, including currently almost 4 months postpartum.


Physical Therapy During Pregnancy

Pelvic floor physical therapy can be a tremendous help during pregnancy for treating muscle and joint related issues. Here’s a list of symptoms pelvic floor physical therapy can help with during pregnancy:

- Low back pain

- Pelvic pain

- Pubic Symphysis Dysfunction

- Round ligament pain

- Hip pain

- Urinary incontinence (leaking)

- Frequent urination

- Fecal incontinence

- Pain with sex

- Hemorrhoids

- Constipation

- Diastasis ***side note, diastasis will occur in 100% of full-term pregnancies and that is normal.


Your physical therapist should give your information and guide you in managing the pressure put on your abs during this chapter. This is not an exhaustive list. Pelvic floor physical therapists can also help with labor prep in the 3rd trimester. This can include:

- Stages of labor

- How to keep labor progressing

- Different positions to labor in

- Techniques a partner or birth support person can use to help get through contractions

- Breathing & pushing


When seeking out care for musculoskeletal related symptoms in pregnancy, a pelvic floor physical therapist is ideal to work with over a traditional orthopedic physical therapist. Questions to ask about the provider:

- Have they worked with pregnant women before?

- Do they regularly practice pelvic floor physical therapy?

- Are they trained in internal assessment & treatment techniques?


Physical Therapy in Postpartum

You are postpartum forever – so whether you had a baby in the last year, or decades ago, you’re still postpartum and physical therapy can help! I wish every woman got an automatic referral to pelvic floor physical therapy after having a baby – regardless of whether she’s having symptoms or not. I went to see friends of mine that are pelvic floor PTs after each of my 3 pregnancies, just to get a baseline on my pelvic floor muscle and abdominal muscle health, specific home exercise program guidance and recommendations based on where my body was currently at. One visit was all that I needed for some specific guidance – for some of my patients, they only need 1-3 visits postpartum. Others who may have lingering symptoms, may see me for longer.


Some pelvic floor symptoms are normal in the first 2-4 weeks postpartum, but overall you should find those symptoms are getting better as time goes on. If they’re not, or not improving significantly, pelvic floor physical therapy would likely benefit you. Some symptoms postpartum pelvic floor physical therapy can help address are:

- Low back pain

- Pelvic pain

- Upper/mid back pain from nursing

- Hip pain

- Urinary incontinence (leaking)

- Frequent urination

- Fecal incontinence

- Pain with sex

- Hemorrhoids

- Constipation

- Tailbone pain

- Difficulty engaging your pelvic floor muscles

- Diastasis

- Guidance on returning to exercise in postpartum


Finding a Pelvic Floor Physical Therapist

Pelvic floor physical therapy is a specialty within the field of physical therapy – I highly encourage asking the clinic you’re considering for pelvic floor physical therapy if they have a provider who is specifically trained to do internal pelvic floor muscle assessment and treatment. Some larger physical therapy chains may have pelvic floor physical therapy on their website, but it’s not necessarily available at all locations. Sometimes it can be challenging to find a pelvic floor PT near you – just remember that you may only need one or two visits, so having to drive a little bit for one visit in the grand scheme of things

isn’t too bad. Most of my pelvic floor PT clients, I work with once a week or once every 2-3 weeks. You could also inquire about virtual visits as well. Here’s a couple websites that you can search to find a pelvic floor PT:

- American Physical Therapy Association: https://aptapelvichealth.org/ptlocator/

- Herman & Wallace: https://pelvicrehab.com/


Your Appointment

Pelvic floor physical therapy utilizes physical therapy benefits. If you don’t know your benefits, call the number on the back of your card. Most insurances require a referral from your OBGYN or PCP to cover physical therapy services. Ask your provider for a referral -- pro tip: if they say you don’t need pelvic floor PT at this time, ask them to document that you asked for a referral and they declined. A lot of times, that will change their mind and they’ll hand over the referral. Some therapists own their own clinics and are out of network with certain insurances. At your appointment, your physical therapist will go over your past medical history with you, ask you questions that may seem very personal, assess your

hips/core externally and then provide an internal assessment. I always tell my patients that internal assessments are not mandatory, it just gives me more information about how their pelvic floor is functioning. At any point we can stop the internal assessment if they’re not comfortable, but I’m going to assess the tension in their pelvic floor muscles, ability to contract their pelvic floor muscles and bladder position.


Good Luck!

Hopefully this article gives you a more clear idea how pelvic floor physical therapy can benefit women during pregnancy and postpartum. I think every woman could benefit from pelvic floor physical therapy during these unique and unpredictable chapters in our lives. If you have further questions or want to book with me, you can reach out to me at dr.katie.b.pt@gmail.com, my clinic at moveptmi@gmail.com or call 734-636-0286. Don’t forget to follow me on Instagram and Facebook, and check out the clinic’s website: www.moveptmi.com

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