The Truth Is… It’s Time to Prioritize Pelvic Health.
As a doula, part of my job is referring my clients to the myriad of resources they may need during pregnancy and the postpartum period. That can be anything from recommending a restoring prenatal massage, acupuncture to help with sciatica, or a mental health professional who specializes in perinatal mood disorders (all of which I’ll be featuring in the coming weeks).
I have also been asked about pelvic floor exercises, which can help strengthen our pelvis during pregnancy and after, so I usually send clients information to guide them through different exercises and postures they can do from home. It wasn’t until recently that I discovered a local Pelvic Floor Physical Therapist who does more for her clients than an online guide ever could. Jamie Scomak, PT, DPT, CLT, PRPC is the owner of the Toms River location of Inner Dynamics Physical Therapy, a Certified Trainer of Low Pressure Fitness, and certified in lymphedema treatment and management from the Norton School and pelvic rehabilitation from the Herman & Wallace Pelvic Rehabilitation Institute.
Dr. Scomak has also grown a fierce passion for the prenatal, pregnant, and postpartum woman after her own fertility struggles. She is an outspoken advocate for more research in physical therapy addressing the mechanical barriers to infertility, which of course immediately sparked my interest. The truth is, it’s my job as a doula to be able to provide my clients with the essential resources they need, like pelvic physical therapy, and I’m so grateful to have connected with Jamie so I can share the services she offers with my community.
What made you decide to specialize in pelvic health physical therapy?
When in PT school, we had a brief discussion about what was called during that time “Women’s health physical therapy.” I had a lot of questions (having some personal connection to what was discussed) and it was recommended that I seek an internship within the specialty. From day one in Gainesville, Florida, I was hooked. To look at the pelvis as the spine’s foundation and what powered the legs made a tremendous amount of sense to me and shaped the way I organize the body and appreciate Kinesiology (the study of human body movement).
Why is pelvic health so important in general and especially during pregnancy and birth?
It’s important that people know and understand their bodies. Anytime we learn a new game, we are told the rules and the goal. However, I educate clients on how often they should pee or THE POSITION they should USE TO poop every day. They aren’t aware that changes in bladder and bowel habits can be normal, like urgency during early pregnancy, or can be abnormal like peeing when you walk in the door to your home or when you sneeze. When we learn a new game, we don’t expect to be an expert without a little practice and we always prepare for a job interview, but for some reason when it comes to labor and delivery, very little thought goes into how to prepare our pelvis FOR THE JOURNEY, DESTINATION AND AFTERMATH.
Explain the spectrum of pelvic healing services you provide and how it encompasses all ages, genders, and health conditions.
We treat people of all ages who have pelvises. So, if you have a pelvis then it has a potential to have dysfunction, pain, or injury. Pelvic therapists treat pelvic floor dysfunction, pain in your back, abdominal, hip, groin or pelvic area, painful intercourse or pain with gynecological examinations, bladder & bowel leakage, urgency and/or frequency, pelvic organ prolapse (heaviness/pressure, vaginal wind), concerns with trans care (pre & post operatively), chronic pain, constipation, endometriosis, vaginismus, vulvodynia, coccydynia, interstitial cystitis, fibromyalgia, irritable bowel syndrome, prenatal/postpartum discomfort, diastasis rectus, labor and delivery preparation, pediatric bowel & bladder dysfunction, prostatitis & post-prostatectomy, arthritic and orthopedic conditions, and MORE.
Dr. Jamie Scomak and her children, Julian and Lucy
From your perspective, why hasn’t more attention been given to pelvic health in America's general healthcare and specifically reproductive healthcare models? Are there differences in other economically developed nations?
I still think many people find the subjects of toileting and activities of nightly living (sexual behaviors) taboo. I’m told I’m desensitized because it’s my daily work, but for those of us who are lucky, pain free pooping is a daily occurrence. And menses, aka menstrual cycles, are often private, embarrassing, or ridiculed. I hate the joke that only those with periods can bleed for three to seven days without dying. What’s being released is endometrial lining, there isn’t an actual wound- we aren't "bleeding." The cycle supports a person’s reproductive capability, if they have a uterus. I’m not saying you need to broadcast a smooth poop, a heavy menstrual flow, a powerful orgasm, or a relieving urinary void— but I’m not hiding any premenstrual bloat, the fact that I got gassy from dairy, or that I really need to jump the line because of diarrhea. Attention to pelvic health is different in other countries. France, for instance, advises six prenatal and six postpartum visits to every pregnant person. The American healthcare model is so unsupportive of families and the health of birthing persons. We all know the disparity of postpartum visits for birthing people versus babies and the expectation that they go back to work at 100%. (Please do not get me started on reproductive rights. I’m still waiting for the government to send my stimulus for my son when he was chilling in my womb.)
What can patients expect when they work with you and how is your practice unique from others?
Patients can expect to be heard, validated, supported, and helped. A huge focus is addressing what each individual wants out of rehab. I don’t focus on pain-free vaginal penetration if intercourse isn’t of interest to them. I don’t attempt to reduce the number of times they get up to pee if that’s not something they’re interested in changing. People are so motivated by their own priorities and rehab professionals help get them there— and we get to share in their joy of being able to pick up their (grand)children while decorating for holidays, standing confidently and safely while preparing a large meal, running along the sidelines of their favorite athlete’s games, attending social outings with confidence, traveling without worry, enjoying intimacy with comfort and pleasure, hitting a personal record in their weightlifting, getting into the inversion without vaginal wind; the list goes on and on. I hope my practice isn’t different from others because it’s what every human deserves- to live life- sometimes while creating life- unrestricted and free from pain (or with minimal pain when it’s purposeful, such as during labor & delivery).
If you could give one piece of advice to our readers when considering their own pelvic floor health, what would it be?
Try it, if it’s not for you- that’s ok. I give my four year old a “no thank you” bowl for unliked new foods even though she’s a pretty adventurous eater. Also, most people have a favorite teacher or coach— so sometimes you may need to try a few different people or styles to find the best fit for you and your needs. Pelvic dysfunction typically doesn’t resolve on its own, so ignoring it won’t make it go away. I always tell my pregnant folks, the worst case scenario is often the best case, because then you are fully prepared with nothing left to learn and you have no restriction or dysfunction in movement.
