pelvic floor wellness

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pelvic floor wellness 〰️

This week, I had the privilege of sitting down with pelvic floor therapist, Melissa McEnroe, to dive deep into a topic that so many women don’t talk about enough, our pelvic floor. From our earliest experiences with our bodies and sexuality, through the transformative years of pregnancy and motherhood, and even into the changes of perimenopause and beyond, Melissa shares invaluable insights every woman should hear.

Whether you’re curious about how to better support your pelvic health, looking for tips to prepare for birth, or wondering what signs to watch for as you age, this conversation is packed with knowledge and practical advice to help you feel empowered at every stage of life.

With that, let’s welcome Melissa to the blog!

Tell us a little bit about yourself and the types of patients you typically see.

I am from New Jersey and went to school in Pennsylvania. After school, I did a bit of traveling and did physical therapy in a few different settings. I landed on outpatient therapy and shortly after that focusing on pelvic health. Today, I work with a variety of women. I see some who are older and dealing with incontinence. I am also working with several who are in various stages of pregnancy. I am passionate about helping these women stay active and address any concerns they have along the way.

What exactly does the pelvic floor region consist of?

The pelvic floor is the base or bottom part of your pelvis. So when you are seated in the chair, it starts with the connection of your seat with that chair. There are three different layers of muscles that basically create a hammock in the base of your pelvis and those are responsible for opening and closing your external openings (think bowel and bladder control), supporting those channels, and supporting the organs above it. Basically everything that rests in your lower belly. Your pelvic floor is also intricately connected to the core as well as the muscles of the hip. As a pelvic floor therapist, I focus on the muscles of the pelvis but I also want to see what is going on in the low back, the hips, and the core.

What can you expect in a typical session?

In a typical session, just like any other injury in physical therapy, I want to know what is bringing you in. What questions, concerns, complaints do you have and how it is affecting your day to day. Essentially, what goals do you have. So once the backstory is complete, I will start assessing those areas we discussed before- the hips, low back- looking at strength and mobility there. I will also pay attention to how you breathe. The diaphragm and pelvic floor work in tandem with one another, so I want to see how well your rib cage moves when you breathe. Once I complete this part of the assessment, then we discuss what is involved in an internal exam. This is not something that is required, but something that may be included if appropriate and if given consent by the client. Like any other muscle in the body being rehabbed, we want to know the available range of motion, so the same thing applies to the pelvic floor. I am looking to see that the muscles of the pelvic floor can contract, relax and lengthen. I also want to see if there are specific muscles that may feel sore or tender to touch. We can treat this as we go! But as always, I want my patients to feel totally comfortable with the therapy they are receiving, so the approach to treatment is tailored to their needs and their level of comfort.

For a younger, active women what should they know about their pelvic floor health?

Ahh, I love this question! This is not typically a demographic I work with but it is still super important! You don’t have to be in the pregnancy stage of life to experience discomfort or symptoms related to your pelvic floor. For example, a young active woman could also experience leakage with high intensity activities. What is most accessible when helping these women with their pelvic floor is through breath work. And really just understanding what the pelvic floor is! But breath work is really such an accessible way to get in tune with your body and use it to your advantage, supporting everything you do. So whether it’s teaching them breathing patterns with lifting or exertion activities, or using techniques to help them understand where the pelvic floor is and what it does, I feel like that could go a long way.

Are there preventative exercises or habits women should start early to support long-term pelvic floor function?

Yes! Bowel and bladder habits are huge! The first thing that comes to mind is using a squatty potty when you go to the bathroom. This puts your body in a more optimal position so you are not straining to have a bowel movement. Another way to minimize need for straining is to stay hydrated and make sure you’re getting adequate fiber. Tension within the backside of the pelvic floor is very common, so anyway you can minimize this is going to be helpful! When you’re toileting in any capacity, make sure you are giving yourself time to relax, allowing the pelvic floor to lengthen and fully empty and don’t push.

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Another tip I have is to pay attention to your breathing patterns when you are working out. So whether you are doing pilates or weight lifting, exhaling on exertion is a great go-to. It allows you to be more in tune with your body when you’re working out and helps minimize unintentional breath holding.

