Your pelvic floor after giving birth: what is normal, and when to start exercising

During pregnancy the growing uterus and baby load the pelvic floor for months, and a vaginal birth stretches these muscles and the tissues around them considerably. That is why many women leak a few drops when they cough or sneeze in the weeks after birth, or feel their muscles are “not the same”. The good news: the pelvic floor can be trained, and most women recover well.

What is common after birth?

Small leaks when coughing, laughing, sneezing or lifting the baby
A feeling of heaviness or “emptiness” in the pelvic area
Difficulty finding the muscles to squeeze
Tenderness around stitches or a tear

Some of these ease by themselves in the first weeks. Leaking urine or wind that does not improve over months, a bulge or a feeling of something “coming down” in the vagina, or painful sex are symptoms that should be checked.

When can you start pelvic floor exercises?

Many health sources say you can start gentle pelvic floor squeezes soon after birth, once you feel comfortable. If you had a caesarean, an episiotomy, a deep tear or another complication, follow your doctor’s or midwife’s advice on when and how hard to start. Your postnatal check is a good moment to ask about your pelvic floor.

How to start

Start lying down: It is easier to find the muscle on your back with your knees bent.
Short, gentle squeezes: In the first days, a few light squeezes of a couple of seconds are enough.
Work with your breath: Squeeze as you breathe out, let go as you breathe in; don’t hold your breath.
Build up gradually: Over the weeks, work up to 10-second holds and 10 long and 10 short squeezes, three times a day.
Link it to your day: Doing a set while feeding or settling the baby makes the routine easier.

What does the research say?

A 2020 Cochrane systematic review reports that women without leakage who did pelvic floor muscle training in pregnancy had a lower risk of leaking in late pregnancy and mid-way through the postnatal period. So pelvic floor exercise can be part of your routine during pregnancy too (with your doctor’s approval), not only after birth.

When to see a professional

You are still leaking urine or wind a few months after birth
You notice a bulge, fullness or heaviness in the vagina
You have pain during exercise or sex
You cannot feel the muscles at all

Pelvic health physiotherapists specialise in postnatal assessment and personalised programmes.

For more on the pelvic floor through life, see Pregnancy, postpartum and menopause.

Sources

This article is for general information and does not replace medical diagnosis or treatment. See a healthcare professional if you have pain, bleeding, fever or ongoing symptoms.