Pelvic Floor Health: An Interview with my Physical Therapist

My road back to running postpartum has been a rocky one, filled with starts and stops. I started back too soon (three weeks postpartum) but put the brakes on when I realized I could have a prolapsed bladder. Thankfully there was no prolapse, but I did enough research to realize that if I continued running I could very easily cause damage that would affect my running for years to come. So I stopped, made an appointment with a physical therapist who specializes in pelvic floor rehabilitation and took an approach I rarely take: slow. I am currently 17 weeks postpartum and running. I am in a much better place physically than I was a few months ago thanks in part to my Physical Therapist, Cristin Zaimes DPT. I've found her knowledge of pelvic floor health and skill as a physical therapist extremely helpful. I am I recently had the chance to speak with her about pelvic floor health, here is what she had to say:

RunFarGirl: What are some of the major signs of a weak pelvic floor and the supporting muscles?

Cristin Zaimes DPT: Urinary leakage, a feeling of heaviness, fullness, falling out in the pelvic floor, an inability to isolate the pelvic floor to contract. Another common pelvic floor dysfunction is spasm, short tight and painful muscles internally.  If you have any tearing, pain with intercourse, constipation, urinary urgency, an inability to perform a Kegel contraction, your pelvic floor may be strained and not just weak.  Imagine you pulled a muscle.  Pure strengthening of that muscle will not be effective because of injury.  Special attention to the specific injury is necessary and a completely different pathway than strengthening.  This is the area of my work that patients and providers are not familiar with. 

RunFarGirl: Pelvic floor health/strength is so important, but seems to go largely ignored by women and their health care providers. Why do you think this is the case?

Cristin Zaimes DPT: I think it is a multi-layered problem which begins with an older philosophy that these problems are a normal part of being a woman, having babies or aging.  Let’s be honest, if it was happening to men, the thought process would be different.  Also, our culture is not very supportive of preventative care overall.  Fix it with a pill or surgery is often preferred.  We don’t have time for slow and healthy.  Many providers mention “Kegel” exercises but fail to understand the complexity of a healthy functioning bladder, bowel and musculoskeletal system.  Individualized treatment by a professional, even for 2-3 visits, can be very beneficial. Part of the blame I think is on us as Moms and women.  We are so hyper-focused on the new baby, our growing kids, the extended family etc.  Everyone else comes first and we struggle to prioritize our health and needs.

RunFarGirl: What prompted you to open your own practice and specialize in pelvic floor rehabilitation?

Cristin Zaimes DPT: I specialized in general orthopedics and treated mostly spine and pelvis.  I myself have a lifelong back injury and this area of specialty always captured my attention.  I loved the puzzle and complexity of the dysfunction.  However, there were many patients, women in particular, that were not very responsive to treatment.  It seemed to me there was a big piece of the puzzle missing.  This feeling lead me to investigate the pelvic floor as another piece of the puzzle.  Once I had 2 children myself, it was very obvious of this connection and I began to study this area in more detail.  I believe my treatments were much more effective when incorporating specific pelvic floor rehabilitation.  Pelvic floor therapy  is widely misunderstood by patients and provider and under referred.  I see what happens to women when untreated for 10-20 years and believe that women deserve to better understand their bodies and what can be done to help themselves.  I am very passionate about this subject and truly enjoy my job. 

I opened my own practice after becoming increasingly frustrated with the bigger hospital systems focus on the dollar and the corporate restraints which I believe effected quality.  I have always envisioned opening my own practice.

RunFarGirl: In your opinion is running during pregnancy (even in the late stages) a good choice in terms of pelvic floor health? What would you recommend for women who want to run up until their due date?

Cristin Zaimes DPT: This would be such a great research study but unfortunately there is not great data.  The pressure and strain on the internal system is great at this point.  I think that the risk for damage is increased.  The same is for an early return when your body is still healing.  I think it is very individual though and some women can handle this better than others.  Depending on your physical state, the stress of running as an activity is varied. 

RunFarGirl: What recommendations/guidelines regarding intensity, duration and frequency do you have for a runner or active woman who wants to return to her activity/running after having a baby? 

Cristin Zaimes DPT: Again, I think that the recovery is varied but in general 6-8 weeks.  This is normal human healing time.  If you have been a lifelong runner and this is an easy activity, a return prior to that at an easy pace may be OK.  Now, most runners I know and have worked with, have a love/obsession with running that they find hard to quit.  Even for a short time.  I love the dedication to personal health but sometimes the need to run overrides the process of healing.  Having a baby is very traumatic to the body.  This process is not well-respected by our culture.  Hospital stays are short, maternity leave is often not paid and short and the expectation to return like nothing ever happened is frustrating to me.  When you look at the cultural differences to delivery and postpartum care, the difference is astounding.  I try to encourage women to get in touch with their body and the markers of healing.  Respect the healing process and the traumatic event that just occurred.  Enjoy the baby and go slow.  The result is a healthy, strong return to running. 

RunFarGirl: How much time and how often should active women be devoting to strengthening their pelvic floor?

Cristin Zaimes DPT: It can easily be worked into your daily life.  Generally, 2 minutes 2-3x/day initially.  Then I recommend using fatigue as a guide rather than a number of reps. 

RunFarGirl: How can PT be beneficial and when would you recommend women seek out help?

Cristin Zaimes DPT:   I think most women are not sure if they are isolating the pelvic floor correctly.  PT can also help you understand which deep core muscles are synergistic muscles to the pelvic floor and are damaged with a normal healthy pregnancy. These muscles are stretched, strained and no longer function as before and require a neurological “re-set”  to return to normal.  Many people are asymmetrical, and the pelvic floor cannot function at optimal strength.   I look at all of these factors to help you return to your pre-baby strength.  Basic strengthening will help some but it is not individualized.  If symmetry and proper strength is not a returned, you will be at risk for back pain, disc herniations, hip bursitis, and many other orthopedic conditions that stem from a poor functioning core. 

Cristin Zaimes DPT specializes in pelvic floor rehabilitation at her practice Oceanside Physical Therapy in Stratham, NH.

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