Pelvic PT Allison Poole Answers Your Burning Questions

For the next few months I’m going to highlight some great health-related practitioners that we are lucky to have here in Southern Maine. This month I spoke with pelvic floor physical therapist Allison Poole about her work. (edited:) She sees women at Rosemont Wellness Center in Portland and is active on social media as Koru PT & Wellness.  If you are not in Maine, there may still be a pelvic floor PT in your area as it is becoming much more common. 

What are common conditions that you treat with pelvic floor PT?

Pelvic floor PT treats bowel and bladder control issues, pelvic pain, sexual difficulty/pain with sex, chronic UTI-like symptoms, pain and weakness associated with pregnancy, and diastasis recti (the separation of muscle in your abdomen during pregnancy). 

What is one misconception about pelvic floor PT you want to clear up?

That it’s for old ladies- I see women from the time before they get pregnant, during pregnancy through menopause. I also see women whom have never had children. 

Do men ever need pelvic floor therapy?

YES! Men are seen for pelvic floor PT for incontinence, pain, issues after prostate cancer among other things. I am not yet trained in seeing men for pelvic floor dysfunction. 

Is it normal for women to urinate a little while laughing/sneezing/etc after birth or when they are older?

IT IS NEVER NORMAL. It is common - 1 out of 3 women will have pelvic floor dysfunction in their lifetime - but it is never normal to leak. Unfortunately, it is a taboo subject, especially among older women. No one talks about it, even to their doctor. . It takes many women several visits to their doctor before bringing it up.  The bottom line is you don’t have to live with these symptoms, and there are very qualified people that are passionate about what they do to help you lead a more active, healthier (drier) life! 

What are these kegel exercises everyone talks about?

Treating the pelvic floor consists of much more than kegels. Kegels were developed by Arnold Kegel in 1948 as a way to strengthen the pelvic floor after childbirth. It’s an act of tightening and lifting the muscles of your pelvic floor, like you would to stop the flow of urine.. However, it is just one tool, and even after verbal instruction, the majority of women can not perform a kegel correctly. 

There is some controversy on the actual benefits of kegels. Do you think they are ever  appropriate?

Kegels are effective in training your pelvic floor. If someone has been found to have a weak pelvic floor, kegels can be helpful to train the muscles to contract quickly as well as for long holds. Just like if you had a weak leg muscle after surgery or injury, you would do small muscle tightening first, then as it got more coordinated and stronger you would transition to squats and lunges. The same thing applies to the pelvic floor muscles.

Kegels are often prescribed without evaluation as most OB/GYNs and birth professionals are not trained in assessing pelvic floor muscle function. For instance, if a woman is complaining of leaking, the provider may assume it’s weakness, but in many cases it’s because the muscles are too tight and they can’t contract against a sneeze or cough, and there’s incontinence. So, if she does kegels at every stoplight, she would be making her condition worse, not better. 

What are some benefits of using pelvic floor PT before and after birth?

Seeing a PT who specializes in pelvic floor rehab and women’s health, including prenatal and postpartum PT can help in so many ways. Prenatally, women can learn safe exercises for the pelvic floor and core muscles as well as breathing techniques to help prevent or speed recovery after childbirth. PT can help treat pain that develops due to pregnancy, including low back and hip pain, pain at the pelvic bone and throughout the ribcage. PT’s are also trained in educating about proper posture and body mechanics to save your neck and back during pregnancy and during those first weeks postpartum.

After childbirth, regardless of vaginal vs. cesarean birth, PT usually starts after the 6-week check-up. A thorough evaluation would address any issues, including pain, assessment of Diastasis Recti (the separation of the belly muscles during pregnancy), pelvic floor weakness/tone and abdominal/back strength and stability. Goals would be set to address specific issues that woman is experiencing.

Even is a woman is not having specific issues, ideally she should have an evaluation to ensure she will not be making a potential issue worse. For example, doing abdominal exercises like crunches and planks may actually make a diastasis recti split worse. 

Many women do not know what to expect from pelvic floor PT.  Can you discuss the first visit and exam?

An initial evaluation of the pelvic floor can be intimidating for many women. Each evaluation is specific to each person, and sometimes it could be 3 or 4 visits before I assess the pelvic floor directly. I take a thorough medical and birth history and spend a lot of time talking about specific issues you may be experiencing..

After the intake, I check posture, strength of the abdominals, assess for Diastasis Recti and muscle tone/tenderness in the “bike shorts region.”. In the case of a cesarean birth, I also check the scar for sensitivity and mobility. For the pelvic floor assessment, the woman is draped and lying on her back with knees bent, no stirrups. With one finger, I assess tenderness and muscle tone of the vulva, observe you doing a kegel and then assess internally the same things; muscle tone and tenderness as well as the ability to contract and relax the pelvic floor muscles. Finally, I assess for pelvic organ prolapse (descent of the internal organs into the vaginal cavity).

The entire evaluation takes about an hour. I explain the findings and what PT would help with. We make goals together, and I always give something to get started on at home that day. The duration and frequency of appointments is completely individual, and I strive to work around what is realistic for each person. I do not believe in “protocol PT” (ex. 2x/wk x 6wks), but instead what is going to make each person successful in reaching their goals.

Any funny stories about pelvic floor therapy to lighten the conversation :)

To train to become a pelvic floor PT, we have to practice on each other. So on my first day at the Herman & Wallace Institute, I introduced myself to my partner whom I had never met, then within an hour we were on a table performing pelvic floor assessments on each other...it’s quite a way to get to know your colleagues at a whole other level!