Pelvic Floor Therapy | Why You Need It (Even If You Think You Don't) | Janelle Antonio PT, DPT, CLT
Updated: May 12
Janelle Antonio has a passion for helping mothers. As a Post Partum Corrective Exercise Specialist and Pelvic Floor Physical Therapist, Janelle helps prenatal and postpartum women realign their bodies and retrain their pelvic floor so that they can live a life free of pain and dysfunction. At Lotus Rehabilitation, she specializes in healing diastasis recti, releasing C-section scars, preventing and treating early stage organ prolapse, bowel and bladder issues, painful intercourse, and pain in the low back, SI joint, and pelvis.
When she first invited me to her Newark, Delaware office for a consultation to assess my own pelvic floor health, I was hesitant. Yes, I am a mother of four and, at the time, my youngest child was just 15 months old so I fell loosely into the postpartum window of her specialty. However, I was under the naïve impression that I was getting by with my day-to-day just fine and that everything seemed to be alright "down there". So what if I wore a panty liner to my fifth grade daughter's school wellness night because I knew there would be kick boxing? Many of the moms in that gym exchanged knowing glances when we collectively realized just how much jumping was involved! Peeing your pants a little when you do jumping jacks is just the plight of woman, right? Wrong! After my time with Janelle, I realized there are many signs of pelvic floor dysfunction that we, as women, are conditioned to believe are normal. Yes, leakage is common, but it is also a sign that your pelvic floor needs help! (This is your sign to seek it!)
Whether we realize it, or not, our pelvic floor health has a huge impact on lives. It affects our ability to perform daily household tasks, the way we carry out our work responsibilities, care for our children, our mental health state, our ability to exercise, and our enjoyment of sex. Janelle is committed to improving quality of life through pelvic floor health education and by restoring the body's natural function through therapy. I gained so much insight into my own pelvic floor health as her patient-- I am excited to share a behind the scenes glimpse into what it is like working with her! I hope you enjoy our conversation! I am sure you will learn something about your body you never knew.
Let’s Start with Introductions-- tell us a little bit about who you are and what you do! I would also love for you to share a little bit about how your career in physical therapy led you to pelvic floor therapy.
Well, my name is Janelle and I’m a mother of twins who are in first grade. I’ve been a physical therapist a little over 15 years and have worked in different areas of specialty such as orthopedics, lymphedema, and oncology. After the birth of my twins I became more and more passionate about helping women during and after pregnancy. There was so much information that I wish I had during that time, that I want to share with others! Some info is basic and takes very little time to go over, but can really change your life and have a positive impact for years. I’m like- everyone needs to know this! I want to help other women, the way pelvic floor therapy helped me!
Would you please share a little bit about what pelvic floor therapy is and how it’s used in pregnancy and postpartum?
To me, pelvic floor therapy is about so much more than the pelvic floor. Our body is all connected and I don’t think I’ve ever found pelvic floor dysfunction without seeing issues in other areas of the body (hip, low back, headaches, TMJ issues, working through past traumas). Whether I am evaluating someone during the prenatal, postpartum time, or years after, I look at how the body moves, manages pressure, and what muscle groups are dominant in the body. I want to know why the pelvic floor is holding tension or not activating when it’s supposed to. I do internal examinations, but this is usually the last part of the evaluation, or it’s done at a follow up visit. I never want to miss the big picture of what is really going on with the person.
During pregnancy, physical therapy is focusing on how the body is adapting to all the changes it is going through. The focus can change week to week, depending on how a pregnant woman is feeling. Overall, it’s about learning to connect with our abdominals, hips, and pelvic floor muscles so we can minimize pain and stay strong. I also do a lot of massage and fascial release to help decrease pain and tension during this time.
Therapy during your pregnancy will also set you up to an easier recovery afterwards! Sometimes I only see people twice during pregnancy, sometimes on a weekly basis during the tough months, it really depends on what each person needs.
What are some reasons that postpartum people seek out pelvic floor therapy after having a baby?
