Updated: Jul 5
If you're anything like many of us, you may never have heard about your pelvic floor or its importance during everyday life. Shortly after my third baby was born, I was advised to get my pelvic floor evaluated by a physiotherapist and go to pelvic floor recovery if needed. I was shocked - not because I might need it, but because it was the very first time anyone had mentioned anything of the kind to me throughout my three pregnancies. I had been seen both in the public and private systems and it just hadn't been suggested to me.
Then I was even more shocked when speaking to a friend to learn that pelvic floor physiotherapy is something you can get in the public healthcare system here in Spain!
But let's back up a little. First of all, what is the pelvic floor and who might need pelvic floor recovery therapy?
The pelvic floor is a group of muscles, sometimes referred to as the pelvic floor hammock. These muscles are responsible for keeping the bladder, uterus, and bowel in place. They may sometimes sustain trauma or lose strength during birth (or anytime) leading women to experience things like incontinence of the bladder or bowel, prolapses of the bladder or rectum, weak back muscles, and other difficulties that can be associated with pelvic floor dysfunction. Activation of the transverse abs is also an important part of a physiologically well-functioning pelvic floor.
The good news? These muscles can be trained and many women report full recovery after working with a pelvic floor physiotherapist.
What does all this mean? The first thing it means is that you can rest easier knowing that if you're experiencing urinary incontinence after giving birth, you are not alone and you don't have to live with it.
Peeing a little while laughing, jumping, or running may be common for many new mothers, but it is not normal or just a side-effect of having children that you just have to accept and deal with.
Urinary incontinence is not the only symptom of a dysfunctional pelvic floor. Depending on the prolapse, the symptoms and impacts on your everyday life will be different. Most prolapses include feelings of heaviness in the vagina or a noticeable bulge into the vaginal wall. Discomfort or pain during sex can be another common side effect of any of the three prolapses (bladder, rectal, or uterine).
A bladder prolapse, also called a cystocele, can cause some of the following symptoms:
bathroom urgency - the feeling that you need to go pee all the time or aren't going to make it to the toilet
leakage of urine while laughing, jumping, or otherwise putting pressure on the pelvic floor
feeling like your bladder is not emptying well enough
A rectal prolapse, also called a rectocele, may cause some of the following symptoms:
problems fully passing a bowel movement because the stool gets stuck in the rectocele pocket
lower back pain
fecal incontinence or inability to control gas
Uterine prolapses, called procidentia typically present with a feeling of heaviness inside the vagina and discomfort with sex.
A woman may experience a prolapse of one or more of these organs when the pelvic floor muscles are not functioning optimally. Prolapses range in severity.
So, who can get a pelvic floor assessment after giving birth?
All women can benefit from retraining of the pelvic floor after giving birth and being assessed for prolapses.
How can you get this done?
Here in Madrid, there are two routes.
The first route is through private healthcare. Pelvic floor physiotherapy is not typically covered by private insurances so when I say private, I really mean out of pocket. This will depend on your healthcare company and your policy. Finding out these details before giving birth can make the whole process of finding a pelvic floor physio postpartum smoother.
Benefits of going through a private practice include being able to do it as soon as you need it, choosing your care provider (and likely being able to find one that speaks English), and being able to go directly to a pelvic floor physiotherapist without a referral.
Downsides are that you are typically paying out of pocket and each session can cost around 80€ per session in Madrid centro (though of course, like everything, this varies some from practice to practice).
To begin seeing a private pelvic floor physio it's as simple as booking an appointment and getting started!
The other option is the public healthcare system. Benefits of going through the public system are that if a pelvic floor dysfunction is diagnosed you will have a certain number of physio visits covered by public healthcare (aka what we often like to call for free).
Downsides include not being able to choose when you will be evaluated or even if you'll get to see a physio to be evaluated, no control over how many visits you'll have, the schedule/timing of the visits, and the waiting time to get in to be evaluated. Also, it'll all be in Spanish which may or may not be a downside for your situation.
How can you get pelvic floor physiotherapy in the public healthcare system here in Madrid?
Contact your GP (medico de cabecera) and ask for an appointment. During this appointment, explain your concern and desire to be evaluated for pelvic floor dysfunction. Unfortunately, many women claim they need to really talk up a dysfunction like incontinence in order to even get sent for evaluation. I'm not saying you need to lie, but to get referred out of the GP's office, you do have to convince them that it's a need and possibly affecting your daily life.
Your GP will send you to the gynecologist (ginecólogo) or midwife (matrona) depending on what they think makes the most sense. I've most often heard of women getting sent to the gynecologist for the first evaluation.
If sent to the gynecologist, you'll wait for them to call you to tell you when your appointment is. This can take up to a few months. If sent to the midwife, you may be seen sooner.
At the gynecologist/midwife appointment you will explain your symptoms, why you'd like to get checked out for a prolapse, and they'll likely ask about your birth experience (whether you had a forceps birth, Cesarean birth, etc).
The gynecologist/midwife will do an initial evaluation and then decide if they think it's serious enough to send to be evaluated in the physiotherapy department (Fisioterapía).
You will again be notified of the date of your evaluation via phone call or text message. This can be a quick process or take a few weeks again depending on many factors.
Next, you'll go to your appointment with the physiotherapist (fisioterapeuta) and they will again evaluate whether they think you need the sessions with a physiotherapist for pelvic floor recovery and they'll decide how many sessions and how often you'll go. For example, they might prescribe you six sessions to be done twice a week for three weeks.
You'll wait for them to call you to tell you what days and times you'll have your appointments. This could be quick or take a few weeks as they will get you in once they have an opening in the schedule.
Once you've gotten this information about your appointments - you'll go to your physio appointments!
After you've finished your round of appointments, you'll return for a follow up evaluation with the original physiotherapist who decided how many appointments you needed. If they feel you've improved enough, you'll be discharged and if they feel you could still benefit from more sessions, they'll prescribe you another number of visits.
If progress isn't made after exercises with the pelvic floor physiotherapist, they may consider surgical repair options. This is typically only for very severe cases.
If you speak Spanish, have access to public healthcare, and are not in a rush - it can be a great option to go through the public system!
If Spanish is a blocker for you, you don't have access to the public healthcare, or you feel you need to start right away - you may wish to work with a private physiotherapist here in Madrid.
No matter what kind of birth you have, a postpartum pelvic floor evaluation can be a good idea. Also, it's not really ever too late! If you're reading this and thinking it's been too long because you have a two-year-old (or older!) don't worry - you can still seek advice and treatment from a pelvic floor physiotherapist!
When your pelvic floor is functioning optimally, you'll likely notice a stronger back, more enjoyable sex, the ability to pick up your kids and run and laugh with them without worrying about a little pee escape - for many women it adds to their quality of life in so many ways! If you need recommendations for a pelvic floor physio, feel free to reach out!
Giving birth in Madrid or a new mom in Madrid? Looking for support on the wild ride called parenthood?
Look no further - book a free discovery call with me (Madison - doula in Madrid) today and let's chat about how together we can work to make your experience a positive one! And be sure to check out the Madoula homepage. If you're looking for doula support during your pregnancy, birth, or postpartum please be sure to contact me for a free consultation!
Giving birth is one of the most vulnerable moments in a person's life. There are many factors to consider at all times. The support of a doula from home to hospital adds an additional layer of support for both the birthing person and partner. Continuous care and individualized support both increase the likelihood of satisfaction with one's birth experience, regardless of the birth outcome.