Healing After Birth: How Pelvic Floor Therapy Can Support Postpartum Recovery

By:  Dr. Kristina Hanson, PT, DPT

Having a baby is an incredible, beautiful accomplishment! Over the course of pregnancy, your body adapts in so many ways to support a growing baby. Your posture changes, your center of gravity shifts, your abdominal wall stretches, your rib cage expands, and your pelvic floor spends months adapting to increasing pressure and weight. Then comes delivery.

Whether you have a vaginal birth or a C-section, your body has a whole new level of healing and adapting to do. And while postpartum care often focuses heavily on the baby, your body deserves care and attention, too.

Postpartum recovery isn't about “bouncing back.” It's about giving your body the time, support and gradual progression it needs to heal well and, in due time, get back to the activities you love and feeling fully connected with your body again.

First Things First: Heal

The first goal of postpartum pelvic floor physical therapy isn't to get you back to full strength as quickly as possible. It's to help you heal well, and with support.

Your body has been through a huge change. After a vaginal delivery, the pelvic floor and surrounding tissues have been through an incredible amount. The muscles, connective tissues, and nerves of the pelvis stretch and adapt during pregnancy and birth, and some people may also experience tearing, swelling, stitches, or lingering soreness afterward. Even when everything goes smoothly, these tissues still deserve time and support to heal, recover, and gradually return to function.

After a C-section, when the baby doesn't pass through the pelvic floor, pregnancy itself has placed months of increased pressure and load on the pelvic floor. A C-section is also major abdominal surgery involving multiple layers of tissue, and your abdominal wall and pelvic floor work together as part of your core system.

The goal of early postpartum recovery is to support that healing process, such as learning how to move comfortably, managing pain and swelling, and gradually returning to normal daily activities. One of the most important things to understand is that your pelvic floor needs to know how to relax, not just contract. Your diaphragm, abdominal muscles and pelvic floor all need to coordinate together to manage pressure. Postpartum pelvic floor physical therapy helps to address that re-coordination after pregnancy and delivery.

Postpartum physical therapy starts as early as three weeks postpartum. We assess things like your movement, breathing, abdominal wall (such as abdominal separation, a.k.a. diastasis recti), and pelvic floor function. After your first follow-up with your OB or midwife, often around six weeks, we can start taking a closer look at how your pelvic floor is doing. An internal pelvic floor exam can help us understand how your muscles and tissues are healing and functioning, and identify any specific areas that may need to be addressed. 

And yes, we need to talk about the first pee and poop! We know that first bowel movement after having a baby can be intimidating. Swelling, stitches, hemorrhoids, constipation, soreness and simply being afraid to push can all make things more difficult. 

Postpartum Bathroom Tips: 

• Staying well hydrated and following your provider's recommendations for fiber or stool softeners

• Using a small stool (like a Squatty Potty) under your feet to create a more comfortable position for bowel movements

• Exhaling rather than holding your breath and bearing down

• Using a peri bottle to gently rinse the area after using the bathroom

• Using a folded toilet paper “splint” for gentle support if recommended for you

• If you've had a C-section, holding a small pillow over your incision for additional comfort and support

If you're having significant difficulty urinating or having a bowel movement, significant pain, or symptoms that aren't improving, talk with your medical provider.

Restore Your Connection to Your Body

Once your body has had some time to heal, we start working towards reconnection.

Pregnancy and birth can sometimes leave you feeling like your core, pelvis, and even your breathing don't quite work the way they used to.

Maybe your abdomen feels disconnected, or your ribs feel like they're always lifted or “flared.” Maybe your pelvis feels like it's constantly tipped forward or tucked underneath you. Or maybe you simply don't feel like your torso and pelvis are working together anymore. This is where we start to restore that connection. A big part of this is breath.

We want to help you reconnect your diaphragm, rib cage, abdominal wall and pelvic floor so they can work together to manage pressure.

A quick exercise:

• Try noticing your breath right now. 

• Can you feel your ribs gently expanding in all directions? 

• Can your belly move without you intentionally pushing it out? 

• Can you imagine the breath moving down toward your pelvic bowl?

• What does it feel like? Fully expansive? Do you notice any areas of tension, restriction, or not feeling connected?

