Pelvic floor recovery after birth: exercises, symptoms and support

Your pelvic floor carried a great deal during pregnancy and birth, and it deserves some gentle attention now. The good news is that it is a set of muscles, and muscles respond to training. This guide covers what the pelvic floor does, which symptoms are worth noticing, how to do the exercises, what the research shows, and when a specialist can help.

What does the pelvic floor do, and how does birth affect it?

The pelvic floor muscles stretch from your pubic bone at the front to your tailbone at the back. They hold your pelvic organs up, close around the openings of your bladder and bowel when you cough, sneeze or lift, and relax to let you empty them. They also work as a team with your diaphragm and deep abdominal muscles every time you breathe and move.^[6]

After birth, the pelvic floor is weakened, and often injured, in most women, and many need instruction and supervision to contract it correctly, especially if they didn't train it before.^[6] A caesarean birth doesn't skip this stage entirely, because nine months of pregnancy also load these muscles. Whatever your birth was like, your pelvic floor deserves time and practice.

How common are pelvic floor symptoms after birth?

A Cochrane review of pelvic floor training in pregnancy and after birth notes that about a third of women have urinary incontinence and up to a tenth have faecal incontinence after childbirth.^[1] Physiotherapists who work with postnatal women describe these conditions as "common but not normal": widespread, but not something you should be told to put up with.^[6]

These are the signs of pelvic floor or abdominal wall dysfunction that the postnatal return-to-running guideline lists:^[6]

How do I do pelvic floor exercises?

Pelvic floor exercises can begin in the immediate postpartum period.^[8] If you had a catheter, wait until it has been removed.^[6] The World Health Organization says pelvic floor muscle training may be done daily to reduce the risk of urinary incontinence.^[7]

A simple way to start:

1. Find the muscles. Sit or lie comfortably. Imagine stopping yourself from passing wind and holding in urine at the same time. You should feel a squeeze and a gentle lift inside, not a clench of your buttocks.
2. Slow holds. Squeeze and lift, hold for a few seconds while you keep breathing, then let go completely. Rest for a few seconds and repeat. Over the weeks, work towards longer holds.
3. Quick squeezes. Squeeze and lift firmly, then let go straight away. These help your pelvic floor react when you cough or sneeze.
4. Relax fully. Letting go is as important as squeezing. Feel the muscles drop back to rest between each one.
5. Progress your position. Once lying and sitting feel easy, try standing, and then add a squeeze as you lift your baby or stand up.

Our pelvic floor exercise timer guides you through slow and quick sets, so you can focus on the feeling rather than counting.

For women aiming to return to running, the guideline suggests a baseline to build towards in standing: 10 quick squeezes, 8 to 12 strong holds of 6 to 8 seconds, and a gentler hold at about a third to half of your full effort for 60 seconds.^[6] That is a long-term goal, not a starting point.

Does pelvic floor training actually work?

The strongest evidence comes from a Cochrane review of 31 trials in women with urinary incontinence. Women with stress urinary incontinence who did pelvic floor muscle training were about eight times more likely to report being cured than those who had no treatment: 56% compared with 6%. The authors concluded that pelvic floor training can cure or improve symptoms of all types of urinary incontinence, and that it could be part of first-line treatment.^[2]

After birth, the picture is more nuanced. A Cochrane review focused on pregnancy and the postnatal period found that early, structured training in pregnancy may prevent leaking in women who don't already have it. But simply offering postnatal training to every new mother, whether or not she has symptoms, is not likely to reduce leaking across the whole group, and the effect of training as a treatment after birth is still uncertain.^[1] An earlier systematic review found that training does prevent and treat leaking when it is supervised, follows strength-training principles with close to maximum squeezes, and lasts at least eight weeks.^[3]

The practical message: pelvic floor training helps, and it helps most when it's done properly and guided by someone who can check your technique. That is why NICE recommends that pelvic floor training programmes are supervised by a physiotherapist or other professional with the right expertise, and offers at least three months of supervised training to women with stress or mixed incontinence.^[4]

What should I do if I have symptoms when I exercise?

The return-to-running guideline advises against running before three months after birth, or later if you have symptoms such as leaking, heaviness or pain before or after trying.^[6] In practice, a day with symptoms is a day for walking, swimming, gentle strength work or rest. NICE notes that there is no evidence that unsupervised activity like walking or swimming makes pelvic floor symptoms better or worse, and that supervised exercise such as yoga may help women who are doing supervised pelvic floor training.^[4]

Eggsports keeps impact, crunches and heavy straining out of the day whenever you mention pelvic floor symptoms, and keeps running and jumping out of plans until there have been two weeks without them. If you keep noticing symptoms over a couple of weeks, that is a gentle nudge to book a pelvic health appointment.

When should I see a pelvic health physiotherapist?

The return-to-running guideline recommends that every woman, however she gave birth, should have the option of a pelvic health assessment with a specialist physiotherapist from six weeks after birth.^[6] In the UK, NICE recommends that midwives, health visitors and GPs talk about pelvic floor health at each postnatal contact, and that women are told about the importance of pelvic floor exercises, how to do them and when to seek help.^[4][5]

How to find one depends on where you live. You might be referred by your GP, family doctor or midwife, and in some places you can book directly.^[6] At the appointment, a physiotherapist will ask about your birth and symptoms, and may offer an internal examination, only with your consent, to check how your muscles squeeze, lift and relax. Then you'll build a programme together that fits your goals.

To see where pelvic floor work fits into the bigger picture, read our guide to when you can exercise after birth. If your tummy also feels different, see diastasis recti recovery, and if you're hoping to run again, read running after pregnancy. Everything comes together in our complete guide to exercise after birth.