Katie: Thank you for tuning in to the Well Within Reach podcast. I'm your host, Katie Salwei. And joining me today is physical therapist, Meghan Faloona. Meghan specializes in pelvic floor rehabilitation. Thank you for joining me today, Meghan. Let's start off by getting to know you a little bit. Can you tell our audience about yourself? Like where you went to school? How you chose physical therapy and specifically pelvic floor therapy?

Meghan: Yes. So I went and got my undergrad from Lewis University. I majored in athletic training and I'm a licensed certified athletic trainer. And then I went on to get my doctorate in physical therapy from Governors State University. There wasn't any one specific event that got me interested in pelvic floor therapy. It was more so just as I went through my clinical rotations as part of my schooling, got experience and exposure to a bunch of different fields. And I found that I was very interested in it. It made sense to me. And I knew if I was dealing with some of these symptoms, I would want to have somebody reliable who could fix it. So decided I wanted to become that person.

Katie: Very cool. Yeah, definitely. You know, you kind of know when you know, and that's good to know. So, today, we're going to be talking pelvic floor therapy and a little bit more of how it can be beneficial during pregnancy. And most people know that pregnancy changes a lot of things in the body, including that extra weight that sits on a woman's pelvic floor. So let's start off by asking the obvious, what is the pelvic floor?

Meghan: So the pelvic floor is a group of skeletal muscles that sit on the lower end, the base of the core. It is going to help with controlling the bowel, bladder, sexual function, and then it also helps to keep the organs inside of the body, specifically for females in that case. They are voluntary muscles, which means that we should be able to contract and relax them on command, which is where physical therapy comes into play in that sense.

However, sometimes things can go wrong when the pelvic floor muscles and the brain try to communicate. And then that's when you come to see me.

Katie: Okay. So specifically during pregnancy, what happens or can happen to the pelvic floor?

Meghan: So any woman who's had a baby will be able to tell you things are changing constantly. There's increased pressure happening on the pelvic floor, on the organs, on the back and on the muscles as the baby grows, which can push down on the bladder causing increased urinary frequency and sometimes incontinence, which is the involuntary loss of urine or stool. In addition, it can also cause pelvic pain as muscles experience increased pressure. You're getting increased laxity in the joints as the baby grows to prepare for giving birth and all of that can lead to a lot of pain.

Katie: Well, it definitely seems like that pelvic floor holds up quite a bit for you and you don't even realize it. So a lot of women have more than one pregnancy. So can multiple pregnancies increase that likelihood of having those pelvic floor issues?

Meghan: Yeah, the more babies that are coming through can definitely cause more issues, especially if you don't manage those symptoms in between pregnancies.

Katie: Okay. So speaking of managing those symptoms and things like that, is there anything that a woman can do during pregnancy to strengthen her pelvic floor muscles?

Meghan: So it's contraindicated right now to manually assess pelvic floor function while you're pregnant, but we can still help a pregnant patient learn how to help control pelvic floor muscles while also addressing those weekly changes that are occurring throughout your pregnancy. It can be done through exercise, breathing techniques, and then soft tissue mobilization as well to help manage pain.

Katie: Are there any activities or things that could make things worse?

Meghan: You should always check with your doctor before changing up your routine during pregnancy, or if you're trying to become pregnant, it's just good to have that communication back and forth. There's always going to be specific cases. There's contraindications to aerobic exercise during pregnancy, which your doctor should discuss with you, or you should ask your doctor if they don't bring it up.

But it's important to note every woman's body is different and every woman's response to their pregnancy is going to be different. So anything that you should avoid is going to kind of depend on you and your pregnancy and how you're feeling.

Katie: Okay. Moving on to types of treatment or therapy. Like what types of treatments or therapies are available to pregnant woman as they prepare for a baby?

Meghan: There's land and aquatic therapy both available to help with the pregnancy and then postpartum pain and mobility that tends to come with the process. I'm working with physicians right now to help pregnant women over to the health and fitness center to utilize the therapy pool, which is warmed salt water.