There isn't one “perfect” posture you need to force yourself into. Instead, we're looking for positions where your ribs, pelvis and abdominal wall can work together comfortably. From there, we start reconnecting to your core.

Core check:

• If you gently engage your abdominal muscles, where do you feel it? Does your abdomen move naturally with your breath? What happens to your pelvic floor?

The goal isn't to constantly tighten everything. It's to help your core and pelvic floor learn when to engage, when to relax and how to coordinate with the rest of your body.

This is the beginning of feeling connected again.

Retrain: Build Strength and Confidence

Once we've restored that connection, we can start asking your body to do more. This is where postpartum pelvic floor physical therapy begins to look more like the exercise and movement you may be used to. We progressively build strength, endurance, coordination and confidence, teaching your core and pelvic floor to work together with your hips, legs, spine and breath.

And we focus on what you actually need your body to do.

That might mean:

• Lifting your baby

• Carrying the car seat

• Getting up and down from the floor

• Walking around the neighborhood

• Returning to strength training

• Getting back to running

• Playing with your older kids

• Or simply getting through a full day without pain, pressure or leaking

The goal isn't just to make a muscle stronger. It's to help your entire body work together so you can move through everyday life with confidence.

Reclaim: Get Back to You

This is where postpartum recovery becomes more about what you want to do now, and what your goals are.

Maybe you want to run again. Maybe you want to lift weights, hike, return to yoga, have sex without pain, sneeze without leaking, or simply feel comfortable and confident in your body again.

Whatever your goals are, pelvic PT can help you get there! The goal is to help you feel strong, capable and at home in your body again.

Heal → Restore → Retrain → Reclaim. This is the approach we take at Uplift Pelvic Health and Wellness.

When Should You See a Pelvic Floor PT?

Our biggest piece of advice? Don't wait until something is really wrong.

Whether this is your first baby or your fourth, a postpartum pelvic floor assessment can be a valuable part of your recovery. You don't need to be experiencing severe symptoms to benefit from having someone evaluate how your body is healing and moving.

Did you Know?: In France, postpartum pelvic floor rehabilitation has long been incorporated into routine postpartum care, with women commonly receiving pelvic floor rehabilitation as part of their postpartum recovery.

And there's good reason to pay attention to these areas after birth. Urinary incontinence affects an estimated 20–30% of women during the first postpartum year, while changes in the abdominal wall, including diastasis recti, are also very common in the early postpartum period.

You may especially want to seek support if you're experiencing:

• Urinary leaking or urgency

• Pelvic heaviness or pressure

• Pelvic, hip or low back pain

• Pain with intercourse

• Difficulty controlling or relaxing your pelvic floor

• Abdominal doming or bulging

• Difficulty returning to exercise

• A feeling that your core isn't “working” the way it used to

• Ongoing discomfort after a difficult, lengthy or complicated delivery

• A desire to understand how your body is healing and how to safely return to your favorite activities

You don't have to wait until six weeks postpartum to start thinking about your recovery. Your medical provider can help determine when an evaluation is appropriate for you based on your delivery and individual circumstances.

You Don't Have to Figure It Out Alone

The postpartum period is a huge transition. You're learning how to care for a new person while navigating sleep deprivation, feeding, changing routines and an entirely different body. You deserve someone on your team who is paying attention to you, too.

At Uplift, postpartum pelvic floor PT isn't just about doing Kegels or strengthening your pelvic floor. We look at how your breath, core, pelvic floor, hips, spine, movement patterns and nervous system are working together, and how all of that fits into your actual, day-to-day life.

We meet you where you are and help you build from there. And your postpartum recovery deserves just as much care as the little person you're taking care of!

Support for Your Postpartum Recovery

Know that healing doesn't have to follow a one-size-fits-all timeline. Whether you're navigating bladder leakage, pelvic pain, changes after birth, returning to exercise, or simply want support as you reconnect with your body, postpartum pelvic floor physical therapy can help.

At Uplift Pelvic Health & Wellness, we provide personalized, one-on-one care to support you through your postpartum recovery, and help you feel more confident and comfortable in your body.

If you're wondering whether pelvic floor physical therapy may be right for you, we'd love to connect. Schedule a complimentary discovery call to ask questions, learn more about our approach, and explore your next steps.

Schedule your discovery call.