After childbirth, mothers have numerous concerns about their postpartum body and its capacity for returning to physical activity. One of the worries is whether physical activity may negatively affect the pelvic floor after pregnancy and delivery.

The pelvic floor is a crucial group of muscles that helps maintain bladder and bowel control, support internal organs, and coordinates with the deep core, diaphragm and deep back muscles. These muscles can require rehabilitation after having done a lot of the heavy lifting during pregnancy and possibly having been injured during childbirth.

In this blog, we’ll discuss how pregnancy and childbirth can affect the pelvic floor. We’ll also share ways to ensure your pelvic floor is strong enough to return to physical activity. As an exercise physiologist who engages in research with postpartum mothers and a physiotherapist with advanced training in pelvic floor rehabilitation, we recognize it’s essential for women to have the necessary physical recovery, knowledge and confidence to return to physical activity. Below we provide answers to frequently asked questions about the pelvic floor after pregnancy and childbirth.

What is the pelvic floor?

The pelvic floor is a group of muscles that helps maintain bladder and bowel control, support internal organs, and coordinates with the deep core, diaphragm and deep back muscles. To locate your pelvic floor muscles, visualize the muscles that span from the back at your tailbone to the front at your pubic bone, and from side to side on your sit bones. This is the floor of your pelvis, like a sling or hammock of muscles, ligaments and fascia. 

Why see a pelvic floor physiotherapist?

Pelvic floor physiotherapists should be part of the postnatal support team, in addition to maternity physicians, lactation consultants, obstetricians, midwives and mental health supports. A recently provided framework for returning to sport postpartum suggests that to optimally prepare mothers for a return to running there should be advance planning for rehabilitation needs (Christopher et al., 2022). This would include an assessment by a physiotherapist to identify musculoskeletal and pelvic health needs after childbirth, before resuming exercise (Donnelly et al., 2019).

In our research, new mothers we spoke to who saw a pelvic physiotherapist said that they wanted to avoid any long-term damage. They also wanted to make sure physical activity was appropriate for their recovery. Describing her postpartum experience with a pelvic floor physiotherapist, a mother told us:

“I decided to see a pelvic floor physiotherapist during early pregnancy and again in later term pregnancy. This allowed me to learn ahead of time what my 6‑week postpartum recovery plan would look like and gave me some direction for rebuilding my core so that I could return to vigorous activity when I was ready.”

How to go about getting your pelvic floor assessed

The gold standard is an individualized assessment by a pelvic floor physiotherapist. This would include an internal vaginal or a rectal exam, or both. If these exams aren’t available to you, you can self-assess these muscles. To do so, insert your finger vaginally and feel for both a squeeze and lift of the muscles when you contract them. You should also feel for a release or letting go when you relax the pelvic floor. 

How to return to physical activity safely without damaging your pelvic floor

In the early stages of postpartum, focus on rest and restoration. You must take time to work on the foundations: doing breathing exercises, prioritizing sleep, eating nutrient-rich foods, walking, and beginning to activate the deep core, pelvic floor and glutes. Your return to exercise should be progressive.

It’s important to listen to your body. And if you’re experiencing any bladder or bowel leakage, pelvic pressure, heaviness or pain with the exercise, then modify your exercise by practising non-weightbearing exercise such as cycling. In general, we want to encourage you to exercise for its physical and mental benefits. However, training past your body’s limits (for example, through pain or leakage) could further contribute to future problems or dysfunction. 

How to strengthen your pelvic floor

There are many factors to consider as you recover after childbirth, including your posture, breathing, pressure management, and strength and coordination of your pelvic and core muscles. Some people benefit from pelvic floor strengthening, which may include performing Kegel exercises regularly. Such exercises help strengthen your muscles weakened by pregnancy and childbirth.

To get started with Kegel exercises, identify your pelvic floor muscles and practise your technique. Imagine that you’re sitting on a marble then tighten your pelvic muscles as if you’re lifting the marble. Do this for 3 seconds and then relax for 3 seconds.

As you engage your pelvic floor muscles, be mindful of keeping your breath calm and your thighs and buttocks muscles relaxed. It may help to exhale as you contract your pelvic floor muscles. Since nobody can see when you’re doing these exercises, you can do them anytime and anywhere. It’s even possible to them at red lights or when brushing your teeth.

You may require further guidance to learn how to do these exercises correctly. It’s also important to recognize that pelvic floor activation isn’t appropriate for everyone. Some people have tight or tense pelvic floor muscles, in which case pelvic floor exercises may worsen symptoms.

Signs that you should modify, reduce or stop physical activity and seek professional support from a physiotherapist

• Urinary or fecal incontinence
• Urinary or fecal urgency that’s immediate and hard to put off
• Heaviness, pressure, bulge or drag in the pelvic area
• Pain with intercourse
• Constipation resulting in problems with defecation
• Separated abdominal muscles
• Decreased abdominal strength and function
• Pain in pelvis and lower back

We urge mothers to take the time to properly assess their pelvic floor after childbirth. This is important because of the pelvic floor’s vital role in supporting their organs and core as well as how much pregnancy and childbirth can have on pelvic floor muscles. Assessments can help mothers ensure their body is ready to return to physical activity. In the words of a mother in our research, “I had a great experience seeing 2 different physiotherapists and learning about their knowledge base and the anatomy of the pelvic floor.”

Recommended resources

Mothers moving forward: A postpartum guide to being physically active (comprehensive guidebook)

Moving women forward: A guide to becoming physically active after childbirth

From one mom to another: Tips for being active after welcoming a new baby

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About the Author(s)

Iris Lesser, Ph.D., completed her doctoral degree in biomedical physiology and kinesiology at Simon Fraser University. She’s an assistant professor in the School of Kinesiology at University of the Fraser Valley. Her research area is in clinical exercise physiology where she aims to increase physical activity in special populations.

Megan Sawatsky, M.P.T., completed her bachelor of kinesiology with an extended minor in psychology at the University of the Fraser Valley. She then went on to complete her master’s degree in physical therapy from the University of Saskatchewan. In addition to her orthopedic and musculoskeletal practice, her clinical skills also involve the treatment of pelvic floor dysfunction such as incontinence, pelvic organ prolapse, pelvic pain and post-partum pelvic floor retraining. Megan is an active member of the Canadian Physiotherapy Association and the Physiotherapy Association of British Columbia.

References

Christopher, S. M., Gallagher, S., Olson, A., Cichowski, S., & Deering R. (2022). Rehabilitation of the postpartum runner: A 4-phase approach. Journal of Women’s Health Physical Therapy, 46(2), 73-86.

Donnelly, G., Brockwell, E., & Goom, T. (2019). Ready, steady…GO! Ensuring postnatal women are run-ready! British Journal of Sports Medicine Blog. Retrieved 4th August 2021 from https://blogs.bmj.com/bjsm/2019/05/20/ready-steadygo-ensuring-postnatal-women-are-run-ready/

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The information presented in SIRC blogs and SIRCuit articles is accurate and reliable as of the date of publication. Developments that occur after the date of publication may impact the current accuracy of the information presented in a previously published blog or article.