Your pelvic floor is the layer of muscles that supports your bladder, bowel and uterus, and pregnancy and birth can stretch and weaken it, whether you had a vaginal birth or a caesarean. Leaking a little wee when you laugh or sneeze, finding wind harder to hold in, or feeling heavy "down below" are all common in the weeks after birth. They're common but not normal, and help is available. Daily pelvic floor exercises are the place to start, and a GP or pelvic health physiotherapist can help if things aren't improving.
What is the pelvic floor, and how does birth affect it?
Australia's Pregnancy, Birth and Baby service describes the pelvic floor as a sling of muscles from your pubic bone at the front to your tailbone at the back. Your urethra (where wee comes out), vagina and anus pass through it. A strong pelvic floor helps with bladder and bowel control, and it matters for sex too.
During labour, these muscles relax and stretch to let your baby out. Pregnancy, Birth and Baby lists pregnancy, both caesarean and vaginal birth, and constipation and straining among the things that can weaken them. Recovery may take longer if you had a large baby, pushed for a long time, or had a forceps or vacuum birth.
The good news is that these muscles respond to training. Pregnancy, Birth and Baby says pelvic floor function often recovers within the first year after birth, and Continence Health Australia (formerly the Continence Foundation of Australia) says most women see improvement in the first 6 months.
How do I do pelvic floor exercises after birth?
The NHS guide to your post-pregnancy body describes them like this. You can do them lying down, sitting or standing.
- Squeeze and draw in your bottom, as if you're holding in wind.
- Squeeze around your vagina and bladder, as if you're stopping a wee.
- Long squeezes: hold for as long as you can, up to 10 seconds, then relax fully.
- Short squeezes: squeeze quickly and let go straight away, until the muscles tire.
- Build up to 10 of each, at least 3 times a day.
- Keep breathing normally, and don't suck in your tummy.
Sources give slightly different numbers. Choose one routine and do it every day; a physiotherapist can tailor it to you.
| Source | How long to hold | How many | How often |
|---|---|---|---|
| NHS (UK) | Up to 10 seconds, plus quick squeezes | Build up to 10 of each | At least 3 times a day |
| Continence Health Australia | 3 to 8 seconds | 8 to 10 | 3 times a day |
| POGP (UK physios) | 10 seconds, resting 10 seconds between | 10 long, then 10 quick | At least 3 times a day |
| ACOG (US) | 3 seconds, adding 1 second a week up to 10 | 10 | 3 times a day |
The Continence Health Australia guide to pelvic floor exercises says to focus on control and technique rather than the count. ACOG's guide to pelvic support problems says not to squeeze your stomach, thigh or buttock muscles, and not to hold your breath.
Signs you might not be doing them right
Continence Health Australia lists holding your breath, a feeling of pushing down, muscles that won't fully relax, pain, or not being able to feel anything. The POGP booklet Fit for the Future, from the UK's specialist pelvic health physiotherapists, says that if you feel a bulge in your vagina when you squeeze, get help from a specialist physiotherapist. Stopping your wee midstream can help you find the muscles once, but Continence Health Australia says not to make it part of your daily practice.
When to start, and how long it takes
The POGP says to start as soon as you can after the birth. If you have a urinary catheter, wait until it's out and you're weeing normally. Pregnancy, Birth and Baby says you may be able to restart gentle pelvic floor exercises from 48 hours after birth, even if you had a tear, and to check with your midwife or doctor for your situation. After a caesarean, its exercise guide says you can do them from around 3 days after the birth. If you're sore, the POGP suggests doing them lying on your side, and says gentle squeezing and relaxing may ease swelling and help healing.
Expect it to take a while. Continence Health Australia says many women notice better bladder control within 6 to 8 weeks of regular practice, with more improvement over 12 weeks and beyond. The POGP says weak muscles may take 3 to 5 months to improve, and to keep going after that.
The knack. Both the POGP and Continence Health Australia suggest a quick squeeze just before you cough, sneeze, laugh or lift, to help stop leaks.
Is it normal to leak wee, wind or poo after having a baby?