Some of the most common reasons are urinary leakage, diastasis recti (ab separation), pain with sex, prolapse, pulling/tightness at the site of a C-section incision, low back pain, or hip pain. Some people just come in and say, everything feels different and I can’t put a finger on it and that’s okay! I’m so glad these ladies come in, because many times there are issues going on that if not addressed, will become a bigger issue down the road. Sometimes our body sends us a general message, “I need help!”
C-section scars can be a silent contributor to other problems, so although people don’t initially come in for scar release, it many times ends up being something we work on. This scar tissue can lead to bladder dysfunction, low back pain and not being able to activate our lower abs so it’s something I always check on.
What are some “best practice” tips for people returning to exercise in their postpartum months?
Just because you can do something, doesn’t mean you should. Often I see people power through high intensity exercise because they want to feel accomplished and strong. Your arms, legs or mindset may be strong enough, but is your pelvic floor? There is certainly a higher risk of developing pelvic floor issues when we push ourselves too fast.
If you feel heaviness in your pelvic floor- Stop. If you have leaking- Stop. If you feel bulging outward in your abdominals- Stop. These are all signs that your body isn’t ready for that exercise!
That's a really great advice. Can you help us get a better picture of the pelvis?
The pelvic floor has so many muscles! 3 different layers with different functions all to provide support for back/pelvis/abdomen, sexual function, and bowel/bladder function. These muscles should contract and relax for us when we need them to, just like other muscles in our body.
In regards to the bony anatomy, we have two large innominate bones that attach into the sacrum, in the front they come together to form the pubic symphysis. Posture and pregnancy can alter our bony alignment, so when addressing pelvic floor dysfunction we also have to consider whether the bones that muscles attach to, are in optimal alignment. The only way a muscle can properly function is if the bones they attach to are in good alignment.
the Pelvic floor seems pretty complex and interconnected with other functions of the body-- Can you explain how our breathing can affect our pelvic floor?
I think the coolest thing about our body’s anatomy in regards to the pelvic floor is that the diaphragm works as a natural pump for the pelvic floor. So working on your breath is one of the best things you can do for your pelvic floor!! Take a sneeze for example. When you have that forceful exhale and the diaphragm lifts up to push air out of your system, it is also lifting up the pelvic floor and having it contract. This helps prevent leaking and to manage pressure in your body. So in therapy, we also look at your breathing!
I'd imagine that frustration with pelvic floor symptoms can really affect a person's mental health and that the past traumas you mentioned might play a role in dysfunction. How can pelvic health affect a person's mental health?
I am so glad you asked that! Pelvic floor issues can have a huge impact on us mentally, socially, and in our personal relationships. Treating the pelvic floor without addressing the mental health piece doesn’t allow a full recovery.
Our pelvic muscles have a protective reflex. They think they are helping us even when they aren’t. They hold onto trauma longer than we mentally do. I think it’s also important to remember that trauma doesn’t have to be sexual assault. It comes in many forms such as painful sex, childbirth that didn’t go as you had hoped, a painful examination, etc. We may feel completely safe and comfortable, but the pelvic floor kicks in a reflex to tighten and protect us when it feels it may get hurt. It doesn’t have the ability of logic that our brain does. Relaxing isn’t as simple as telling the muscles to relax, they are safe now. We can become frustrated and disconnected with the pelvic floor. My message would be not to get too frustrated. It can be worked through with physical therapy.
Can you share a patient success story with us? I would love to hear how a real mom has benefited from Pelvic Floor Therapy!
A recent postpartum mom came to me and was in such distress because she had to use moderate to max absorbency pads for urinary leakage. We focused on engaging the diaphragm with the pelvic floor, managing pressure in her abdomen so when she coughed or sneezed that she didn’t have increased pressure in her pelvis. I did some fascial release to her low back and she had a home program of stretches and exercises. Within two sessions she was no longer wearing any pads at all. She is a really great example of how some simple recommendations and treatment can alleviate some very distressing symptoms!
That's awesome-- and so encouraging to hear!
I would imagine that many people are too intimidated to voice concerns they may have with their pelvic floor health to their midwives or gynecologists. What advice do you have for people that may be nervous about bringing up this topic with their providers?
