This is a place where we primarily talk sleep, as well as other real life and parenting topics, but I also love having guests come on and share their expertise with us.

I’m interviewing Dr. Lindsay Massumi, my favorite pelvic floor physical therapist, and we’re going to talk all things pelvic floor PT, and also how it relates to sleep – both as a parent trying to get your babies to sleep and how that can impact your pelvic floor, but also how your quality of sleep, overall, impacts your pelvic floor and so much more.

Introduce Yourself

My name is Lindsay Durand Massumi, and I am a physical therapist by trade, specializing in the perinatal pelvic health population.

As a former gymnast and from various injuries, I had gone to physical therapy, so I knew I wanted to be a PT from a young age. And I was always excited about pregnancy and birth, and I soon realized there was a whole untapped niche of pelvic health PT when it came to work with the active perinatal population.

My primary focus is now active moms who are pregnant and want to maintain their level of activity – they want to be strong and active throughout their pregnancy and when postpartum.

In addition to working with the active moms, we also work with men and children, spanning all ages and phases of life. So our main focus is perinatal, but our goal is to serve active families and help keep them active in a way that’s empowering for them.

What is the pelvic floor?

The pelvic floor is a whole group of muscles that sit at the bottom of the pelvis. It’s a bowl shape and it connects from the bottom of the pelvis, all the way through the tail bone.

People traditionally think about the pelvic floor as a flat muscle, but it is quite intricate, involving over 28 different muscles. And these muscles are all influenced by our other body systems – your core, back, and hips.

The main role of the pelvic floor is to support they pelvis and everything inside – it helps keep urine and poop in, is responsible for sexual pleasure, and supports the overall movement of your whole body. For women, it supports the uterus and a growing baby, and for men, it helps support the prostate.

Every time you grab something, stand up, walk, roll over in bed, or breathe, the pelvic floor is working.

Who could benefit from pelvic floor physical therapy?

Everyone has a pelvic floor, so let’s start there – everyone can have issues with their pelvic floor!

The most common issues we see in children include nighttime wetting (or even daytime!) and chronic constipation.

The most common pelvic floor issues we see with adolescent and adult women include chronic UTIs, bladder pain, IBS type symptoms, pelvic pain, back pain, hip pain, and pain with intercourse.

For pregnant and postpartum women, specifically, we see a lot of bladder issues, incontinence, prolapse (the feeling that your organs are going to fall out), and injuries from childbirth (i.e. tearing or tailbone injuries).

We also see a rise in pelvic floor issues when women reach perimenopause and menopause! Even if they haven’t had pelvic floor issues yet, this big hormone shift may cause challenges like pain with intercourse, prolapse, and leakage or a lack of bladder control.

And finally, the most common issues we see with men are bladder issues (urgency, frequency, or pain with urination), constipation, IBS type symptoms, and erectile dysfunction.

As you can see, pelvic floor issues don’t just impact men and women, but children, as well!

If there is one “must-do” exercise for pregnant or postpartum women when it comes to the pelvic floor, what would it be?

If you’re only going to learn one thing in pelvic floor PT, or if you walk away only remembering one thing, I would hope it’s the understanding of and knowledge of how to do deep diaphragmatic breathing. I want everyone to know how to coordinate their breath with what their core and pelvic floor are doing.

To do this, put one hand on your chest and one hand on your belly, and take a nice deep breath – inhale through your nose, and exhale out your mouth. As you do this, see if you can keep your hand on your chest and just let the hand on your belly move.

With each inhale, you should feel an expansion in the abdomen, and with each exhale, the abdomen should come back in.

When most people start this type of breathing, they do the opposite – they breath into their chest and that belly almost sucks in as they’re inhaling. But this is not how we want to breathe, and can actually lead to pelvic floor issues, too. Whether that’s from tension or a lack of coordination, breathing the wrong way can lead to pelvic floor issues at all ages!

Some athletes I’ve worked with run marathons or dead lift, but they can’t do the simplest core activation, or the tiniest stabilizing exercise, because they’ve never worked those muscles properly.

So this diaphragmatic breathing should be the foundation of everything else we do.

How can holding a baby or putting a baby to sleep impact the pelvic floor?

It’s important for moms, especially, to be mindful of their postures or positions when holding or wearing their baby.

