The Part of Recovery Nobody Talks About Enough

Everyone asks how the baby is sleeping. Very few people ask how your pelvic floor is doing. And yet pelvic floor health affects nearly every aspect of postpartum life: how you move, how you exercise, how you feel during intimacy, and yes, whether you laugh a little too hard and need to change your underwear.

Pelvic floor issues after birth are incredibly common. They are also incredibly treatable. The problem is that most new parents do not know what is normal, what is not, and what they can do about it.

What Is the Pelvic Floor?

Your pelvic floor is a group of muscles, ligaments, and connective tissue that spans the base of your pelvis like a hammock. These muscles support your bladder, uterus, and rectum. They play a role in urinary and bowel control, sexual function, and core stability.

During pregnancy, these muscles bear increasing weight as your baby grows. During vaginal birth, they stretch significantly to allow your baby to pass through. Even if you had a cesarean birth, your pelvic floor was affected by pregnancy itself.

Common Postpartum Pelvic Floor Issues

Urinary Incontinence

Leaking urine when you cough, sneeze, laugh, jump, or run is called stress urinary incontinence. It is extremely common postpartum. Common does not mean inevitable or permanent. This is a symptom of pelvic floor weakness or dysfunction that can be addressed.

Pelvic Organ Prolapse

Prolapse occurs when the pelvic organs (bladder, uterus, or rectum) descend from their normal position due to weakened support. Symptoms can include a feeling of heaviness or pressure in the pelvis, a sensation of something "falling out," or visible bulging. Mild prolapse is more common than most people realize and often improves significantly with pelvic floor therapy.

Diastasis Recti

While technically an abdominal issue, diastasis recti (separation of the rectus abdominis muscles along the midline) is closely connected to pelvic floor health. The abdominal wall and pelvic floor work together as part of your deep core system. A significant diastasis can compromise pelvic floor function and vice versa.

You can check for diastasis recti by lying on your back with knees bent, lifting your head slightly, and feeling along your midline above and below your navel. A gap wider than two finger-widths may indicate diastasis that could benefit from targeted rehabilitation.

Pain During Intimacy

Discomfort or pain during sexual activity after birth can be related to pelvic floor tension (muscles that are too tight), scar tissue from tearing or episiotomy, hormonal changes (especially while breastfeeding), or a combination. This is not something you need to "push through." It is addressable with the right support.

Starting Your Recovery

The First Six Weeks

In the early postpartum weeks, focus on gentle reconnection rather than strengthening:

  • Diaphragmatic breathing. Lie comfortably and breathe deeply, allowing your belly and pelvic floor to gently expand on the inhale and release on the exhale. This reconnects your brain-body awareness to these muscles.
  • Gentle pelvic floor engagement. Not aggressive Kegels, but soft, mindful contractions. Think of lifting a blueberry with your pelvic floor rather than clenching with maximum force.
  • Walking. Short, gentle walks are one of the best early postpartum movements. Start with 5 to 10 minutes and increase gradually.
  • Posture awareness. Nursing and baby-holding postures can strain your core and pelvic floor. Use pillows for support and alternate positions.

After Six Weeks

The six-week postpartum checkup is often the point where you are "cleared for exercise." But this clearance is typically based on a brief exam, not a comprehensive pelvic floor assessment. Many pelvic floor therapists recommend that every postpartum person receive a specialized evaluation, regardless of symptoms.

Once cleared, you can begin more intentional rehabilitation:

  • Progressive pelvic floor exercises. Move beyond basic Kegels to include endurance holds, quick flicks, and functional movements that integrate pelvic floor engagement with daily activities.
  • Core rehabilitation. Focus on exercises that restore deep core function: bird dogs, dead bugs, glute bridges, and modified planks. Avoid traditional crunches, sit-ups, and heavy lifting until your deep core system is functioning well.
  • Gradual return to impact. Running, jumping, and high-impact exercise should be reintroduced slowly and only after your pelvic floor can handle the demands. A pelvic floor therapist can help you determine readiness.

When to See a Pelvic Floor Therapist

The short answer: anytime you want to. You do not need to be "broken" to benefit from pelvic floor therapy. Think of it as physical therapy for the muscles that just went through the biggest event of their existence.

Definitely seek evaluation if you experience:

  • Urinary leaking that persists beyond the first few weeks
  • Feelings of heaviness, pressure, or bulging in the pelvic area
  • Pain during intercourse that does not improve
  • Difficulty with bowel movements
  • Low back or hip pain that is not resolving
  • A diastasis recti wider than two fingers
  • Difficulty engaging or feeling your pelvic floor muscles

What to Expect at Pelvic Floor PT

A pelvic floor physical therapist will take a thorough history, assess your posture and movement patterns, and typically perform an internal exam (with your consent) to evaluate muscle tone, strength, and coordination. Based on their findings, they will create a personalized rehabilitation plan.

Sessions may include manual therapy, biofeedback, electrical stimulation, targeted exercises, and education about body mechanics. Most people see significant improvement within 6 to 12 sessions.

Finding the Right Provider

Search for pelvic floor therapists and postpartum fitness specialists through BAABY's provider directory. Look for therapists who:

  • Specialize in postpartum and pelvic health
  • Are trained in internal assessment techniques
  • Take a whole-body approach, addressing core, hips, and breathing patterns alongside the pelvic floor
  • Create individualized programs based on your specific goals

Your Body Is Not Broken

Pelvic floor issues after birth are not a punishment, a failure, or an unavoidable consequence of motherhood. They are a treatable condition caused by a predictable physical event. With the right support, most postpartum pelvic floor issues resolve significantly or completely.

You deserve to run, laugh, sneeze, and live without worrying. And that is absolutely achievable.