What are some common misconceptions about the pelvic floor that you wish every woman knew in her 20s?

Kegels don’t solve all your pelvic floor issues! If you are having pain or leakage, kegels are usually not the answer. And I supplement that by saying, if you want a strong pelvic floor, you have to know how to lengthen it first. This is where breath work again plays a huge role and can help you feel more connected and help you access a more functional range of motion. And there’s so many ways to get that connection to happen!

What changes happen to the pelvic floor during pregnancy, and why is it important to pay attention to it at this stage?

With the growing belly, there will be changes in your center of mass. This will lead to changes in your overall posture, and the position of the rib cage as it relates to your hips and your pelvis. This can obviously led to some discomfort, whether it be across the low back or the front of the pelvis. So being able to maintain mobility in the thoracic spine and the hips is a great place to start. The demand and load through the pelvis will continue to grow through pregnancy so it’s important to utilize strength, mobility and support from surrounding areas and not just the pelvic floor alone.

As it relates to the birthing process, when we start to prepare for birth, it becomes even more important to learn what it feels like to lengthen through the pelvic floor muscles. This can be a challenging but is incredibly helpful in supporting the labor process.

How do you help prepare women for birth?

Right now I have a mix of mommas who are planning for both a medicated and unmedicated birth. Depending on their path, I may vary the education I provide based on their plans, goals and needs. For the ones looking to have a more natural birthing process, there’s going to be a lot of different postures and positions she can work through since she will be able to move around the room. For an epidural, there are still options available, just more limited. They may require more supports to allow them to get comfortable on the bed. But everyone’s birth is so different, there is not one way that is better for the pelvis than another. If you’re comfortable, it works. And I do my best to prepare each mom with options for day of.

What are some good exercises to practice to prepare for birth?

Yes! If you have a physio ball you can do a lot of mobility exercises to make sure the pelvis can move forward and back, side to side. Puppy pose is a good position with or without the support of the ball. If you do this with your feet slightly turned out, this will allow for internal rotation of the hips which helps open the backside of the pelvis. Table top to child’s pose rock backs can open the hips and back side of pelvic floor as well. This is great for those final stages of pregnancy. Deep squats can be great as well, holding onto a supportive structure with your upper body can help facilitate this movement. A grounded side lunge is nice for inner thighs. Exploring a variety of hip mobility exercises and finding what works for you!

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Using a physio ball can help with mobility exercises at you get later into your pregnancy.

Gentle pelvic tilts front to back, or in a circular motion using the physio ball.

What are some safe exercises pregnant women can do to support their pelvic floor and prepare for delivery?

Definitely breathwork and thoracic mobility- including side bending and rotation. There’s a variety of hip stretches that you can do as well, both symmetrical and asymmetrical, all with the goal of trying to relax through the muscles at the base of the pelvis and minimize tension in this space.

Gentle side bending is a great stretch for pregnant mommas.

Optional- using a yoga block for support, rotate from right to left, opening the hips.

Do you know any tricks to help reposition a malpositioned baby?

If a momma is nearing the end of her 3rd trimester and they are told that baby may not be in the optimal position for birth just yet, it can be helpful to do inversions. And I am not talking headstands! As long as your hips are elevated above your head in some capacity, this can be helpful in facilitating baby’s position. This could be something as simple as puppy pose, where your hips are high and your chest is dropped down on the floor. You can elevate this a little more if you kneel on the couch and bring your forearms to the floor. Once you get to that comfortable inversion, hang there for a few breaths and come back out of it.

Puppy pose is a gentle, pregnancy safe inversion that allows your hips to be above you head.

This concludes part one of our conversation with Melissa McEnroe! I hope you are leaving with a deeper understanding of your pelvic floor and how to care for it. But this is just the beginning! Next week, we will be back with part two of our conversation, where Melissa shares her expertise on postpartum recovery, perimenipose and maintaining pelvic floor health into the years after childbirth. Stay tuned- you don’t want to miss it!