Pelvic Floor Rehabilitation Explained

An expert on getting your vagina get back to its former, er, pre-baby self, in terms of tightness – or in case that sounds too porny – the ability to not pee your pants.

The first time we heard a friend casually mention vagina therapy, our minds went all over the place. Is that like a hoo-ha facelift? Does it involve asking your vagina how it really feels? And of course the biggie: Oh God should I be doing that, whatever that is? Turns out it’s a casual term for pelvic floor rehabilitation, which can help your vagina get back to its former, er, self, in terms of tightness – or in case that sounds too porny – the ability to not pee your pants.

So meet our experts: Niva Herzig, the founder of Core Dynamics Physical Therapy in Englewood, New Jersey and her associate Jennifer Byers. They’re basically the pelvic floor fairy godmothers, and withstood our burning (and slightly embarrassing) questions in the interest of a clear, open, and no-secrets guide to something so many women are too shy to ask about. Here’s the deal…

1. How Do I Know If I Need Pelvic Floor Rehabilitation?

If you’re experiencing one or more of the following – treatable! – symptoms: Peeing when you sneeze, pain from a C-section scar or episiotomy, pain (or loss of sensation) during sex, any sort of groin pain that results in difficulty walking, lower back pain, prolapse (when an internal organ drops down from its original place), or similar issues.

2. Am I Being A Diva About My Vagina If I Want To Go?

A LOT of women treat issues like occasional incontinence, aches and pains, or difficulty with sex as just part of their new life as a mom. But that’s not the norm! It’s common, yes, but it’s not how you have to live. There is help!

3. Won’t These Issues Just Get Better With Time?

Sorry to say but the opposite is true. The longer you let pelvic issues go on, the longer you don’t work on any symptoms or treatments, the harder it is to get rid of them. Things become chronic, which makes them more difficult to reverse.

4. Isn’t It Kind Of Embarrassing To Do This?

Niva and Jen hear their patients say over and over: Am I the only one with this problem? Hardly. The fact that pelvic floor clinics exist are proof enough! You’re not alone and there’s nothing to be ashamed of.

5. OK, So, What Exactly Goes On In Pelvic Floor Rehab?

If you’re dealing with peeing your pants all the time… they’ll use techniques to increase your muscle strength and endurance via pelvic exercises (think: holding and resting for specific amounts of time.) They may also use biofeedback, which measures your muscle activity via an internal sensor (think: a smaller version of an ultrasound wand that goes inside you) or surface electrodes – that then reflect what’s going on through a graph on a computer screen. While you might be able to cheat during kegels on your own, you can’t cheat with biofeedback – you see (or hear) when you’re contracting or relaxing. There will also be “homework” exercises like wall squats and step-ups to help coordinate your pelvic floor muscles during daily life.
If you’re dealing with vaginismus (i.e. involuntary tightness during sex)… There will be manual therapy – like stretching and soft-tissue massage down there – to increase pelvic floor muscle flexibility. They also may introduce a dilator, which is exactly what it sounds like – and is used to desensitize via treatment with a gradually increased size as you progress. (Sexy, right?) Biofeedback will also be at play here – you’ll be able to see on the screen what happens while the dilator is inserted. And yes, they will show you sex positions that are best for your pelvic floor. (Think: A personalized, wellness-focused Kama Sutra.) And of course, at-home stretches for your inner thighs and lower back, as well as additional dilator work.

6. Can’t I Just DIY Fix This With A Bunch Of Kegels?

Everyone says to practice Kegels by stopping the flow of urine, but you can achieve that by squeezing lots of other things in your body. You have to learn to isolate the pelvic floor appropriately. So yes, there’s a chance you’re doing them wrong. Also, it’s quality over quantity. So many people are overdoing their Kegels because they think the more the better, but they’re often fatiguing their muscles and making things worse. As Niva says – I would never do 100 kegels – I mean, would you do 100 sit-ups a day?

7. So… How Long Til I Can Sneeze Without Paranoia? (Or Get My Old Sex Life Back)?

You know it’s going to be different for everyone, but Jen and Niva have seen that patients typically see a change in about 6-8 visits – and that they tend to treat patients over the course of 3-6 months.

8. And How Much $$ Are We Talking?

While costs will fluctuate depending on where you live, these appointments will generally run in the $100-$300 family. And yes, as you suspected, they’re always one-on-one. Depending on your insurance situation, a pelvic floor clinic may offer a sliding pay scale or, even if they are out-of-network, be willing to accept assignment on certain insurance plans. If you’ve already met your deductible, some insurances will start to reimburse you for your sessions (usually at 50-100%) under your physical therapy benefits.

9. How Come Nobody Talks About This?

Mom groups talk about the best organic formula, what to do to stop the crying, but it’s not so much about taking care of themselves. We take newborn classes on how to diaper and swaddle, but no one talks about keeping your body healthy, functioning, and pain-free. In an ideal world, women would come in to a pelvic floor clinic at least once during pregnancy and again postpartum, and insurance would cover it all.