Pelvic Floor Physiotherapy After Birth: What Actually Happens

Pelvic floor physiotherapy is physiotherapy for the muscles that sit at the base of your pelvis. It treats leaking, heaviness, pain and weakness after pregnancy and birth.

Bladder leakage after a baby is common. HealthLink BC says it can last “up to three months and sometimes longer after your baby is born.” Common, though, is not the same as normal, and it is not something you have to accept.

What is pelvic floor physiotherapy?

Your pelvic floor is a hammock of muscles slung between your pubic bone and your tailbone. HealthLink BC describes what they do simply: these muscles control your bladder and help hold your pelvic organs in place.

They also support your low back and work with your deep abdominal muscles.

Pelvic floor physiotherapy assesses those muscles and retrains them. A physiotherapist with pelvic health training leads it. The work combines assessment, hands-on treatment, education and graded exercise.

Why birth changes these muscles

Pregnancy loads the pelvic floor for months. Birth can stretch it further.

HealthLink BC lists the usual culprits behind a weakened pelvic floor: “Age, being overweight, pregnancy, childbirth, and surgery.” Two of those five apply to every new parent.

A caesarean birth does not exempt you. Nine months of load happens either way, and abdominal surgery adds its own recovery.

Bladder leakage is common, and treatable

HealthLink BC’s postpartum guidance is direct about the timeline. Leakage can last “up to three months and sometimes longer.”

It adds that “a cough, sneeze, laugh, or physical activity, such as jumping on a trampoline can make this happen.”

The same page says pelvic strengthening exercises help control bladder leakage, and that “for most women, this gradually improves.” Improvement is the expectation.

What happens at a first appointment

Most people worry about this part, so here is the honest version.

Female practitioners are available for prenatal and postnatal appointments. You can choose your practitioner when you book online.

How HealthLink BC says to do Kegels

A Kegel is a squeeze of the pelvic floor. HealthLink BC gives a specific protocol rather than a vague “do your Kegels.”

HealthLink BC also notes that Kegels “work best when done on a regular schedule.” Two thorough sessions beat twenty half-hearted ones.

Two mistakes that make Kegels useless

The first is performing them while emptying the bladder. HealthLink BC is explicit that this should not become a habit, because over time it can irritate the bladder.

The second is squeezing through pain. HealthLink BC says to stop and speak to your doctor if the exercises hurt.

There is a third problem the guidance cannot solve on paper. Some pelvic floors are already too tight, and squeezing a tight muscle harder makes symptoms worse. A pelvic health physiotherapist can tell you which pattern you have.

Heaviness and pelvic pressure

Some people notice pressure or a dragging feeling rather than leakage. It often shows up later in the day, or after lifting.

This is common after pregnancy, and it responds well to treatment. HealthLink BC puts it plainly: it “isn’t usually a big health problem,” it “can be treated if it bothers you,” and “it may get better with time.”

A useful clue is what changes your symptoms. HealthLink BC notes they are “worse when you stand, jump, or lift” and “usually are relieved if you lie down.”

None of that means something is wrong. It simply means the problem is worth looking at properly rather than waiting it out.

It is not only about leaking

Pelvic health physiotherapy also helps with ongoing low back or pelvic girdle pain, and abdominal separation.

Recovery after a caesarean section is part of it too. Scar tissue and a deconditioned core both respond to graded loading.

Our pelvic floor physiotherapy team works alongside our pre and post-natal physiotherapy service. You can carry the same plan from pregnancy through recovery.

Some people also see a kinesiologist to rebuild strength for running or lifting. Others add clinical counselling, because the first year after a baby is hard in ways that have nothing to do with muscles.

When should you book?

Six weeks postpartum is the usual starting point. Book sooner if you have pain, a heavy dragging feeling, or trouble controlling your bladder or bowels.

Later is fine too. Pelvic floor muscles respond to training years after birth, so a five-year gap does not close the door.

In BC you can see a physiotherapist directly. The Canadian Physiotherapy Association’s Pelvic and Reproductive Health division covers the field in more depth.

Frequently asked questions

What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is physiotherapy for the muscles at the base of the pelvis. HealthLink BC describes those muscles as the ones that control your bladder and help hold your pelvic organs in place. Treatment combines assessment, education and graded exercise.

Is it normal to leak when you cough or sneeze after having a baby?

It is common. HealthLink BC says leakage can last up to three months after birth, and sometimes longer. A cough, sneeze, laugh or physical activity can trigger it.

HealthLink BC also says pelvic strengthening exercises help, and that for most women it gradually improves.

When should I start pelvic floor physiotherapy after birth?

Most people start around six weeks postpartum, after their maternity care provider has checked them. Book sooner if you have pain, a heavy dragging feeling, or trouble controlling your bladder or bowels.

Do I need a referral for pelvic floor physiotherapy in BC?

No. In British Columbia you can book a physiotherapist directly. Some extended health plans ask for a doctor’s note before they reimburse, so check your plan first.

Is an internal examination required?

No. An internal assessment is the most accurate way to assess these muscles, but your physiotherapist offers it rather than assumes it. You can decline and still be treated, and you can change your mind at any time.

How do I do Kegel exercises correctly?

HealthLink BC advises contracting and lifting the pelvic floor muscles, drawing them inward and upward. Hold for 3 seconds, then relax for 5 to 10 seconds, and build up by one second a week to a 10-second hold. Do 10 squeezes per session, 3 to 8 sessions a day, keeping the abdominal, thigh and gluteal muscles relaxed.

Can I request a female physiotherapist?

Yes. Female practitioners are available for prenatal and postnatal appointments. You can choose your practitioner when you book online.

Can Kegels make things worse?

Sometimes. If your pelvic floor is already too tight, more squeezing can increase symptoms. HealthLink BC says to stop and speak to your doctor if the exercises cause pain.

Find your nearest Synergy clinic

We run 19 clinics across the Lower Mainland and Fraser Valley. Every location offers physiotherapy, and most add chiropractic, massage therapy, kinesiology and acupuncture under the same roof.

Hours vary by location. Check the locations page for current opening times and directions.

Still pregnant? Our guide to prenatal therapy covers what to do before the birth. Our low back pain guide pairs well with pelvic floor work.

This article is general information, not medical advice. Please see a physiotherapist, midwife or physician about your own symptoms.