I’m very excited today to bring you a Q&A with Jen Morgan, my incredible pelvic floor physical therapist who has become Insta-famous for the way she explains pelvic floor issues in an easy-to-digest way. Her bubbly personality mixed with incredible knowledge about the female body is a winning combination that makes it easy to understand her incredible success both locally and online.
I recently started seeing her after some intense round ligament pain and the work we’ve done together has not only helped the pain immensely, but she swears the exercises and all the bouncing I do on my trusty yoga ball will help me have a “breezy” birth. The jury is still out on that one but she hasn’t been wrong yet so my fingers and toes are crossed that she’s right there too.
I asked for your questions on IG last week and got hundreds, so it was hard to narrow them down but I tried to go with the most asked questions for this post. If you had a question that wasn’t answered, ask it in the comments section and I’ll have her answer you there in the next few days.
What is the best way to prepare for birth during pregnancy?
I recommend staying active during your pregnancy. Strengthening has great benefits during this time and can improve your birth experience. During pregnancy, there are a few areas that are most impacted: glutes, hamstrings, core, midback, and pelvic floor. I’d recommend working with a pelvic PT or a fitness pro who specializes in pregnancy/ postpartum to address these areas. During the third trimester, it is important to shift your mindset to focus on lengthening pelvic floor with stretches and potentially perineal massage techniques. These techniques paired with breathing exercises and education on labor and delivery positions can help to decrease risk of 3rd and 4th degree tearing and give you the knowledge to move into your birth experience as prepped as possible.
Are kegels really necessary?
It depends on the person! Kegels are contractions of the pelvic floor muscles and have two different aspects: contract AND relax; think of a bicep curl for your pelvic floor. There are some individuals who have a difficult time localizing these muscles or relaxing these muscles once they are contracted; for these individuals, it may be helpful! However, you would never do 100 bicep curls a day OR ONLY do bicep curls and expect your shoulder function to improve… your pelvic floor muscles & kegels are the same; you cant SOLELY do kegels and think your pelvic floor problems will be solved. It is important to train your pelvic floor functionally within your core canister and not just solely rely on one aspect of pelvic floor rehab.
How soon can you start working on your pelvic floor postpartum?
It is important to focus on recovery after birth. I tell most individuals that you can (& should) start a plan of care with a pelvic health physical therapist around 6 weeks postpartum. However, that does not mean that you need to wait 6 weeks to start activating the muscles challenged during pregnancy: breathing, activating transverse abdominus or pelvic floor muscles; gentle (very gentle) activities.
What are some exercises I can do to avoid pee/sneezing?
This one is a tough one to answer as stress urinary incontinence (or “peezing” for short) is fairly person-specific. Individuals may leak due to a weak pelvic floor, a pelvic floor that is too tight/ doesn’t move well; improper pressure management within our abdomen/ core canister, and external pelvic muscle weaknesses. I would recommend seeing a pelvic PT to figure out what your specific needs are.
I’ve never had a baby but I still “leak” a lot daily! Anything I can do?
This is fairly common! One does not have to have experienced birth to notice pelvic floor issues. See the above answer on stress incontinence.
Should I start pelvic floor PT postpartum or while pregnant?
I LOVE seeing my mamas throughout their pregnancy AND postpartum. During pregnancy, the focus is keeping you strong & pain-free in the first two trimesters and then preparing the pelvic floor and you for birth during the third trimester. Postpartum, we work together to address muscular weaknesses & imbalances and improve your bowel, bladder, & sexual health as well as safely return you to your goals (exercise, strength, etc)
Any tips for repairing diastasis recti?
I’d strongly recommend starting your diastasis recti healing with a pelvic PT as there are many aspects of healing a diastasis. I do have resources for DRA screening and beginning exercises that can be found here.
What can I do for “lightning crotch” pain? I’m 30 weeks pregnant!
Lightening crotch can be fairly common for mamas in the third trimester. That zingy, sharp pain in the vagina can take your breath away. The exact cause can be for a few different reasons, but most can feel that the nerves are involved similar to sciatica or nerve symptoms down your arm. Some individuals do well with strengthening the pelvic region or a support garment like an SI belt or compressive garments. I recommend seeing a pelvic PT to verify the lightning crotch diagnosis and not a different pelvic pain driver and find the best course of treatment for you.