It's common, and you're far from alone. Continence Health Australia says 1 in 3 women who have had a baby have some loss of bladder control. It also says that leaking is common but not normal, and that help is available.
Things you might notice:
- leaking wee when you cough, sneeze, laugh, lift or exercise
- needing to wee more often
- finding it hard to hold in wind
- air escaping from your vagina, often when you kneel then stand up
- poo stains on your underwear, or finding it hard to wipe clean
The NHS guide to your body after the birth says it's quite common to leak a bit of wee when you laugh, cough or move suddenly. Pelvic floor exercises can help, and if they don't, tell your GP at your postnatal check, who may refer you to a physiotherapist.
The NHS postnatal check page specifically asks you to mention trouble holding in wind or wee, or soiling yourself with poo. It's on the list of things to raise, so you can say it plainly.
What are the signs of a prolapse after birth?
A prolapse is when the uterus, bladder or bowel bulges down into the vagina. The NHS pelvic organ prolapse page lists pregnancy and childbirth as a cause, and these symptoms:
- a feeling of heaviness, discomfort or pressure in your lower tummy or vagina
- feeling or seeing a bulge or lump inside, or coming out of, your vagina
- problems weeing, such as feeling your bladder hasn't emptied, needing to go more often, or leaking when you cough, sneeze or exercise
- problems pooing, such as constipation
- pain, discomfort or numbness during sex
Some people have no symptoms. The NHS says to see a GP if you notice a lump or other symptoms; it isn't an emergency. Australia's Pregnancy, Birth and Baby exercise guide says prolapse is common after birth, isn't a danger to your health, and that you can still exercise with one.
The NHS suggests regular pelvic floor exercises, plenty of fibre and water, and avoiding heavy lifting, running and trampolining. Treatment can include pelvic floor training with a women's health physiotherapist or a vaginal support device called a pessary.
When should I see a GP or pelvic health physiotherapist?
A pelvic health physiotherapist (also called a women's health physiotherapist; in the US, a pelvic floor physical therapist) can check your muscles and give you a programme that suits you. The POGP suggests asking to see one if you have:
- leaking wee or poo, or wind you can't control
- sudden discomfort in your vagina, or a bulge
- pelvic girdle pain or backache
- bulging of your tummy muscles
- trouble doing the exercises, or symptoms that aren't improving
The POGP says your 6- to 8-week check is a good time for a pelvic health assessment if you can get one. In the UK, the NICE pelvic floor guideline recommends that doctors consider a 3-month supervised programme after a forceps or vacuum birth, a birth with the baby facing up, or an injury to the anal sphincter. It also says to offer supervised training for at least 3 months for leaking when you cough, sneeze or exercise.
Pregnancy, Birth and Baby suggests seeing your doctor for any bladder or bowel problems; they may refer you to a physiotherapist or a continence nurse. Continence Health Australia encourages getting support early, at the first sign of leaking, and its website lists the National Continence Helpline in Australia. A physiotherapist may offer an internal check to see how your muscles are working, and Pregnancy, Birth and Baby says you'll be asked for consent first.
What happens after a third- or fourth-degree tear?
The NHS episiotomy and tears page says up to 9 in 10 first vaginal births involve some kind of tear, graze or episiotomy, and that stitches usually heal within about a month. The RCOG's guide to third- and fourth-degree tears explains the more serious kinds. A third-degree tear reaches the muscle that controls the anus (the anal sphincter); a fourth-degree tear goes further, into the lining of the anus or rectum. The RCOG says they happen in about 3 in 100 vaginal births, and about 6 in 100 first vaginal births.
What usually happens next. The RCOG says the tear is usually repaired in an operating theatre soon after birth. You'll usually be offered:
- pain relief and a course of antibiotics
- laxatives, to make pooing easier and more comfortable
- an appointment with a physiotherapist
- a follow-up appointment 6 to 12 weeks after the birth, to check healing and bowel control
Recovery. Soreness is likely for 4 to 6 weeks, especially when walking or sitting. Bowel control may not be as good as before for the first few days. Start pelvic floor exercises as soon as you can, as they help healing. The RCOG says 6 to 8 in 10 women have no long-lasting problems. A small number have trouble controlling their bowels or wind, and they should be referred to a specialist team, which may include physiotherapy.