There's a lot of research to suggest that this is one of the most effective forms of therapy for a pregnant woman, especially with pains, swelling. It's going to help with offloading the baby from your low back. Like I said, it can help with edema and it's going to allow you to slowly work on strength and endurance that tends to get lost in that lovely first trimester when many women are just trying to get through the day with the illness that they're feeling.

Katie: Oh, yeah. There's definitely a lot of aches and pains and feelings and changes that happen during pregnancy. So you mentioned edema, is that another way of saying swelling in your arms and legs?

Meghan: Yes.

Katie: Okay. Just want to make sure. Not necessarily everybody is clinically minded. I want to make sure that everybody gets that piece of it. So how would somebody get an appointment or do they need a referral in order to be seen by a therapist or by you?

Meghan: So at this time, Riverside does require a physician or if you see a physician assistant or a nurse practitioner as your primary care provider, we require a referral from them in order to receive physical therapy services. Now, if you're pregnant or postpartum, that can also be from your OB-GYN, of course.

You can simply call your doctor's office and ask if they want to see you before they refer you for physical therapy. They might want to check in with you first. But if you're somebody who's been seeing your doctor frequently and they know this is something that's been going on, this is a service that you can request as well.

Katie: And along with that, Riverside has a few different locations where we've got pelvic floor therapy. Can you talk about where those locations are?

Meghan: At this time, you can find a pelvic floor therapist at the Pelvic Floor Clinic in the Hospital Pavilion up on the sixth floor, in Manteno and Frankfurt.

Katie: Okay. So we've got Riverside Medical Center's Pavilion, which Megan said it was the sixth floor and then our primary care location in Manteno also has got physical therapy-- pelvic floor physical therapy, I should clarify. And then, Frankfurt and Frankfurt is newer, right? We just started pelvic floor clinic there?

Meghan: Yes, actually just in the last year, Frankfurt started offering general physical therapy and then this year, we started offering pelvic floor therapy.

Katie: Okay. It's so nice to have those additional services. So we talked all about pelvic floor therapy and   pregnancy stuff. Is there anything else that we may have missed that you wanted to mention?

Meghan: Well, I understand that a lot of women are uncomfortable trying anything new during a pregnancy. Certainly, if they're high-risk or they're just not having a great time with their pregnancy, they don't want to add anything new to their daily routine, which is understandable. But I do urge you to ask your doctor about physical therapy after the baby is born.

My own personal goal with pelvic floor therapy is to help create a standard that all women are seeing a pelvic floor therapist six to eight weeks postpartum once they're cleared with their physician. Of course, this is if their physician approves of that, but this will allow us to address DRA, which is a separation of the abdominals that occurs with pregnancy a lot of the time. We can address pelvic floor dysfunction, such as incontinence, losing your urine with coughing, sneezing, laughing and then pain in the pelvic area that lasts longer than necessarily should be.

This field is constantly growing and changing as we learn more about the body during pregnancy and postpartum. And unfortunately, the research is a little bit limited at this time due to the sensitive nature of treatments, but we're making sure that we're as conservative as possible in helping new moms get through this as best as they can.

Katie: Yeah. I really liked the idea of having it kind of be a standard piece of practice to visit a PT six to eight weeks after postpartum, because I know personally I've got three kids and yeah, man, that changes things and it's not always easy and almost kind of seems a little uncomfortable to admit that you might need or have something going on that somebody could help you with, like a therapist could help you with. And so I think that would be a great piece to incorporate. I really like that idea.

Meghan: Absolutely. And it shouldn't be a thing that anybody is ashamed of. This is something that most, I will never say all because there's always going to be the exception to the rule, but most women are experiencing increased pain or discomfort or back pain, or they're having headaches and posture problems with a new baby. I mean, there's all kinds of things that come along with it that we can help you treat.

Katie: Well, thank you so much for all this information today and for joining us, Meghan.

Meghan: Thank you so much.

Katie: Thank you for tuning in to the Well Within Reach podcast with pelvic floor therapist, Meghan Faloona and your host, Katie Salwei.

To learn more about Riverside's therapy and rehabilitation services, visit RiversideHealthcare.org.