Five Questions from our Conversation about Pelvic Floor Support with Dr. Margo Kwiatkowski

Recently, our founder, Lauren, chatted with Dr. Margo Kwiatkowski, DPT, CSCS, PCES, founder of P4Moms and @postpartum_pop_pt, about our pelvic floor support garments and how they can help with pelvic organ prolapse.

We loved talking with Margo about the design and functionality of our garments, as well as answering some of her followers’ questions about how to wear them and how they can help with POP symptoms.

Catch the whole conversation on YouTube, or check out some highlights of 5 questions we answered during our chat!

 

1. What was the biggest takeaway from garment testing?

Lauren: I forget because I'm so close to this now, but the biggest thing from testing was the body shapes and coming out with our two styles.

When I went into testing, I only had what is now our Curvy style. But then we got to testing people who were not in that curvy version category and were like, “This is great. It provides support, but it's a little bit baggy in the crotch, in the butt, and in my legs.” I was like, “Oh, okay, that makes so much sense.” So the takeaway was that support was good, but it wasn't fitting people who were in more of the inverted triangle or straight body shapes.

And so we were able to then essentially take what we had in the Curvy style and copy it to create our Straight style. The support is essentially the same in both fits, but we reduced the leg opening size and we took some of the fabric out of the backside. That's the key difference. But what it allows us to do is to get a more customized fit for people of different shapes.

2. When can you start wearing the garment postpartum?

Lauren:  Depending on your type of delivery and those kinds of things, for folks who have had a c-section, you're going to want to wait for the incisions to heal, especially with the high-waisted aspect. That way it's not irritating and can give your skin the space it needs.

For vaginal deliveries, I think you could really wear it right away because the benefits that come from it are helpful early postpartum. 

So it's going to be on a case-by-case basis. And of course, the thing we say to everyone is, your bodies are changing so much. So of course if there's any discomfort or things like that, then you're going to want to wait and investigate what's causing the discomfort. You want to be careful with anything that is compression. But for some people it can work very early on postpartum.

3. How did you design your garment, and how does the support work?

Lauren: Some of it was reverse-engineering; understanding just in general how pelvic floor support garments work. They provide the lift and the support to the perineum. They provide gentle compression that can increase blood flow and also work to stabilize externally. Those are some of the key things I was realizing. 

I also investigated how other garments are achieving this, and what you can see from some of them is that they'll have a more stabilizing fabric that's not stretchy, but then that can be challenging when the whole garment is not flexible. Or then it's too stretchy and then you can't get enough support.

And so essentially what we did was look at the majority of the garments out there–I've got almost all of them in my closet–and really just investigated the things that make them work and what's really challenging about them. And then we iterated, through 25 plus prototypes, to get it to where it is now. 

One of the hardest things was getting the garment to provide the support but also be comfortable. And that's when we stumbled on the support hammock. I was working on the garment with my mom and I was like, “Why isn't this working?” And she said, “Well, I've got these compression socks that I use.” So we cut out the footbed with the very heavy compression, and I pinned those in the garment and we tested it. And I thought, “Well, if I lift it up a little bit more in the back, then that feels right.”

And so it was a lot of iterating through things like that, understanding fabrics and how those come into play, a lot of testing and tons of hours and into that, and then really refining the fit after that.

Margo: Lauren is talking about the gusset part of the garment, and there's two parts of it. So there's this separate hammock support and that's really giving the perineum that lift, right?

Lauren: That's exactly right.

Margo: By providing some support to the perineum, essentially what you're doing is you're helping the people who have a lot of laxity and weakness, and you're also helping the people who have too much tension. So if I know some of you have probably experienced this where you're like, “Oh my God, it's so heavy,” and you just want to put your hand in your perineum. So there's that. It gives you that lift and helps your muscles be more active if they are not active enough. 

And if you're more like me on the hypertonic (more tension) side of things, that external support can then help your muscles go, “Okay, I can actually let go because there's something else there giving me that lift.” So it's not like a pessary where it's lifting your organ backwards; it's facilitating better muscular support, and that's that hammock feature, right?

Lauren: Yes, and that's how we ended up finding that balance of getting it to work where the garment would feel comfortable, but you could have the fabrics doing what they needed to do without doing weird things with the garment.

4. Do people wear the garments as underwear, or do you recommend wearing underwear underneath them and then the garment on top?

Lauren: Great question. There's a couple of factors there, and it's going to come down to personal preference. 

You can wear them either way and they will be effective. I personally like wearing them as underwear. It's just less clothing that I have to manage throughout the day. However, if you wanted it to not have to wash it as frequently, or if you had fewer pairs and you were trying to make them go further, you could wear underwear underneath to help with that. So that's something folks have done and can do, but you could go either way.

5. How can external support truly help what feels like a very internal issue?

Margo: Everyone's symptoms with prolapse come from different sources. For some of us, our symptoms truly are you feeling that organ displaced because the sensory sensation in our vagina is different and it's in that outer one third and you're feeling it. Sometimes external support can help that. 

Or maybe you're on the side where all your symptoms are muscular and the tension is making you feel that “misplaced tampon” sensation, that bulge, that heaviness. And so these would be probably a really great option in that case. And then there's other people who have more issues with swelling, so they might have vulvar varicosities, hemorrhoids, and things like that. And so a compression on the perineum and throughout that gusset area would be really helpful for those conditions. So it really depends on where your symptoms are coming from with prolapse. But in my mind, the garment is worth trying because the more options you have for symptom management, the better and more freeing life feels.

**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.