For the moms (or dads!) doing a lot of standing or bouncing to get their baby to sleep, make sure you’re not pushing your hips forward and leaning back with your shoulders (I call this the “pregnant stance”), as this positioning puts more pressure on your pelvic floor.

For the parents regularly standing with their sleeping baby, I highly recommend baby wearing. Find a carrier that fits well and feels good, and make sure you have enough support!

Similarly, if you have to stand or bounce or rock quite a bit to get your baby to sleep, or even to calm, get out your yoga ball and sit there, instead – this is much easier on the pelvic floor, especially in those early recovery days after having your baby.

Additionally, if you find yourself sitting a lot with your sleeping baby, make sure you’re not falling forward with rounded shoulders/upper back. That forward position makes those abs really tight and puts more pressure on the front of the pelvic floor, which can cause more bladder or prolapse issues.

Even for breastfeeding moms – use a boppy pillow or my breast friend when feeding your baby. These simple positioning tips really add up and can make a big difference!

How is the pelvic floor connected to sleep, in general?

When I work with adults or kids, one of our intake questions is, “How many hours do you sleep?” We also ask, “Do you wake up feeling well-rested?”

There is so much research being done right now on how sleep is related to digestion and bladder function.

We are finding that poor sleep is associated with higher rates of pain and higher rates of bladder issues and constipation, as well as bloating.

Getting into a state of deep sleep is how our nervous system calms – it’s how we enter “rest and digest.”

Anytime we are breathing our pelvic floors are working, so if we’re not getting into a deep state of sleep, our pelvic floors are still working, and our kidneys and digestion are acting as if we’re still awake. Without that deep sleep, we’re missing a lot of physical restoration and we see more pelvic floor issues develop.

This counts for young kids, too!

When kids get poor sleep and they don’t enter a true deep sleep cycles, we see a lot of nighttime wetting. Without that deep sleep, their bodies are not signaling to their kidneys to slow down, causing them to still have to pee every 3-4 hours like they do during the day.

Sometimes parents tell me their child seems “dead to the world,” or they’re really hard to wake up, yet they’re still wetting the bed at night.

What’s happening there is while their bodies going into a deep, almost “hypnotized” state, their brains are remaining in a high state of activity, which registers as stressful stimulation. And just like excited puppies, that “high stress” can actually cause a child’s bladder to release, or it can cause other GI issues.

How does virutal pelvic PT work? Isn’t it better to see a physical therapist in person?

My background in PT and how I trained is in movement analysis – it’s a whole program and philosophy based on movement. So before even touching a patient, we evaluate and assess a patient based on a movement perspective.

When it comes to pelvic floor physical therapy, we need to view patients through a whole body/holistic lens. So as a PT, I’m asking questions about hip and core strength, sleep, digestion, and nutrition. We are able to dive into all of this virtually, as it doesn’t require hands-on care.

As a PT, especially in the virtual setting, I also need to trust that patients are giving me feedback as they are doing a certain exercise or stretch. This helps me give you a lot more tools, and also teaches you how to assess yourself.

When we work with individuals, we often find a balance of synchronous support, when we’re live and doing that one-on-one work, as well as asynchronous work, when you’re doing your exercises outside of our sessions.

I have found that we have had just as great of results with our virtual clients as we have our in-person clients. This model of business has made PT accessible to more people, and it’s built a lot more independence, too.  

How can someone get help from you? What should their first step be?

If you’re interested in learning more about how we, at Virtual Physio, can help you, reach out through our website! You can also message us on Instagram and we’ll help get you where you need to go.

Is there anything else you’d like to share?

I want everyone to know that it’s never too late to work on your pelvic floor! Whether you’ve had four babies, or you’ve been having issues for 20 years, it’s never too late! And you deserve that care.

I also want you to know that it’s never too early. If you’re considering getting pregnant, or if you’re pregnant for the first time, get connected with a pelvic floor PT to make sure you are able to stay strong thorughout your pregnancy and postpartum!

About Dr. Lindsay

Dr. Lindsay Durand Massumi is a pelvic health physical therapist and certified personal trainer. She and her husband run a hybrid physical therapy and health coaching company, Virtual Physio, where they provide active, full body, family-centered care for patients in person and online. 

Follow Dr. Lindsay on Instagram here!