Pelvic Floor Therapy: an Interview with Jenny Putt, PT

This week we invited Pelvic Floor therapist, Jenny Putt to join us to talk about her work! Jenny’s enthuseasum and love for all that she does shines through in her writing, and we are so happy to share her knowlege with you today! We hope you enjoy this weeks blog; Pelvic floor therapy : An interview with Jenny Putt, PT

Thanks so much for joining us this week Jenny! Can you tell us about yourself and how you got into physical therapy work, particularly pelvic floor therapy

Coming out of high school I was a math nerd. When I started applying for colleges my major was undeclared. During this process, I sat down with a counselor and was asked about my lack of a decision when it came to what I wanted to do. I explained my love for math to her, but that none of the math professions seemed all that enticing. The counselor asked what else I was interested in, which was soccer, outdoors, friends and family. Somehow with that answer, she suggested I look into physical therapy. I wish I could go back and thank her because she was spot on.

The beginning of my practice

I view the body almost like a math problem. As a physical therapist, I gather data, develop a hypothesis and prove it right or wrong. Everyone’s body is different. Every day I am presented with a new set of problems to solve. I also love to learn and help people, which bodes well for me as a physical therapist. Coming out of physical therapy school, I attended a year-long orthopedic residency to become a certified orthopedic specialist. After working in a few outpatient clinics, I found that the insurance model didn’t treat patients the way I wanted, I wanted more time without restrictions on what I am allowed to do in my appointments, so I ended up opening my practice.

Getting into pelvic floor therapy

I am consistently looking at what’s missing, what isn’t working, and what is needed to improve my ability to help. At one point, I felt like I had a handful of patients with chronic low back or hip pain that had plateaued. It dawned on me that every single one was postmenopausal postpartum women, so I started asking pelvic floor screening questions. They all had at least one pelvic floor symptom. Of course! The pelvic floor is the bottom of the core. How could I completely neglect such a vital component of spinal stability in treating low back and hip pain?! At the same time, I also got pregnant, making the pelvic floor even more relevant to my life. I immediately started the education required to become a pelvic floor physical therapist and actually completed my last training (for now) 10 days before I went into early labor.

The moment you become a pelvic floor physical therapist, you become an advocate for all pelvic floors. Now that I address the pelvic floor in all that I do; I am astonished that pelvic floor assessment and treatment aren’t part of standard physical therapy school. It’s also such a disservice that so few people know about their own pelvic floors. Many live a life full of suffering, because they have no idea there is something to be done about it. It’s baffling how much pre-hab and rehab goes toward an ACL injury, and yet, nothing is done to prepare and restore the pelvic floor after having a kid. It makes absolutely no sense! 

So tell your friends, family, and even strangers that pelvic floor physical therapy is a thing. While you’re at it, we could use quite a few more pelvic floor specialists, if anyone is interested in becoming one 🙂 

What is your pelvic floor?

The pelvic floor comprises a series of muscles that sit within the pelvis like a hammock, extending from tailbone to pubic bone, right to the left. To clarify, all people have pelvic floors. Not just those who identify as female at birth. 

The pelvic floor is a series of muscles. Just like every other muscle in the body, it can be rehabilitated, this means prolapse, incontinence, pelvic pain, hemorrhoids, constipation, inability to orgasm, etc., can be changed! The pelvic floor has three layers that correlate to the depth of your knuckles. The first two layers contain the sphincters, which are mostly responsible for keeping pee and poop in until you consciously decide not to. The third layer supports everything that lies above: all of your organs and sometimes a growing fetus. A proper. kegel, or contraction of the pelvic floor, consists of a squeeze and a lift to get all three layers of the pelvic floor.

The pelvic floor also allows for penetration or erection as well as orgasm. It moves lymph through the pelvic space, and in coordination with the abdominals and diaphragm, it stabilizes the spine. The pelvic floor has important functions, I would say!

what is a pelvic floor therapist?

A pelvic floor physical therapist is a licensed physical therapist who has done additional training and is qualified to assess and treat the pelvic floor internally. As pelvic floor specialists, we are trained to do internal technique and we also have access to approaching the pelvic floor externally for anyone who doesn’t want internal therapy.

Many, if not all, of my patients come to pelvic physical therapy expecting stirrups and metal speculum, and they leave pleasantly surprised by how different the experience is. Assessment of the pelvic floor is like every other muscle in the body. I feel for trigger points or fascial restrictions as well as the strength in all three layers. The bigger picture must also be addressed this is done through posture, breathing techniques, and the hip and low back assessment. This ensures the pelvic floor is not only happy in isolation but also within the whole system as the bottom of the core. 

