Pelvic Floor After Birth: Leaking, Kegels and Returning to Exercise

What the pelvic floor does

A hammock of muscles from the pubic bone to the tailbone holds up the bladder, uterus and bowel, helps control pee, poop and gas, and plays a part in sex. Pregnancy stretches it whether you give birth vaginally or by C-section.

Common after birth (and often improving)

• Leaking urine with coughing, sneezing, laughing or lifting: about 1 in 3 people in the first months.
• Urgency: a sudden rush to get to the toilet.
• Heaviness or a bulge in the vagina, worse at the end of the day: can be prolapse, which is common, often mild and very treatable.
• Leaking gas or stool, especially after a third- or fourth-degree tear.
• Pain with sex or inserting a tampon.
• Belly separation (diastasis recti): a gap or doming down the middle of the belly. Most people have some at 6 weeks, and many close a lot by 6-12 months. Common does not mean you have to live with it. All of these can be helped.

How to do a pelvic floor contraction (Kegel)

1. Lie or sit comfortably. Breathe normally.
2. Squeeze and lift as if you're holding in gas and stopping pee at the same time. Your belly, buttocks and thighs should stay fairly relaxed.
3. Hold for a few seconds, building toward 10. Then let go fully for the same time. The letting go matters as much as the squeeze.
4. Add some quick squeezes. Aim for about 10 of each, a few times a day.
5. Start gently in the first days if it's comfortable. Don't practice by stopping your pee mid-stream.
6. If it hurts or you can't feel anything, a pelvic floor physical therapist can check your technique.

Everyday habits that help

• Exhale on effort: breathe out and gently lift your pelvic floor as you lift the car seat, stand up or pick up a toddler.
• Don't strain on the toilet: feet on a small stool, lean forward, relax. Treat constipation.
• Don't hover over the toilet or pee "just in case" often; it can train urgency.

Getting back to exercise

• Walking, breathing work and gentle core and pelvic floor exercises can usually start early.
• Build up gradually once your provider clears you. Many pelvic floor specialists suggest waiting until about 12 weeks for running, jumping or heavy lifting, after you can walk, balance and do simple strength moves without leaking, heaviness or pain.
• For diastasis, focus on breathing and deep core work first; a therapist can tell you when crunches and planks fit in.

Pelvic floor physical therapy

• A pelvic floor PT assesses the muscles (often with an internal exam, only with your consent) and gives you a plan. In many U.S. states you can book one without a referral; check your insurance.
• Worth seeing for any of the symptoms above, after a severe tear, or before returning to high-impact sport.

When to check in

• Bring up leaking, heaviness, pain with sex or a belly gap at your postpartum visit, and again at any later checkup if it hasn't improved by about 3 months.
• See your provider soon if you can't pee, or have new leaking of stool you can't control.