WHAT TO EXPECT FROM YOUR PELVIC FLOOR IMMEDIATELY POSTPARTUM
Written and reviewed by Anna McMaster, PT, DPT, PRPC
If you're nearing the end of your pregnancy, you might be wondering what will happen to your pelvic floor after childbirth. After all, your pelvic floor muscles have been supporting extra weight for months and are about to undergo significant stress during delivery. Here's what you can expect in those first weeks after welcoming your baby.
WHAT HAPPENS TO YOUR PELVIC FLOOR DURING DELIVERY?
During vaginal delivery, your pelvic floor muscles (the hammock-like muscles that support your bladder, uterus, and bowel) stretch dramatically. Research shows these muscles stretch to approximately 250% of their normal length during delivery, which is a remarkable feat for any muscle in the body. This extensive stretching, combined with the hormonal changes and pressure from pregnancy, can temporarily affect how these muscles function.
WHAT'S NORMAL IN THE FIRST 6 WEEKS
Weakness and reduced function: It's completely normal for your pelvic floor muscles to feel weak or difficult to engage immediately after birth. This is true regardless of whether you had a vaginal delivery or cesarean section, though vaginal births typically have a greater impact on these muscles.
Urinary leakage: Many new moms experience some degree of urinary incontinence -- leaking urine when you cough, sneeze, laugh, or exercise. Studies show that up to 42% of women experience stress urinary incontinence in the later weeks of pregnancy, and this can often continue into the early postpartum period.
Heaviness or pressure: You might feel a sensation of heaviness or pressure in your vagina, especially toward the end of the day or when standing for long periods. This is often due to the temporary weakening of your pelvic floor support.
Perineal pain or discomfort: If you had a vaginal delivery, especially with tearing or an episiotomy, you'll likely experience some discomfort in the perineal area (between your vagina and rectum). This is normal and typically improves significantly within the first two weeks.
Difficulty feeling or controlling your muscles: You might find it challenging to properly contract or relax your pelvic floor muscles. This temporary lack of coordination is common as your body begins the healing process.
RECOVERY TIMELINE
Your body begins healing immediately after birth, and significant changes occur during the first 12 weeks. Here's what you can expect:
Weeks 1-2: Inflammation and swelling begin to subside. You may still have significant discomfort, especially if you experienced tearing or an episiotomy. Your pelvic floor muscles remain stretched and weak, and many women report difficulty feeling or controlling these muscles during this period.
Weeks 2-4: Initial tissue healing occurs. Perineal pain typically improves significantly, though it may still be present, especially with movement. You may begin to regain some awareness of your pelvic floor muscles, though strength remains limited. Urinary leakage is still common during this time, especially with sudden movements.
Weeks 4-6: This marks the end of the initial recovery phase. Inflammation should be largely resolved, though the muscles remain weakened. Your healthcare provider will typically check your recovery at your postpartum appointment, usually 6-8 weeks after delivery. By this point, many women report they can feel when they contract their pelvic floor, though the contractions may feel weak or uncoordinated.
Weeks 6-8: After clearance from your healthcare provider, you can typically begin more structured pelvic floor exercises. The muscles are still healing but can now handle more directed strengthening. Some women notice improvement in urinary control during this period, though challenges often remain with higher-impact activities.
Weeks 8-12: Most women experience continued improvement in pelvic floor strength and coordination. Research shows measurable increases in muscle strength during this period. Symptoms like heaviness or pressure often decrease, though they may still be noticeable at the end of the day or during prolonged standing. For many women, this is when they begin to feel more confident in their recovery -- though full rehabilitation of the pelvic floor typically continues beyond this 12-week mark.
WHAT YOU CAN DO TO SUPPORT RECOVERY IN THE FIRST 6 WEEKS
While your body has amazing healing capabilities, there are things you can do to support your pelvic floor recovery:
Rest. Your entire body, including your pelvic floor, needs rest to heal. Try to limit prolonged standing and heavy lifting in the first few weeks.
Gentle engagement. You can begin very gentle pelvic floor awareness as early as a few days to a week after delivery, if it feels comfortable. There's no need to wait until your 6-week checkup to begin this gentle reconnection work -- though you should get clearance from your healthcare provider before progressing to a more structured exercise program.
Proper posture. Pay attention to your posture when sitting and standing, as this affects the pressure on your pelvic floor. Aim for a neutral spine position rather than excessive arching or slumping.
The Knack. This technique involves consciously contracting your pelvic floor muscles just before activities that increase abdominal pressure, such as coughing, sneezing, or lifting. This simple strategy can help prevent leakage.
Proper toileting habits. Avoid straining during bowel movements, as this puts additional pressure on your healing pelvic floor. Staying hydrated, eating enough fiber, and using a small footstool to elevate your knees above your hips when on the toilet can all help.
WHEN TO SEEK HELP
While many pelvic floor issues improve naturally with time, some require professional attention. Consider seeing a pelvic floor physical therapist or discussing concerns with your healthcare provider if:
Urinary or fecal incontinence persists beyond 6-8 weeks postpartum
You experience persistent pain during intercourse after clearance from your provider
You feel ongoing heaviness or pressure in your vagina
You notice a bulge in your vagina
You're having difficulty with bowel movements despite proper hydration and fiber intake
Remember, seeking help isn't admitting defeat -- it's taking proactive steps toward recovery. A 2021 study found that women who received pelvic floor physical therapy postpartum showed significant improvement in symptoms compared to those who didn't.
A FINAL WORD
Your body has done something incredible in growing and birthing your baby. The postpartum period is a time of transition and healing -- be patient with yourself and remember that recovery isn't linear. Some days will feel better than others. With time, proper care, and appropriate professional support when needed, most women regain good pelvic floor function after childbirth.
For personalized postpartum pelvic floor support, Amie offers programs designed by pelvic floor PTs for every stage of your journey.
REFERENCES
Beuttenmuller, L., Dias Fernandes, A.C. & Spolidoro, G.C.I. (2022). Pelvic floor dysfunction in postpartum women: A cross-sectional study. BMC Women's Health, 22(1), 429.
Cuthbert, S.C., & Arroyo-Gil, V. (2023). Maximizing recovery in the postpartum period: A timeline for rehabilitation from pregnancy through return to sport. International Journal of Sports Physical Therapy, 17(5), 835-850.
Dietz, H.P., & Garnham, A.P. (2021). Recovery of pelvic floor muscle strength and endurance 6 and 12 months postpartum in primiparous women -- a prospective cohort study. International Urogynecology Journal, 32(8), 2079-2086.
Gluppe, S.L., Hilde, G., Tennfjord, M.K., Engh, M.E., & Bø, K. (2022). Pelvic floor support and symptoms one year postpartum in relation to excess body habitus before, during and after first vaginal birth. American Journal of Obstetrics and Gynecology, 226(5), 673.e1-673.e9.
Sigurdardottir, T., Steingrimsdottir, T., Geirsson, R.T., Halldorsson, T.I., & Aspelund, T. (2021). Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity. Scientific Reports, 11(1), 12850.
Taghipour, A., Mirteimouri, M., & Roudsari, R.L. (2020). Social recovery: a neglected dimension of caring for women with perineal trauma. Iranian Journal of Nursing and Midwifery Research, 25(4), 333-340.