Do I need Pelvic Floor Therapy? An interview with Pelvic Floor Therapist Lindsey Vestal

When I had my baby, I was absolutely shocked by how little I had known about my inner core. Yes, I had been a ballet dancer and I had worked on my inner core, but I didn’t have a real understanding of the muscles. Like many women, I never gave my pelvic floor much thought until after I had my baby. This is a main reason that I became certified in postnatal fitness.

In my work as a postnatal personal trainer, I have experienced quite a few women who were experiencing issues, like incontinence, gas, hernias and more that needed more attention than a workout was able to give them. In these circumstances, I suggest that my clients see a Pelvic Floor Therapist. I was excited to get to pick the brain of Pelvic Floor Therapist Lindsey Vestal. Lindsey has dedicated her career to empowering women to find relief from conditions such as bowel and urinary incontinence, constipation, dyspareunia, pelvic pain, prolapse and pre and postnatal complications. Lindsey earned a Master’s of Science in Occupational Therapy from NYU and is the founder of The Functional Pelvis, a private practice specializing in pelvic floor therapy for pre and postnatal women.

As Lindsey and I discussed her practice, we both agreed that women deserve more education about the pelvic floor regardless of whether or not they just had a baby. Lindsey is incredibly knowledgeable and I am delighted to share our conversation with you.

What exactly does the pelvic floor do?

The pelvic floor is a crucial component of the inner core, which is comprised of the transverse abdominus, diaphragm, pelvic floor and multifidus. These muscles are the focus of most postpartum rehab work. Lindsey calls these muscles the ‘Core 4’.

The Pelvic Floor has 3 main functions:

  1. Elimination. Of both the bowel and bladder. This includes both full elimination and also holding waste in.

  2. Intimacy. The pelvic floor should support comfortable, pleasurable sex.

  3. Support. The pelvic floor supports the bladder, rectum and uterus.

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Why might I need pelvic floor therapy?

Lindsey argues that any woman who has had a baby should go in for at least one visit. When you are pregnant the curvature of your spine changes, your blood volume increases by 40%, your organs move and your vagina muscle stretches to 250 times its normal length. These changes under any other circumstances would no doubt warrant a visit to a physical therapist.

What is pelvic floor therapy?

Pelvic floor therapy is physical therapy focused on bringing understanding to, coordination and control over the inner core muscles.

What are some larger conditions that could be improved with Pelvic Floor Therapy?

Women often seek out pelvic floor therapy if they are experiencing:

  • Pelvic pain

  • Back pain

  • Problems holding in urine or bowel movements

  • Problems fully eliminating urine or bowel movements

  • Urge to empty your bladder more than once every 2-4 hours

  • Discomfort around C-section or perineum scar

  • Gas control issues

  • Pelvic organ prolapse

Can you do preventative pelvic floor therapy?

Yes! Lindsey tells me that there is a strong argument for doing pelvic floor work before having a baby. Women often wait until there is a big problem to visit a pelvic floor therapist, at which point the work may become more difficult. Not only does Lindsey help pregnant women connect to their pelvic floor to help support the growing baby and fluids, she also helps women prepare for childbirth. In a birth prep session, Lindsey will place pregnant mamas in common or desired birthing positions and assess whether the body is relaxed or clenched (relaxed is ideal for birth) through biofeedback.  

What can we do on a broader level to educate women about the pelvic floor?

Lindsey and I agreed that women deserve a deeper understanding of their pelvic floor regardless of whether or not they have just given birth. Lindsey tells me that it is important to remember that pelvic floor therapy is much more complex than mindlessly doing kegels. She points to the importance of working the entire inner core apparatus as a whole, as well as mindfully performing exercises within a full range of movement and visiting a specialist to understand your specific needs.

What can you expect from a pelvic floor therapy session?

If you work with Lindsey, your first appointment will be a detailed pelvic floor evaluation.  This includes a review of your medical history, discussion of your current issues and a physical examination. When examining the pelvic floor muscles, Lindsey is looking for coordination, ability to contract and relax the muscles as well as examining c-section or perineum scars. After, Lindsey is able to give each woman an individualized report of what is happening in her body and what this means for day-to-day activities and also for exercise.

Lindsey may see a woman once or will possibly work with her for 5- 10 more sessions, depending on the woman. Future individually tailored sessions may include: biofeedback (an instrument that gives you visible feedback to help you understand how well your pelvic muscles are working), exercises to restore and strengthen your pelvic floor, abdominal and other supporting muscle systems, behavior and activity modifications, assessing your dietary habits -- all culminating with a strong understanding of how you have the ability to take control over your most basic of human functions.

How to work with Lindsey? If you are in New York City, you can set up an appointment by emailing Lindsey also offers digital sessions where she will meet you via Zoom, Facetime or Skype. Just like with in-person sessions, you will fill out extensive paperwork ahead of time and most of her questions during the initial meeting revolve around what she discovered in the forms. You will receive tangible homework (including exercises via an app featuring Lindsey’s specific protocols). She will be in touch between sessions and then usually meet again in 1-2 weeks to touch base on what has been happening since the last meeting. We’ll review the exercises via video and make adjustments as needed. Lindsey’s sessions qualify for tax-free Flexible Spending Accounts.