What it is
You feel pressure down there, or heaviness, or you have been told to do kegels and are not sure you are doing them right. This page is about the pelvic floor: what it is, what birth does to it, and what pelvic floor PT is.
The pelvic floor is a hammock of muscle from the pubic bone to the tailbone. It holds up the bladder, uterus, and bowel. It has to relax to let you pee, poop, and give birth.
In pushing, these muscles stretch to about three times their length. Some fibers tear, and nerves get stretched. Ultrasound studies find a muscle injury called an avulsion in roughly one in five to one in three first vaginal births.
What's typical
Heaviness and pressure are common in the first two to six weeks and usually ease as swelling goes down. Leaking with a sneeze is common in the first three months. For many mothers these settle by six months. For many they do not, and that is where pelvic floor PT comes in.
A pelvic floor PT visit is about an hour. The therapist asks about leaking, pain, sex, and pooping. With your consent, she checks the muscles with a gloved finger. Then she teaches you what to squeeze, what to relax, and how to breathe when you lift.
What's known
ACOG says pelvic floor symptoms should be asked about at the postpartum visit and referred on. A Cochrane review found supervised pelvic floor training reduces leaking after birth. Kegels alone are not the whole story. Many mothers have a pelvic floor that is tight and weak at once, and squeezing harder makes it worse. Learning to relax it matters as much. France funds pelvic floor sessions for every mother after birth. In the United States you usually have to ask.
What helps
- Breathe out on effort: lifting the baby, standing up, pooping. Holding your breath pushes down.
- A gentle kegel: squeeze as if holding in gas, lift, hold a few seconds, then fully let go. The letting go is half the exercise.
- Keep stool soft. Straining is the hardest thing you can do to a healing pelvic floor.
- Ask for a pelvic floor PT referral at any visit.
When to call someone
- Now (go in): you cannot pee, or heavy bleeding comes with the pressure.
- Todaya bulge you can see or feel at the opening of the vagina, leaking stool, or severe pain.
- At your next visitany leaking, heaviness, pressure, pain with sex, or trouble holding gas. Ask for pelvic floor PT.
- At three to six months: symptoms that have not cleared. Ask again.
Who helps
Tools: Birthworker Directory · My Birth Team
Related
- Peeing after birth and leakingPostpartum: Your Body
- Prolapse: heaviness, bulging, and what helpsPostpartum: Your Body
- Diastasis recti: abdominal separationPregnancy: Your Body
- Returning to exercisePostpartum: Your Body
- Sex after birth: when, pain, dryness, desirePostpartum: Your Body
- Healing a tear or stitchesPostpartum: Your Body
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Sources
- American College of Obstetricians and Gynecologists — Committee opinion on optimizing postpartum care
- Cochrane — Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women
- APTA Academy of Pelvic Health Physical Therapy — What is pelvic floor physical therapy: patient resource
- NHS — Pelvic floor exercises
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