I P** When I Sneeze! Advice from a Pelvic Floor Specialist

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Reema Thakkar, PT, DPT and Family

Long before I ever heard the term “pelvic floor” my new mum friends and I would speak in hushed tones (if at all) about 

“accidents” while sneezing or coughing or laughing and issues around post-baby sex. Even now these items can be delicate and embarrassing to discuss,

even with healthcare professionals. I met Reema Thakkar, PT, DPT Professor at Touro College of Health Sciences and One Wellness & Rehabilitation, specializing in wellness for new moms at an event here at the studio for expectant mums hosted by Modi Toys

I was struck by her honesty and humor around this very tricky subject. Her comfort around discussing care during and post-pregnancy was refreshing. I asked her to share some insights for our blog and newsletter. 

Hi Reema- Thanks so much for taking the time to speak with me! As a mom of a two-year-old and a little one due any day now in addition to your certification and experience, you are an amazing resource for mums and mums to be! 

I have loads of questions! Let’s start with all those initials after your name- what does a PT, DPT mean for women seeking help with pelvic floor issues? How did you get onto this specialty?

Hello! PT, DPT is just a bunch of fancy letters saying I did my Doctorate in Physical Therapy and am licensed to practice in New York State and the State of New Jersey. So, I’m a Doctor of Physical Therapy pursuing her WCS (Women’s Health Certified Specialist) qualifications, just to add some letters.

I got into this particular field working with female gymnasts, actually. I had little to no intention of exploring women’s health and was mainly specializing in sports orthopedics post-graduation. It was there that I realized that there was a hole (literally) in our treatment plans as we ignored the anchor of the female body (and male for that reason – because everyone has a pelvis!!) when trying to rehabilitate them. It was here that my curiosity and practice niche stemmed.

When should a woman see someone like you- are there things that you can help with to mitigate pelvic floor issues before the baby arrives?

I usually recommend that women seek out pelvic rehabilitation treatment around their second trimester if they have no previous history of any dysfunction. Of course I always make sure their OBGYN or Midwifery team is on board. This way we can assess the integrity of the pelvic floor during the partum phase, help with any of the discomfort that pregnancy brings and of course guide them to prepare for the labor experience itself.

What are some issues that crop up before giving birth that can be alleviated by seeing a pelvic floor therapist? 

Many women have pelvic complaints even before they decide to get pregnant. This can be in the form of pain with intercourse, discomfort during menstrual cycles, urinary incontinence or leaking. It’s not just pregnancy that brings these on but pregnancy can often exacerbate the pain, which is why we end up seeing more patients this way.

Pelvic Floor Physical Therapists are able to help manage and mitigate this dysfunction but also, our main goal is to help you figure out how to do this at home. Very often I see patients once or twice prior to sending them on their way with the tools needed for successful rehabilitation.

Very often friends will ask- is this or that “normal” after giving birth- my question is- being uncomfortable after having a child is understandable to a point- whether a vaginal birth or a C-section

but what issues occur after birth that would indicate seeing a pelvic floor specialist?

This is a tough question for me because I TRULY believe that we need better post-partum care for mothers. In France and Canada, a 6-week pelvic floor evaluation by a PT is standard practice. Nothing has to “happen” to send you there because the biggest thing HAPPENED ALREADY!!! …..and this goes for C-section deliveries as well. The pelvic floor still carried that uterus for a long time and had relaxin (the protein that allows all of your pelvic ligaments to stretch and get ready for childbirth) run rampant through the body – so it still can use some help.

However since I know it’s unrealistic that everyone will come, I often say that you shouldn’t have any leakage, pain or irritation in the vagina or along the C-section scar by 8 weeks post-delivery. I can even stretch it to 12 weeks if we want to be more conservative. However, that should paint a picture for a lot of the moms out there because I often see people who are carrying 8 month olds and still peeing their pants when they laugh. Not normal or needed – at any age!!

Sex after baby may be one of the most sensitive subjects in this area. Tell me how a pelvic floor specialist can help get intimate relations back on track.

Allowing your pelvic floor muscles and the tissues to heal post-partum is needed and normal but oftem depending on tearing during labor or any sort of stitching that ensued, women stop enjoying sex. In addition, dryness can cause this. This can lead to a lack of sexual appetite overall as well. We can always discuss this in the clinic and then do a thorough assessment to see what the hindrance is. Is it dryness? In which case we can recommend creams and lubrications; or is it tightness from post-operative stitches and healing?. Either way a plan of action can be put in place to combat this ASAP.

Outside of having a child- are there other reasons why a woman would have pelvic floor issues? What situations would warrant seeing you?

So as I’ve mentioned above, any incontinence, pain during menstrual cycles or general pain in the pelvic region, difficulty with bowel movements, painful intercourse are all things that we can address together. As with any musculoskeletal injury, there are varying degrees of help that conventional rehabilitation can do but I have seen pelvic rehab work wonders on all of the above, often coupled with other treatments as needed.

Should readers wish to reach out to you for information how should they reach out?

Since we do not see patients in a single brick and mortar location, the best way to contact me for information or help setting an appointment in your area would be to use the Instagram handle @pelvicdpt and sending me a direct message. At that point, I can always link you to our online portal as well.

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