Pelvic Floor After Birth: Recovery, Exercises and When to Get Help

Pelvic floor recovery after birth usually takes months, not weeks. You can start gentle pelvic floor exercises soon after the birth, and the NHS says a programme should run for at least 3 months before you judge whether it is working. Leaking when you cough or sneeze is common in those months. It is also treatable.

What is the pelvic floor, and what happens to it after birth?

The pelvic floor is a sling of muscles running from your pubic bone at the front to your tailbone at the back. It helps close the front and back passages so you do not leak urine, stool or wind, supports your pelvic organs, and plays a part in sex.

These muscles are stretched during pregnancy and birth, and that can lead to weakness afterwards. An NHS hospital leaflet puts it plainly: most postnatal women will have some pelvic floor symptoms, and most get better with time and exercises.

NICE lists the pregnancy and birth factors that raise the risk of pelvic floor problems:

• An assisted vaginal birth (forceps or vacuum, sometimes called instrumental delivery)
• A vaginal birth with the baby lying face up
• Pushing (the active second stage of labour) for more than 1 hour
• An injury to the anal sphincter during birth (a third- or fourth-degree tear)
• Being over 30 when having a baby, or having given birth before

After a C-section delivery the picture is different, but not risk-free. A Swedish study that followed first-time mothers found a caesarean was linked to less stress incontinence one year after birth, while noting that the surgery carries its own pelvic floor risks. NHS leaflets describe the muscles being stretched by pregnancy as well as birth, and POGP's pelvic floor advice applies after a caesarean too.

How long does it take for your pelvic floor to recover after birth?

Expect months. One NHS maternity leaflet says it might take up to three months for your muscles to get strong again. POGP, the UK network that supports specialist pelvic health physiotherapists, says that if your muscles were weak you should notice an improvement in 3 to 5 months, and then keep practising to hold on to it. The NHS says you may have to do the exercises for a few months before you see any benefit.

Symptoms are common along the way. A Cochrane review reports that about one-third of women leak urine in the first three months after giving birth. In the Swedish study of first-time mothers, 31% reported stress incontinence at one year. If you are leaking at six weeks, you are far from alone.

When to start pelvic floor exercises after birth

POGP says to start as soon as possible after you have had your baby, even within the first few hours, whether you had a normal delivery or a C-section. The one exception is a urinary catheter: wait until it has been removed and you are passing urine normally. If you have stitches, gentle rhythmic squeezing and relaxing may ease pain and swelling, and lying on your side can be more comfortable.

How to do pelvic floor exercises (Kegels) correctly

Find the muscles first. Imagine you are trying to stop passing wind and stop passing urine at the same time. You should feel a squeeze and a lift inside the vagina. Do not actually stop your urine flow on the toilet as an exercise; one NHS trust leaflet says this is not recommended.

• Long squeezes: tighten, hold, then let the muscles fully relax. POGP suggests working up to 10 squeezes held for 10 seconds, with 10 seconds of rest between each.
• Short squeezes: tighten quickly, then let go straight away. Aim for 10.
• Always let the muscles fully relax after each squeeze.
• Breathe normally. Do not hold your breath, clench your buttocks or squeeze your stomach or thighs.
• Start little and often if you can only hold for a couple of seconds, and build up over weeks.
• Begin lying down or sitting, then progress to standing and moving.
• Do the routine at least 3 times a day.

Leaflets differ a little on the numbers. The NHS asks for at least 8 squeezes, at least 3 times a day, for at least 3 months; one NHS hospital suggests five or six sessions a day for the first 12 weeks. ACOG in the US suggests starting with 3-second holds and adding a second each week.

POGP also teaches "the Knack": tighten your pelvic floor just before you cough, sneeze, laugh or bend. The NHS gives the same advice for lifting, including picking up children: tighten before and during the lift.