Is it covered by insurance when you’re pregnant?
Pelvic PT is a specialty niche of physical therapy. So depending on the provider you see, if they/ their institution are in-network with your plan, it should be covered. Now, many pelvic PTs are actually out-of-network providers. This means that they may not directly contract with insurance companies and there is an upfront cost to see the PT and you may be able to submit for reimbursement.
There are many reasons a provider would go out of network; speaking from my own experience, I chose to be out of network as insurance companies do not know you. These non-clinical individuals are making decisions, like how many sessions you are allowed, is this even covered for you, should this diagnosis code actually be covered (some insurances dont cover diagnoses like pelvic pain or pain with sex), based on a diagnosis code & your plan details BEFORE your visit. They are not paid to actually care for you & they rarely see your evaluation and objective measures. You deserve more than that, you deserve to remove the middle man-gate keeper from your care.
Are there exercises I can do to avoid tearing during birth?
Look into perineal massage and pelvic-floor muscle stretches for birth-prep paired with breathing! You can find a pelvic PT to aid in this process of preparing for birth!
What to expect during pelvic floor PT appointments!
It may not be the same across the board, but it will probably be similar to what one would experience if they came to see me: first, you’ll fill out some new patient paperwork. Then we sit and chat– you tell your story; unabridged, could be 15 minutes could be 55 minutes— your story is important. Then, we chat pelvic anatomy and asseseement and utilize the pelvic model. This is followed up with the objective tests and measures for your hips, low back, ankles, how you lift & carry, movement screen, breathing assessment, pelvic floor muscle assessment, fascia and scar mobility, and more! The last part & arguably the most important part is the wrap-up. Where we start to put all the pieces together, create a game plan, give you some homework & answer all questions.
It may not be the same across the board, but it will probably be similar to what one would experience if they came to see me: first, you’ll fill out some new patient paperwork. Then we sit and chat– you ; unabridged, could be 15 minutes could be 55 minutes— your story is important. Then, & and utilize the pelvic model. This is followed up the & for your hips, low back, ankles, how you lift & carry, movement screen, breathing assessment, pelvic floor muscle assessment, fascia and scar mobility, and more! The last part & arguably the most important part is the . Where we start to put all the pieces together, create a game plan, give you some homework & answer all questions.
What are your top postpartum recovery exercises?
Everyone’s postpartum rehab needs are different, and we want your postpartum recovery exercise plan to reflect that. A few activities that most mamas benefit from adding in: Hip hinging, transverse abdominus and Oblique activation exercises & diaphragmatic breathing.
What’s the best way to find a pelvic floor PT in my area?
Searching for a pelvic PT can be done via a few different search engines (the one I recommend most is pelvicrehab.com). I actually did an entire post on Instagram on this topic that can be found here. I always recommend asking these screening questions too before booking to make sure they are a good fit for you!
Do you need a doctor referral to see one?
That depends on a few things: where you live, which provider you wish to see / the institution they practice within, and your insurance plan. All 50 states & D.C. have some form of direct access, which means that you do not need a referral to see a physical therapist. Unfortunately, some institutions and insurance companies have not caught up to that legislature and they may require you to have a referral from a doctor. Call the pelvic PT practitioner you wish to see and ask them if they require a referral. For me, I am an out-of-network provider in the state of Connecticut. This means I do not need a referral to see you initially, but I may need one if we wish to have more than 6 visits together and/or if you are submitting to your out-of-network benefits for reimbursement.
Do you do virtual sessions?
100%! I have a newfound LOVE for virtual sessions. They are a great way to connect with individuals from across the country and jumpstart their pelvic health & wellness.
More questions for Jen? Ask below and we’ll get them answered for you! And follow her on Instagram for some great tips that you probably never even knew you needed. If you’re local and pregnant or suffer from any pelvic floor issues, I can’t recommend her enough. You can book appointments with her here.
Photo by Julia Dags.