Just know that your providers have heard it all! Talk about it. Here’s a common example- “It feels like I have a tampon in, that’s falling out, but I don’t have one in… this is probably weird… I just won’t mention it…” (that is a common one!) Whatever it is, your practitioners have heard it! There are a lot of symptoms that are just shrugged off as a part of motherhood but it doesn’t have to be that way.
When would you like to see patients come in for an evaluation? Before they start experiencing symptoms or after?
Before!! It is always so much easier to prevent than to treat a problem, and takes much fewer visits. A little bit of education goes a long way! I think that a postpartum visit with a physical therapist should be standard of care.
I was twenty when I became pregnant with my eldest daughter-- literally none of my providers educated me on my pelvic floor. It wasn’t until I developed a regular prenatal yoga practice during my third pregnancy, that I became aware of the importance of these muscles. Education is so important! What kinds of proactive pelvic health education are you involved in?
I think things are really changing, and people are talking more so there is more awareness. I feel like just knowing these issues are common, but not normal, and that there is actually something you can do about them is education in itself! I frequently pop in to mom groups in the area, whether 4th Trimester Moms, Baby Movement classes or yoga workshops to say Hi and let them know that there is help! Talking with OB/GYN providers is important and something I have been doing. If providers share knowledge, it starts changing the narrative in the community. Social media is certainly not my comfort zone, but I’ve also put myself out there on IG. I’ll be giving a free class on lymphedema management through the DE Cancer Support Community this month, and next month a free mini talk at a Wellness Event in Middletown for new mothers. Some local group classes are being planned for the Spring/Summer, so hopefully I’ll be able to share that soon!
Can you do some myth busting for us around bladder control such as: Why peeing your pants is not normal? Should we be pushing our pee out? It makes sense to go “just in case” when you are leaving the house right? Drinking less water can help you not have to pee as much?
Ooh yes! Some of this stuff we hear from others in our circle and we just assume it’s normal and just have to deal with it. It’s common, but doesn’t mean it should be accepted as our normal. Peeing your pants isn’t normal - even if its just a small to medium amount of leakage. Some will say Well, it just happens when I laugh, or just when I sneeze, bend down or cough, but none of these situations should cause you to leak. There is help!
To the "Should we push our pee out?" question: The answer is No. You actually never fully empty your bladder, there is always a small amount left and this is normal. Feeling the need to push your pee out though many times indicates a pelvic floor issue that needs to get checked out.
On the question of “just in case” pee, even though it makes sense to our brains to go to the bathroom “just in case” when we are leaving the house, we are training our bladders to contract too early. Your bladder will end up learning ‘It has to go!’ when it’s only half full, but this will become it’s new normal. So go if you need to, and don’t go if you don’t feel a true need.
Drinking less water can increase the feeling of urgency to go!! When we have less water, our urine becomes more concentrated. This concentrated urine is an irritant to the bladder. So increasing your water intake decreases the concentration of your urine, and can lessen your urge to go.
What kind of patients do you serve outside of pregnancy and postpartum? What other services do you offer?
I also specialize in treating those undergoing treatment and surgery for cancer, whether it’s during their treatment or in the years beyond. As a Certified Lymphedema Therapist I can help with lymphedema management, in addition to cording, shoulder dysfunction and rehab after breast surgery. The most common types of cancer that I treat people with are breast and head & neck cancers.
I also do lymphatic drainage sessions for other populations. When I left the cancer center, a friend asked me to help her after liposuction for lipedema, and I of course said yes, but then paused to think, Who is helping all of these women? Lymphatic drainage is needed beyond cancer care. So I now additionally help those after liposuction, breast augmentation and abdominoplasty. Sometimes when I tell people what I do, it can seem all over the place, but at the end of the day, it’s all about treating women and helping them feel comfortable in their bodies. I’m blessed to be able to help in a few different ways.
How can people get in touch with you?
Email me at firstname.lastname@example.org or call me at (302) 598-8592.
If you enjoyed this interview, check out these other articles featuring birth and baby workers and creative momprenuers!