Pelvic Floor Recovery After Birth: Where to Start

Q: Is it normal to feel nothing when I try to contract my pelvic floor after birth?

Yes. It is common to feel little or nothing straight after birth, and to find it hard to connect with the muscles. This usually eases over time. If the feeling does not return, if you have pain, or if symptoms carry on after several weeks, it is worth talking to your GP or a pelvic health physiotherapist rather than waiting.

Q: How do I know if I need to see a physiotherapist for my pelvic floor?

It can help to see a women's health physiotherapist if you leak urine or stool, feel heaviness within the vagina, have pain in the pelvic area, or struggle to find or squeeze the muscles. A supervised programme of at least three months is recommended if you have symptoms like leaking urine. You can ask your GP for a referral, and in some areas you can refer yourself. Services vary from place to place across the UK, so check what you can access locally.

Q: What should I avoid when doing pelvic floor exercises?

Try not to hold your breath, clench your buttocks or thighs, or bear down instead of lifting. Avoid practising by stopping and starting your urine mid-flow, as this can interfere with normal bladder function. The squeeze should feel like a gentle upward and forwards lift, done as you breathe out.

A tired stressed pregnant woman resting at home.

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In the days after birth, you might notice a heaviness in the vagina, a sense of disconnection to your pelvic floor muscles, or find that a cough or sneeze leads to some urinary leakage. These feelings are common, and for many they are the first sign that this part of the body needs some TLC. Birth puts your body through a lot, and pelvic floor recovery after birth tends to be one of the things nobody mentions until you are already in it.

Leaking when you do not expect to, accidental bowel leakage, a feeling of heaviness or something bulging low down (a prolapse), and pain are all common parts of the weeks and months after birth. Around one in three women leak urine three months after giving birth, and around one in five have accidental bowel leakage a year on. If any of this sounds like you, each one is worth raising with your GP or midwife.²

What the early days feel like

Straight after birth, you may feel very little connection to your pelvic floor muscles. You might try to contract the muscles and feel almost nothing, or be unsure whether anything is happening at all. This is normal. Those muscles have been under a lot of pressure, during pregnancy and go through a big stretch during a vaginal birth. That sense of disconnection usually eases over time. If it does not, or if you have pain or symptoms that stick around, it is worth raising with your GP or a pelvic health physiotherapist rather than waiting.³

Why rest comes before exercise

For the first six weeks or so after birth, rest is part of how you recover. Gentle movement is enough during this time, whatever a given day feels like. If you had a caesarean, significant tearing, or other complications during birth, your timeline may look different, so follow the advice your midwife or physiotherapist has given you.⁴

Small movements can help in these early days. Pointing and flexing your ankles keeps your circulation going while you rest. Rolling onto your side before you sit up, when getting out of bed, can help to take takes the strain off your tummy muscles. These are low-effort habits that protect healing tissue.¹⁵

Beginning pelvic floor recovery after birth

If your birth was a straightforward vaginal delivery, you can start gentle pelvic floor exercises within 24 to 48 hours, once you feel comfortable any catheter has been removed and you have passed urine for the first time without any issues. If you had a caesarean or significant tearing, follow the advice your midwife or physiotherapist gives you before you start. They can assess your specific situation and provide guidance tailored for you.⁶

Breathing as a foundation

Before you think about squeezing or holding anything, notice your breath. Your pelvic floor and your diaphragm, the muscle at the base of your rib cage, move together. Breathing naturally before you try contract the pelvic floor and help you to connect with it better. Breathing in, naturally helps the pelvic floor muscles to lengthen and relax.

To contract your pelvic floor, breathe in gently, then as you breathe out, contract around your anus, as if you are stopping yourself passing wind and bring this contraction forwards to the pubic bone, at the front of the pelvis, as if you are also stopping the flow of urine. The movement goes upwards and forwards. You are not pushing down or gripping your buttocks or thighs.⁷

What to notice rather than what to achieve

A gentle starting point is to hold a contraction for around five seconds, then let go fully, and repeat up to ten times. Alongside that, short quick contractions, where you tighten and release straight away, train the muscles to react fast, which helps for moments like a sneeze or a cough. Over three to six months, a ten-second hold becomes a fair aim, though there is no rush to get there.⁹

In these early weeks, go gently and pay attention to what you feel. Notice whether you can feel anything at all, whether the sensation shifts day to day, and whether letting go feels as easy as contracting. Both are as important as each other. If you struggle to find the muscles, or feel pain when you try, ask for a physiotherapy assessment before you carry on alone.

What physiotherapy can offer

A pelvic health physiotherapist can check how your pelvic floor is working, which is hard to judge from the outside. If you have symptoms like leaking urine, working with a physiotherapist on a structured programme for at least three months will aim to improve your symptoms. It is more structured than home exercises on your own, and it is shaped around what your body needs.¹⁰

Your midwife or GP should ask you about pelvic floor symptoms as part of your postnatal care. If that conversation has not come up, you can raise it yourself. You can reach a specialist physiotherapist through a GP referral, and in some areas you can refer yourself. Perinatal pelvic health services run in some parts of the UK for up to a year after birth. What is on offer varies a lot from place to place, so it is worth asking your GP or local maternity service what you can access.¹¹

Frequently Asked Questions

When can I start pelvic floor exercises after giving birth?

Is it normal to feel nothing when I try to contract my pelvic floor after birth?

How do I know if I need to see a physiotherapist for my pelvic floor?

What should I avoid when doing pelvic floor exercises?

Sources

[1] Fit for the Future

Pointing and flexing your ankles helps circulation while you are resting. Rolling onto your side before sitting up avoids putting unnecessary strain through your abdominal muscles.
[2] Pelvic floor dysfunction: prevention and non-surgical management - Equality impact assessment

Around one in three women experience urinary leakage three months after giving birth, and around one in five experience accidental bowel leakage a year postpartum.
[3] Pelvic health after having my baby

Immediately after birth it is common to have very little sensation in the pelvic floor, and this sense of disconnection typically improves over time.
[4] Pelvic health after having my baby

In the first six weeks after birth, rest is a necessary part of recovery and only gentle movement is appropriate during this period.
[5] Postnatal Exercises - The First Six Weeks

Pointing and flexing your ankles helps circulation while you are resting. Rolling onto your side before sitting up avoids putting unnecessary strain through your abdominal muscles.
[6] Pelvic health during and after pregnancy

Gentle pelvic floor exercises can be started within 24 to 48 hours of giving birth, once comfortable and once any urinary catheter has been removed.
[7] POGP Pelvic Floor Patient Information Leaflet

To perform a pelvic floor contraction, breathe in gently, then as you breathe out, squeeze and lift the muscles as if trying to stop passing wind and urine at the same time.
[8] POGP Pelvic Floor Patient Information Leaflet

Avoid holding your breath, clenching your buttocks or thighs, or stopping and starting your stream of urine mid-flow when doing pelvic floor exercises.
[9] POGP Pelvic Floor Patient Information Leaflet

A gentle starting point is to hold a contraction for around five seconds, repeat up to ten times, alongside short quick squeezes. Over three to six months, a ten-second hold becomes a reasonable aim.
[10] Recommendations | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE

For women with symptoms such as urinary incontinence, a supervised pelvic floor muscle training programme lasting at least three months is recommended.
[11] Pelvic health after having my baby

Access to a specialist physiotherapist is available through GP referral, and in some areas you may be able to self-refer. NHS perinatal pelvic health services are available in some parts of the UK for up to a year after birth.