Your pelvic floor after birth

Leaking pee when you laugh or cough is common after birth. Pelvic floor exercises can help, and a GP can refer you to a physiotherapist if they are not helping.

What these muscles do

The pelvic floor muscles support the bladder, rectum and womb. They help control the release of pee, poo and wind. Pregnancy and childbirth can weaken them, and weakness can contribute to leaks. Pelvic floor muscle training is also called Kegel exercises, particularly in US guidance.

A heavy feeling between the vagina and anus is another symptom to discuss with a GP or health visitor. The NHS says pelvic floor exercises may help, and a clinician can advise or refer you to a specialist. Describe what you feel and when it bothers you.

Finding a squeeze and a release

You can practise lying down, sitting or standing. Imagine holding in wind, then gently draw up and squeeze around the vagina and the tube you pee through. Keep breathing. Try to work the pelvic floor rather than tightening your tummy or thighs.

Release the squeeze and let the muscles fully relax. NHS guidance describes both longer holds and short squeezes followed by an immediate release. Ask a clinician to help you choose a manageable routine; NIDDK recommends an exercise plan matched to your needs.

Practise after you have finished peeing, rather than repeatedly stopping the flow. NIDDK warns that regularly doing the exercises while peeing can stop the bladder emptying completely and increase the risk of infection. The NHS also places the exercises after a toilet visit.

Finding a daily routine

The UK Chief Medical Officers’ advice is to start pelvic floor exercises as soon as you can and continue daily. NIDDK adds that the exercises are not suitable in every situation, so check with your health professional before beginning. Ask for individual guidance if you are unsure how to start after your birth.

Doing more is not always helpful. NIDDK advises against increasing the exercises beyond your plan, because overdoing them can lead to straining when peeing or opening your bowels. If the routine is difficult, ask for it to be reviewed rather than simply adding more squeezes.

Choose a reminder that fits your day, such as practising while sitting comfortably. If you keep a note, record what you managed and any questions for the physiotherapist.

What a physiotherapist can help with

Many people find it hard to identify the right muscles. A doctor, nurse or pelvic floor therapist can check whether you are doing the movement correctly. This may include an examination while you try the exercises. Ask what an assessment involves before it begins.

Tell the clinician about bladder leaks, difficulty controlling wind or poo, perineal pain and pain during sex. The NHS lists these as things to raise at your postnatal check. You can ask for help earlier if a physical problem is bothering you; the check is another opportunity to discuss it.

You could say: “I leak when I cough, and I cannot tell whether I am doing the squeeze correctly.” Or: “There is a heavy feeling when I am up and about.” Add what you would like help to return to, such as walking comfortably or joining an exercise class.

When to get help

Seek urgent medical assessment now if you cannot pee at all or have severe lower tummy pain. Contact your maternity unit (UK), obstetric clinician (US), or local urgent service now; go to emergency care if you cannot be assessed promptly.

Contact your midwife or GP today in the UK, your obstetric clinician in the US, or your local doctor or midwife if you can pee but it is very difficult, perineal pain is increasing, or discharge smells unpleasant. These symptoms need advice about recovery rather than another exercise session.

For continuing leaks, heaviness or painful sex, book a GP or doctor appointment and ask about pelvic health physiotherapy. Explain when the symptoms happen and what they stop you doing.