Who could benefit from pelvic floor therapy

I believe everyone can benefit from pelvic floor physical therapy but specifically, anyone planning to have a kid, anyone who has had a kid, or anyone experiencing one or more of the following: pelvic, low back, tailbone, sacral or hip pain, prolapse, incontinence, chronic constipation not related to diet, hemorrhoids, hernias, diastasis recti, pain with sex, inability to orgasm, erectile dysfunction, endometriosis, overactive bladder, interstitial cystitis, inability to hold pee or poop for long enough, difficulty initiating urine stream, pain with peeing or pooping, waking up at night to pee, pain at scar tissue from tears or episiotomies, pain or dysfunction related to hysterectomy, ovarian, prostate or uterine cancer. I am sure I have forgotten some!

Can you explain the importance of working on your pelvic floor for preconception, pregnancy, and postpartum?

The pelvic floor is the all-star of having a kid. Not only does it support the weight of a growing fetus above it, but your pelvic floor also has to allow for a kid to come through it. Given this, it’s no surprise it is prevalent to have pelvic floor dysfunction after having a kid. 

The sooner you can get into pelvic physical therapy, the better. You can do your best to optimize your pelvic floor in preconception, so it stands a better chance in pregnancy. You can do what you can to build strength in pregnancy before you start to lose it, then prepare the pelvic floor for labor and delivery. And in postpartum, it’s all about the rebuild process, which is very familiar if you started either before you got pregnant or in early pregnancy. There is so much to do for your body and pelvic floor in the process!

Is there anything else we should know about pelvic floor therapy?

I think the biggest misconception is the pelvic floor health is all about Kegels. The truth is the exact opposite! I rarely give Kegels to my patients because most pelvic floors are too tight. There are many reasons for this. Sometimes it’s compensation for glute weakness or a consequence of posture. Other times it’s because the pelvic floor is holding on for dear life to support a baby growing above it. Or, it’s reacting to the fact that a kid just came out and there is scar tissue. Most commonly, it’s because we hold tension in our pelvic floor like we hold tension in our neck with stress, trauma, and emotional holding.

The thing to understand is that a tight pelvic floor is also a weak pelvic floor. When a muscle is tight, it has already contracted so it has no room to contract more. The pelvic floor is meant to be responsive and is meant to contract with response to the pressure of a sneeze or cough. It should contract as you go to pick up something. If the pelvic floor is tight, this contraction can’t happen which results in prolapse, incontinence, and pain. For this reason, Kegels on top of a tight pelvic floor is contraindicated. They will only contribute to the problem. The emphasis needs to be on relaxing the pelvic floor. This is especially true during pregnancy and postpartum which is the exact opposite of what most people think.

How often should you see a pelvic floor specialist?

I view pelvic physical therapy just like traditional physical therapy. Everyone should have it when experiencing a symptom or going through a big physical transition in life. Typical bouts of treatment range from 1-12 visits, usually over 3-12 weeks. If you are symptom-free, I would suggest an assessment each year to address any imbalances you have to remain symptom-free. Perinatal pelvic physical therapy is a little different. If you have a symptom during pregnancy, you may need several visits to manage, especially as you get to the end of your third trimester.

I recommend a visit in the 1st trimester and a visit between 30-34 weeks pregnant for those who have no symptoms. This allows for optimizing your pelvic floor function during pregnancy and preparing for labor and delivery. Postpartum pelvic physical therapy may extend all the way into your second year postpartum depending on what your goals are. It may be unreasonable time-wise and financially for people to be seen all the way through, even though. I think it’s essential so I have created an online postpartum planning program.

Where can we learn more about the services you offer?

For more information visit my website. I offer many things that might be a bit overwhelming, so in a nutshell, I do monthly sliding scale pelvic floor health workshops virtually (alternating between prenatal and postpartum). You can find more information and sign up at https://jennyputtpt.com/workshops/ Its looking like I might start an in-person version through Blossoms Birth and Family (https://www.blossombirthandfamily.org) so stay tuned on that. 
I see patients in person in Santa Cruz. Please email me at  jennyputt@gmail.com to schedule an appointment.

Thank you Jenny for joining us on this week’s blog and diving into all things pelvic floor therapy! For more tips and tricks on all things pregnancy, birth, postpartum, and parenthood please visit our weekly blog.