When Dr. Adina Leifer graduated as a doctor of physical therapy in 2007, she knew absolutely nothing about the pelvic floor. Like most programs, hers simply ignored it. But on a whim, she signed up for a continuing education course on the topic a few years later. “I’d just had my first child and it looked cool,” says Leifer, who got hooked on learning how to help with problems associated with pregnancy, such as prolapse (when organs drop into the vagina) and diastasis recti (abdominal separation). She became a certified pelvic rehabilitation practitioner, and the mom of four now runs Able Pelvic Physical Therapy in Atlanta.
Illustration by Lucy Rose
Q: Why aren’t new moms better educated about pelvic floor physical therapy?
A: That’s what happens when it comes to areas people can’t see. My job is pee, poop, and sex. No one wants to talk about these things. Postpartum, you go to your six-week appointment with your doctor and you’re sent on your way. No one is telling you that women who nurse have decreased estrogen. That makes pelvic muscles get weaker, which can cause urinary and bowel issues. No doctor is just saying, “You had a baby—go to physical therapy.” It’s starting to change.
Q: In France, pelvic floor therapy is standard for new moms. Why not in the U.S.?
A: The way we do medicine here is very different. We treat an issue; we don’t prevent. That’s what insurance will pay for. And there’s another issue. The men who come into my office say, “I’m leaking urine and sex is painful. Fix it. Fix it now.” The women will say, “I’ve had this for years.” New moms are so overwhelmed with their babies—and other children. You have to take care of yourself too.
Q: With age, some of this is inevitable, right?
A: Yes, like everything in our body. But it can be made a lot better. One study showed that a minimum of 10 Kegels per day can drastically change your pelvic floor.
Q: What can people expect during an appointment?
A: We do biofeedback using internal vaginal sensors or external wires. We do pelvic contractions. Breathe in through your nose, breathe out through your mouth. You see that ticker go up as you tighten, and then, as you rest, it goes down. Biofeedback is a tool that makes you able to see what you’re doing.
Q: I know moms who avoid jumping and certain kinds of exercise. How common is that?
A: It’s a big issue called stress urinary incontinence. If you’re having problems when you jump or cough, it’s not normal and it can be fixed. It’s a muscle weakness. If it’s our leg and we’re having trouble walking, we’d get it fixed. It’s the same thing.
Q: Is there anything you tell patients that surprises them?
A: The bladder is really dependent on your habits. It’s one thing if you’re getting up in the middle of the night to use the bathroom because the baby is up. But once the baby is sleeping through the night, that should stop. If you’re younger than 65, you shouldn’t need to wake up in the middle of the night.
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