The postpartum pelvic floor
The pelvic floor is a crucial region located between your pubic bone at the front and your tailbone at the back. It houses essential structures, including your pelvic organs (bladder, bowels, uterus), connective tissues (ligaments and fascia), and pelvic floor muscles. These muscles and connective tissues work together to lift and support your pelvic organs, maintain bladder and bowel continence, and play a role in sexual function.
During pregnancy, your body undergoes numerous hormonal changes to accommodate a growing baby. These changes include the stretching and relaxing of connective tissues, which increases pressure on your pelvic floor muscles. These muscles must now support not only your pelvic organs but also your baby. As the baby grows, the pressure intensifies, potentially affecting pelvic floor function. If these muscles aren’t working effectively, symptoms such as urinary incontinence during sneezing, coughing, or laughing, constipation, a feeling of heaviness in the vagina, and more can arise. Additionally, pelvic floor function can influence birth outcomes. Difficulty relaxing these muscles during labour may lead to increased tearing, the use of instruments, prolonged pushing time, and slower postpartum recovery. Remember, this is something that a pelvic floor physio can help identify risk factors for and prevent if you see us from second trimester onwards!
Therefore, pelvic floor exercises are essential regardless of whether you’ve had a vaginal delivery or a c-section due to the extra demands placed on the pelvis during pregnancy, changes to core stability and hormonal shifts. Although the specific impacts on your pelvic floor differ between delivery methods, rehabilitation remains equally important and will help you return to your movement goals safely.
Vaginal Delivery
Postpartum pelvic floor function after a vaginal delivery depends on several factors:
Use of instruments such as forceps or vacuum
Birth injuries, including episiotomy, perineal tears, levator avulsion, and nerve damage
Duration of active pushing
Baby’s weight (greater than 4 kg)
Number of pregnancies (more pregnancies mean more hormonal and pressure changes affecting the pelvic floor)
Pelvic floor dysfunction during pregnancy
C-Section Delivery
A common myth is that a c- section delivery doesn’t affect the pelvic floor muscles. But we have to remember that these muscles play a vital role in core stability, alongside the deep abdominal and lower back muscles and the diaphragm. This commonly results in disco-ordinated and overactive pelvic floor muscles post birth if not prevented and treated by a pelvic floor physio. This can also be a factor in lower back pain and hip pain post partum.
Both deliveries
Even if you have a positive vaginal or c- section birth experience and are feeling great physically, there are also hormonal changes to consider postpartum that can affect the lubrication, sensitivity and elasticity of the pelvic floor tissues. These hormonal changes are characterised by a drop in oestrogen which continues until your period returns and/ or you finish breastfeeding. This is something that a pelvic floor physio can assess for and refer for a topical oestrogen cream prescription if needed from a medical practitioner.
Importance of Postpartum Pelvic Floor Rehabilitation
Rehabilitating your pelvic floor muscles during the postpartum period offers numerous benefits, including:
Reducing the risk of symptoms such as bladder and/ or bowel incontinence, pelvic organ prolapse, lower back pain, persistent pelvic girdle pain and abdominal separation
Facilitating return to sexual activity without pain and apprehension
Supporting your return to exercise, especially high-impact activities that put additional pressure on the pelvic floor
Preparing your body for future pregnancies
To optimize pelvic floor health after giving birth, we recommend booking an appointment with a pelvic floor physiotherapist 4-6 weeks postpartum. During this session, your physiotherapist will perform a detailed evaluation of your pelvic floor, assessing injuries, prolapse, muscle strength, endurance, coordination, and your abdominal wall. Together, you’ll develop a tailored plan to address your specific goals, needs, and concerns. Everyone’s pelvic floor muscles are unique, just as everyone’s core strength or cardiovascular fitness varies! This is why an individualised assessment is recommended.
While many people aim to return to exercise, others simply want to regain enough strength to manage daily tasks and care for their little one—both goals are entirely valid. Remember, if you’re experiencing symptoms, STRENGTH isn’t always the solution!
If you’re postpartum and experiencing symptoms or want to better understand your pelvic floor, please don’t hesitate to reach out or book an appointment with one of our amazing physiotherapists.
Authors: Jessica Adams & Divya Koujalgi, 2025