An honest note on the evidence: a 2020 Cochrane review found that for women who started exercising after delivery, the effect on leaking one year later was uncertain, and the quality of the studies was generally low to moderate. NICE still recommends encouraging pelvic floor training after birth, and to explain that it helps prevent symptoms. The review found two reports of pelvic floor pain and no other harms.

Can't feel your pelvic floor after birth?

POGP's advice is clear: if you find the squeeze difficult, or you feel a vaginal bulge when you try, get help from a specialist physiotherapist. A physiotherapist can check whether you are contracting and relaxing the right muscles. For women who cannot manage an effective contraction, NICE says biofeedback, electrical stimulation or vaginal cones can be added to training.

Leaking urine when you cough or sneeze: common, but treatable

Leaking when you cough, sneeze or laugh is called stress incontinence, and the NHS lists pregnancy and vaginal birth among its risk factors. For stress incontinence, NICE recommends offering a supervised pelvic floor programme of at least 3 months. Other things that help, according to the NHS: treat constipation and avoid straining, avoid heavy lifting where you can, and do not cut down on fluids, because that can make leaking worse.

Prolapse symptoms: heaviness, dragging or a bulge

Pelvic organ prolapse is when the womb, bladder or bowel bulges into the vagina, and pregnancy and childbirth are among its causes. The NHS lists these symptoms:

• A feeling of heaviness, discomfort or pressure in your lower tummy or vagina
• Feeling or seeing a bulge or lump inside, or coming out of, your vagina
• Pain, discomfort or numbness during sex
• Problems pooing, such as constipation
• Feeling your bladder is not emptying fully, needing to pee more often, or leaking when you cough, sneeze or exercise

ACOG notes that many women have no symptoms and many do not need treatment. When symptoms bother you, options include pelvic floor training with a specialist physiotherapist and vaginal support pessaries, and NICE suggests at least 4 months of supervised training for a symptomatic prolapse that does not extend more than 1 cm beyond the hymen when straining. The NHS also advises avoiding heavy lifting, running and trampolining if you have a prolapse, and one NHS hospital leaflet advises avoiding jogging and other high-impact exercise for about three months after any birth.

Read what pelvic health physiotherapists say about running after birth

Is pelvic floor physiotherapy worth it, and how do you get referred?

NICE says pelvic floor programmes should be supervised by a physiotherapist or similar expert, and recommends considering a 3-month supervised programme after a forceps or vacuum delivery, a face-up baby, or an anal sphincter tear. POGP suggests that the 6 to 8 week check is a good time for a pelvic health physiotherapy assessment, if you can get one.

• In the UK: ask your GP to refer you; NICE says midwives, health visitors and GPs should discuss pelvic floor problems with you at each postnatal contact. POGP and the NHS say some areas let you refer yourself to a specialist physiotherapist or continence service.
• Outside the UK, including India, Nigeria, Pakistan, the Philippines and the US: ask your doctor about a physiotherapist (physical therapist in the US) who specialises in pelvic health. ACOG notes that you may be referred to one for leaking.

See the postpartum workout plan, week by week

When to call your midwife or doctor

• You have not passed urine within 6 hours of the birth or of your catheter being removed: tell your midwife.
• You have difficulty passing urine, or the feeling of needing to go has changed: tell your doctor immediately.
• Your perineal or C-section wound is oozing, the pain is increasing, or you feel feverish or unwell: contact your midwife or GP.
• You notice a lump in or around your vagina, or other prolapse symptoms: see a GP.
• You leak urine, stool or wind you cannot control, or have sudden vaginal discomfort: ask to see a pelvic health physiotherapist.

MatraBloom's daily check-in and week-by-week recovery timeline, set by how you gave birth, can help you keep up pelvic floor work and notice if symptoms are not settling. It cannot examine you.

Frequently asked questions

A daily reminder to squeeze, sized to your week

MatraBloom's daily check-in and guided movement, gated by week and birth type, keep pelvic floor work in your routine. It cannot examine you, so leaking or heaviness still needs a physiotherapist.

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