What the pelvic floor is and why it matters after birth
The pelvic floor is a layer of muscle and connective tissue at the base of the pelvis. It supports the bladder, uterus and bowel, helps maintain continence and plays a role in sexual function and stability.
Pregnancy and birth put strain on this system from above and below at the same time. Muscles can be overstretched, nerves irritated and tissues swollen. For that reason, pressure, weakness or coordination problems after birth are not automatically a sign of permanent damage.
Typical symptoms after birth
Many complaints in the first weeks are mainly signs of healing, swelling and fatigue. The course over time is decisive: does it improve step by step, stay the same, get worse or do new problems appear.
Feeling of pressure and heaviness
A feeling of pressure, as if everything is being pulled downwards, can occur after birth. It is often worse after standing for a long time, carrying loads or in the evening. Sometimes there is a foreign-body sensation in the vagina.
Incontinence
Many experience stress urinary incontinence — losing urine when coughing, sneezing, laughing or jumping. Others have urgency, the sudden need to get to the toilet. Both are common and treatable.
Pain, scar tightness, problems with sex
Pain can result from healing, dryness, scar tissue, muscle tension or overload. It is important not to ignore pain and not to return too early to activities that trigger it each time.
Difficulty holding bowel or air
Difficulty holding wind or stool is particularly serious, even if it is uncomfortable to talk about. Early help is worthwhile because targeted therapy can make a big difference.
What can be normal in the first weeks and what is not
Immediately after birth the pelvic floor is temporarily less resilient for many. Swelling, wound healing and sleep loss change perception and control. This is a phase where less is often more.
More typical in the first weeks
- Mild downward pressure, especially in the evening
- Urine loss with coughing or sneezing that gradually becomes less frequent
- Difficulty sensing the pelvic floor muscles
- Pain or pulling around scars that slowly decreases
Reasons to seek assessment
- Clear foreign-body sensation or a visible bulge in the vagina
- Loss of stool or inability to hold wind
- Urine loss that does not improve after several weeks or that significantly limits you
- Severe pain, fever or rapid deterioration
Recovery: what it can and cannot do
Postnatal recovery is not a repair completed in six sessions. It is more the starting point for coordination, strength and load management. Some notice quick progress, others take longer, especially after a complicated birth, multiple pregnancy or a long recovery period.
Quality matters. The pelvic floor must not only be able to contract, but also to relax again. And it must work in everyday situations, not only when lying down.
There is good evidence that pelvic floor exercises can help, especially for incontinence. A Cochrane review describes pelvic floor muscle training as a common and effective intervention to prevent and treat incontinence around pregnancy and after birth. Cochrane Review in PMC: Pelvic floor muscle training
When physiotherapy is appropriate
Physiotherapy is particularly helpful when you want more than general postnatal recovery — for example, when you have a specific problem or are not progressing. A major advantage is assessment: coordination, strength, relaxation, breathing, abdominal wall, scars and everyday posture. Often the missing piece is not more exercise, but better timing and technique.
Common reasons to see a specialised pelvic floor physiotherapist
- Incontinence that has not clearly improved after several weeks
- Strong pressure sensation or suspicion of prolapse
- Pain, scar tightness or pain during sex
- Problems with bowel control, inability to hold wind or stool
- Feeling that you cannot activate the pelvic floor or that you only ever tighten it
- Returning to sport and experiencing symptoms
NICE recommends pelvic floor training as a central measure to prevent and treat pelvic floor dysfunction and emphasises that long-term training can be beneficial. NICE: Pelvic floor dysfunction, recommendations
Prolapse: what it is and how it may feel
A prolapse means that organs in the pelvis shift downward more than usual, for example the bladder, uterus or bowel. This is not always dramatic. Many have mild forms and mainly symptoms that come and go.
Typical signs
- Pressure, heaviness or pulling downwards
- Foreign-body sensation in the vagina
- Symptoms worse after long periods of standing, carrying or at the end of the day
- Sometimes difficulties with passing urine or bowel movements
RCOG explains prolapse in plain language and describes that pelvic floor training can improve symptoms, even if it does not always completely reverse a prolapse. RCOG: Pelvic organ prolapse
Everyday life and loading: why less can sometimes be more
Many symptoms are not caused by too little exercise, but by too much downward pressure and too rapid increases in load. Carrying, long standing, early jogging, jumping or intense abdominal training can increase downward pressure.
Practical principles that often help
- Increase load like climbing stairs, not like making a jump
- Use symptoms as feedback, not ignore them
- Where possible, support coughing and sneezing with a stable stance
- Avoid constipation because straining puts a lot of pressure on the pelvic floor
If you want a simple, reliable explanation of pelvic floor exercises, the NHS page on pelvic floor exercises is a good starting point, although correct individual technique is best checked by a physiotherapist. NHS: What are pelvic floor exercises
When you should seek timely assessment
You do not have to wait until something becomes unbearable. Early assessment often saves months. This is especially true if your daily life is limited or you feel things are getting worse.
Assessment is sensible if
- you cannot hold stool well or wind escapes uncontrollably
- you notice a clear bulge or a strong foreign-body sensation
- you have pain that increases or prevents sleep
- you have problems with passing urine, for example you cannot empty completely
- you see no clear improvement in incontinence after weeks
ACOG describes typical symptoms of pelvic floor descent and emphasises that conservative measures such as physiotherapy and pelvic floor training are frequently part of treatment. ACOG: Pelvic support problems
Conclusion
The pelvic floor after birth is often not weak or broken, but overloaded, irritated and uncertain in coordination. Postnatal recovery is a sensible starting point, but it is not enough for all problems. If pressure, incontinence or prolapse symptoms persist or limit you, specialised physiotherapy is not a luxury but a very practical solution.