Tell your GP or midwife about sudden urges to poo that you can't control, or wind you can't hold in. If symptoms are still there after 6 months, the RCOG says to see your healthcare professional. If you have another baby, it suggests talking about birth options at your follow-up or early in the next pregnancy.
How do I avoid straining and constipation after birth?
The NHS says you probably won't poo for a few days after the birth, but it's important not to get constipated, and to try not to push or strain. Straining puts pressure on your pelvic floor, stitches and any caesarean wound, and the NHS prolapse page lists long-term straining as a cause of prolapse.
- Drink enough. The POGP suggests 1.5 to 2 litres a day, mostly water; the RCOG suggests at least 2 litres after a third- or fourth-degree tear.
- Eat fibre. The POGP suggests plenty of fruit, vegetables and fibre.
- Sit well. Sit fully on the toilet with your feet on a stool so your knees are above your hips, and rest your arms on your thighs.
- Relax and breathe. Keep your tummy relaxed and don't hold your breath. The POGP says a gentle bear-down is fine, but not "push, push, push".
- Support your stitches. The NHS suggests holding a pad of clean tissue over them while you poo.
- Wee normally. Continence Health Australia says not to push your wee out, and the POGP suggests not going "just in case".
The NHS says to talk to your midwife or GP if constipation won't go away, as a gentle laxative may help. If you're breastfeeding, check with a pharmacist, midwife or GP about which laxative to use. The NHS says piles are very common after birth and usually go within a few days or weeks.
When can I have sex again after birth?
The NHS page on episiotomy and perineal tears says there are no rules about when to start having sex again. The POGP says to wait until you feel ready, and that some women prefer to wait until after their 6-week check.
- Pain is common at first. The NHS says pain during sex is very common in the first few months after a tear or episiotomy.
- Lubricant helps. The POGP says breastfeeding can cause vaginal dryness. The NHS suggests a water-based lubricant, as oil-based products can damage condoms and diaphragms.
- Contraception. The NHS says you can get pregnant from 3 weeks after the birth, so use contraception from the first time.
If sex is still painful, tell your GP; the NHS postnatal check page lists painful sex as something to raise.
When should I get medical help straight away?
Most pelvic floor problems are worth a routine appointment, but a few signs need help sooner.
Call 999 now, or go straight to A&E, if you have:
- heavy bleeding, such as soaking through a pad every hour or two; Pregnancy, Birth and Baby's postpartum haemorrhage page says this needs urgent care
- chest or upper back pain, severe difficulty breathing or a racing heart, which the NHS pulmonary embolism page lists as emergencies
- a painful, swollen calf or leg, which can be a blood clot; the NHS deep vein thrombosis page says the risk is higher if you've had a baby in the past 6 weeks
The NHS DVT page suggests urgent same-day help for leg symptoms alone, and an emergency call with breathlessness or chest pain. After birth, take the faster route.
Get medical help today (your midwife, maternity unit or a same-day GP; if you can't be seen today, go to A&E) if:
- you can't wee, or only pass small amounts; the POGP says to tell the midwife if you haven't had a wee within 6 hours of the birth
- stitches become more painful, red or swollen, or ooze pus or smelly fluid
- you have a temperature of 38°C (100.4°F) or more
- wind or poo comes out through your vagina; the RCOG says this is not normal and needs urgent review
Talk to your GP or a pelvic health physiotherapist (book an appointment) about leaking wee, wind or poo, urgency, heaviness or a bulge, pain during sex, or constipation that won't settle.
Leaking and pain can wear you down. If you're feeling low or anxious, talk to your GP or call Samaritans on 116 123, and see postnatal depression and anxiety.
If you have thoughts of harming yourself or your baby, call Samaritans on 116 123 or 999 now.
What's useful to note down?
Before an appointment, a few days of notes can help: when you leak and what you were doing, how often you wee and poo, and whether you feel heaviness by the end of the day. Write down any questions too. For returning to exercise safely, see exercise after birth; for the rest of your recovery, see recovery after birth.