Pregnancy and birth place a lot of pressure on the pelvic floor. After delivery, these muscles may feel weak, numb, difficult to control, or slower to respond. You may notice urine leakage, trouble holding wind, vaginal pressure, or weakness when coughing and lifting.

Gentle pelvic floor exercises can help rebuild support around the bladder, vagina, uterus, and bowel. They may also improve bladder control and symptoms of pelvic organ prolapse. (nhs.uk)


When Can You Start Pelvic Floor Exercises?

Gentle pelvic floor exercises can often begin soon after birth, provided they feel comfortable and your healthcare provider has not told you to wait. Start with small, light contractions rather than strong squeezing.

If you still have a catheter, wait until it has been removed before beginning. Your recovery may also take longer if you had:

  • A C-section
  • Forceps or vacuum-assisted delivery
  • A third- or fourth-degree tear
  • A painful episiotomy
  • Heavy bleeding
  • Birth complications
  • A wound or infection

After a C-section, your pelvic floor still needs attention because pregnancy itself stretches and weakens these muscles. However, your overall exercise plan should progress more slowly because you are also recovering from abdominal surgery.


How to Find Your Pelvic Floor Muscles

Imagine that you are trying to:

  • Stop yourself from passing wind
  • Stop urine from coming out
  • Gently close and lift the openings around your vagina and bottom

You should feel an internal squeeze and lift. The movement should go upward inside your body.

You should not:

  • Push downward
  • Bear down as though having a bowel movement
  • Tighten your buttocks strongly
  • Squeeze your thighs together
  • Hold your breath
  • Pull your stomach in as hard as possible

If your vagina seems to widen, you feel downward pressure, or you leak urine or wind while squeezing, you may be pushing down instead of lifting. Stop and reduce the effort. A pelvic health physical therapist can check your technique. (EKHUFT Patient Information Leaflets)

Do not repeatedly stop your urine flow while using the toilet. You can use that idea to understand which muscles should work, but regularly interrupting urination may interfere with normal bladder emptying. 


1. Start With Pelvic Floor Release

Your pelvic floor must be able to relax as well as tighten. Constantly squeezing without fully releasing can create tightness, discomfort, and poor muscle control.

  1. Lie on your back with your knees bent and feet flat.
  2. Place one hand on your lower stomach.
  3. Breathe in and allow your stomach to rise naturally.
  4. Let the muscles around your vagina and bottom soften.
  5. Breathe out without pushing downward.
  6. Repeat for five slow breaths.

You are not trying to force the muscles downward. You are simply letting go of tension before beginning the strengthening exercises. 

2. Gentle Pelvic Floor Squeezes

This is the best place to begin during the early postpartum period.

  1. Lie down or sit in a supported position.
  2. Let your stomach, legs, and buttocks relax.
  3. Breathe in normally.
  4. As you breathe out, gently squeeze and lift your pelvic floor.
  5. Hold for two seconds.
  6. Release completely.
  7. Rest for at least two seconds.
  8. Repeat four or five times.

Your starting point may be only a two-second hold repeated four times. That is fine. Do not force a ten-second contraction before your muscles are ready. 


3. Quick Pelvic Floor Squeezes

Quick squeezes help the muscles react when you cough, sneeze, laugh, stand up, or make a sudden movement.

  1. Squeeze and lift the pelvic floor quickly.
  2. Release immediately.
  3. Make sure the muscles fully relax.
  4. Repeat five times.
  5. Gradually work toward 10 quick squeezes.

Stop when the contractions become weak, slow, or difficult to control. 


4. Seated Pelvic Floor Exercises

Once you can find the muscles while lying down, practice while sitting.

  1. Sit upright on a supportive chair.
  2. Place both feet flat on the floor.
  3. Keep your shoulders relaxed.
  4. Breathe in and relax your stomach.
  5. Breathe out while gently squeezing and lifting the pelvic floor.
  6. Hold for two to five seconds.
  7. Release completely.
  8. Repeat five times.
  9. Finish with five quick squeezes.

Sitting makes the pelvic floor work against more gravity than lying down. As your control improves, you can progress to standing exercises. 


