Pregnancy and childbirth can place significant strain on the pelvic floor muscles, leading to symptoms many women are never fully prepared for. Leaking urine when coughing or sneezing, pelvic pressure, pain, or difficulty making it to the bathroom in time are all more common postpartum experiences than many people realize.¹

Although these symptoms are common after pregnancy and childbirth, they should not simply be accepted as part of motherhood. Pelvic floor therapy is a specialized form of physical therapy designed to help strengthen and support these muscles, improve symptoms, and support long-term recovery and quality of life after birth.

What is the Pelvic Floor?

Your pelvic floor is a supportive hammock-like structure made of a group of muscles.² These muscles keep the organs in your pelvis, such as your bladder, uterus, ovaries, and rectum, in place. They also facilitate coordination of urine and bowel control with other pelvic structures, such as the urethra and the anus.³ To locate your pelvic floor muscles, take a moment to imagine you are trying to stop the flow of urine while you pee. The muscles you would squeeze to do this are your pelvic floor muscles.⁴

Related: Postpartum Symptoms: What Is Normal?

How Pregnancy and Birth Affect the Pelvic Floor

During pregnancy, your pelvic floor supports your baby as your uterus grows and your placenta, and an increased blood supply to nourish your baby.⁵ This increased weight causes stretching and potentially weakening pelvic floor muscles.⁶ This is why some women experience pelvic floor weakness symptoms during pregnancy.² Constipation during pregnancy and straining to pass a bowel movement can also cause the pelvic floor muscles to weaken.⁵

For a vaginal delivery, the pelvic floor muscles must stretch even further, up to three times their original length. This allows your body to accommodate your baby’s descent down the birth canal, particularly during pushing.¹³

In addition to pelvic floor muscles experiencing trauma, nerves can be stretched, causing postpartum pelvic pain, which may happen with or without sex.

If forceps or a vacuum are used to help deliver your baby, the risk of pelvic floor injury increases.

In addition to urine or bowel incontinence, pelvic floor weakness can sometimes affect how well these muscles support other pelvic organs later in life.⁷ This can lead to a condition known as pelvic organ prolapse, as the organs that the pelvic floor is designed to support (the uterus, bladder, and rectum) drop down into the vaginal canal.⁸

Some women’s bodies recover more quickly and completely after giving birth, while others may take longer or need additional restorative support. It is important to pay attention to how your body feels during recovery. If you are experiencing symptoms that are negatively impacting your quality of life, it is best to seek resources from your OB provider, such as a referral for pelvic floor therapy (or postpartum physical therapy) specifically aimed at restoring strength in your pelvic floor muscles.⁵

Related: Pelvic Floor and Core Health After Pregnancy

How Can a Pelvic Floor Therapist Help?

Pelvic floor therapy focuses on improving strength, coordination, mobility, and support within the pelvic floor muscles. The goal is to help resolve symptoms of pelvic floor dysfunction through various exercises and strengthening techniques.⁹ A pelvic floor therapist is a physical therapist who has additional training to identify and treat pelvic floor disorders.¹¹

Pelvic floor physical therapy treatment can also focus on strengthening the abdominal muscles for mothers who have diastasis recti or a separation of the abdominal muscles that can happen during pregnancy and delivery.⁶

Pelvic Floor Therapy: What To Expect

Many women feel nervous before their first pelvic floor therapy appointment, especially if they are unsure what treatment involves.

Effective pelvic floor physical therapy begins with your therapist discussing your medical history, current symptoms, and goals for therapy.⁹ Your therapist can teach you about the anatomy of the pelvic floor using a model of a pelvis or pictures to explain how the weakening of specific pelvic floor muscles may cause your symptoms.¹²

Your therapist will perform a physical exam, including an assessment of your hips, spine, and pelvic floor muscles, to assess which muscles need strengthening.¹¹ The pelvic floor muscles are examined during a pelvic exam, similar to the one you get during a pap smear, but there is no need for a speculum or stirrups.

The therapist inserts a gloved finger into your vagina to determine the specific muscles contributing to your symptoms. You may be asked to squeeze and relax your pelvic floor muscles as instructed by your therapist. Be sure to communicate with your therapist if you are not comfortable at any point.⁹

Next, your therapist will discuss your treatment plan to meet your individual needs and how to prevent worsening dysfunction as you age.^2,6 Techniques include exercises, biofeedback therapy, and stretches you can do to strengthen your pelvic floor muscles.²

You may also receive recommendations on lifestyle changes to help improve pelvic floor function and prevent things that may worsen your condition, like constipation.⁹

Related: Postpartum Must-Haves for Recovery After a Vaginal Birth

Does Insurance Cover Pelvic Floor Therapy?

Many insurance companies that cover physical therapy will cover pelvic floor therapy. It is best to verify with your insurance provider beforehand whether your treatment is covered and whether you’ll need a referral from your doctor.¹⁰

Are Kegel Exercises Enough?

Kegel exercises are often recommended postpartum, but they are not the right solution for every pelvic floor issue.

It is a common misconception that doing Kegel exercises alone at home can help all pelvic floor issues.¹¹ Also, many people do them incorrectly initially; for example, they may hold their breath or tighten their thigh or buttocks muscles.⁷ This could do nothing to help your symptoms or may make them worse. A pelvic floor therapist can determine if Kegels are right for you and, if so, teach you the proper techniques so they are effective. They can also answer any questions you may have.¹¹

Kegel exercises are one of the many forms of pelvic floor muscle strengthening. Here’s how to do them:⁷

• Squeeze and hold your pelvic floor muscles for 3 seconds
• Relax the muscles fully afterward
• Repeat in sets of 10
• Aim for 3 sets throughout the day
• Gradually increase the hold time as your muscles strengthen

Related: Kegel Exercises: How to Do Them and Why It’s Important

Can You Do These Exercises During Pregnancy?

Kegel exercises are safe during pregnancy; however, if you have symptoms such as pain or urine leakage before delivery, talk with your OB provider.⁴ You may get relief with formal pelvic floor physical therapy. Your pelvic floor therapist can teach you exercises for your specific needs and continue or modify treatment as needed after delivery.¹²

When To Consider Pelvic Floor Therapy Postpartum

As your body recovers from giving birth, your muscles undergo further physical changes. This is why some symptoms of pelvic floor weakness resolve on their own with time. However, if you have symptoms at your six-week postpartum follow-up appointment, talk to your provider about what you are experiencing. Your provider can refer you to a pelvic floor therapist. If you haven’t made it to six weeks and your symptoms are negatively impacting your quality of life, you may want to seek treatment sooner.¹⁴

Your body goes through tremendous physical changes during pregnancy and childbirth, and recovery can take time. While pelvic floor symptoms are common postpartum, they are often treatable with the right support and guidance. If you are experiencing leaking urine, pelvic pressure, pain, or other symptoms affecting your quality of life, talking with your provider or a pelvic floor therapist may help you feel stronger, more supported, and more comfortable in your body again.