5. Pelvic Tilts

Pelvic tilts gently reconnect the pelvic floor with the deep stomach and lower-back muscles.

  1. Lie on your back with your knees bent.
  2. Place your feet flat and about hip-width apart.
  3. Breathe in and relax.
  4. As you breathe out, gently lift your pelvic floor.
  5. Slowly flatten your lower back toward the floor.
  6. Keep your buttocks on the floor.
  7. Breathe in and return to the starting position.
  8. Repeat five times.

Build toward 10 slow repetitions. The movement should remain small and controlled. Stop if your stomach pushes outward, forms a ridge, or domes along the middle. 

6. Heel Slides

Heel slides teach your pelvic floor and stomach muscles to support you while your legs move.

  1. Lie on your back with both knees bent.
  2. Breathe out and gently lift the pelvic floor.
  3. Slowly slide one heel away from your body.
  4. Keep the heel touching the floor.
  5. Stop before your back arches or your stomach bulges.
  6. Slide the heel back toward you.
  7. Release your pelvic floor.
  8. Repeat on the other side.

Begin with three repetitions on each side. Gradually build toward five to 10. 


7. Mini Bridges

Do not rush into bridges during the first days after delivery. Add them once lying down, bending your knees, and gently tightening your stomach and pelvic floor feel comfortable.

  1. Lie on your back with your knees bent.
  2. Keep both feet flat and hip-width apart.
  3. Breathe out and gently engage your pelvic floor.
  4. Flatten your lower back slightly.
  5. Press through your feet.
  6. Lift your hips a small distance.
  7. Keep your ribs lower than your hips.
  8. Slowly lower your back and hips.
  9. Relax the pelvic floor.
  10. Repeat three to five times.

Build toward 10 controlled repetitions. Stop if you feel vaginal pressure, increased bleeding, incision pain, pelvic pain, urine leakage, or abdominal doming. 



8. Use Your Pelvic Floor Before Coughing or Lifting

This technique is sometimes called the knack.

Just before you:

  • Cough
  • Sneeze
  • Laugh
  • Lift your baby
  • Lift a car seat
  • Stand from a chair
  • Pick something up

Gently squeeze and lift your pelvic floor. Keep the contraction during the difficult part of the movement, then release.

This helps the pelvic floor respond before pressure increases inside your abdomen. 


What to Avoid

Avoid:

  • Holding your breath
  • Pushing downward
  • Squeezing as hard as possible every time
  • Keeping the pelvic floor tightened all day
  • Practicing while urinating
  • Continuing through pelvic or vaginal pain
  • Moving to running or jumping while you are still leaking
  • Heavy lifting during the early healing period
  • Straining during bowel movements
  • Exercises that create vaginal heaviness or pressure

Avoid high-impact activity and heavy lifting for the first four to six weeks, with a slower return for women who had major tears or complications. More demanding exercise should be introduced gradually and should not continue if it causes leaking, vaginal pressure, bulging, or dragging. 


What if Kegels Cause Pain?

Pelvic floor problems are not always caused by weakness. Some women have muscles that are tight, painful, poorly coordinated, or unable to relax properly.

Stop repeated strengthening exercises and request an assessment if squeezing causes:

  • Pelvic pain
  • Vaginal pain
  • Rectal pain
  • Bladder pain
  • Increased urgency
  • Trouble emptying your bladder
  • Constipation
  • Pain during sex
  • More pressure instead of support

A pelvic health physical therapist can determine whether you need strengthening, relaxation, scar treatment, coordination work, or a different exercise plan. 


When to See a Pelvic Floor Physical Therapist

Ask for a referral if you experience:

  • Urine leakage
  • Trouble controlling wind or bowel movements
  • A heavy or dragging feeling in the vagina
  • A vaginal bulge
  • A feeling that something is falling downward
  • Pain during sex
  • Pelvic pain
  • Difficulty finding or contracting the muscles
  • Difficulty relaxing after a contraction
  • Symptoms that are not improving
  • Abdominal doming during basic exercises

These problems are common after birth, but you do not have to accept them as your new normal. Specialist pelvic health physical therapists assess pelvic floor strength, relaxation, bladder and bowel symptoms, pain, scarring, and exercise technique.