The pelvic floor is one of the most important muscle groups in the body, yet many people have only a vague sense of where it is and what it does — until something goes wrong. After childbirth, both vaginal and by caesarean section, the pelvic floor requires specific attention and rehabilitation. This is not optional self-care for the especially motivated. It is essential maintenance for long-term continence, sexual function, and comfort.
The pelvic floor is a group of muscles and connective tissues that forms a hammock-like structure at the base of the pelvis. It spans from the pubic bone at the front to the coccyx at the back, and from side to side between the sitting bones.
This group of muscles has several critical functions:
The pelvic floor works in coordination with the deep abdominal muscles, the diaphragm, and the deep back muscles to manage pressure within the abdominal cavity. When this system is working well, it handles activities like coughing, sneezing, jumping, and lifting without allowing leakage or creating excessive downward pressure on the pelvic organs.
Vaginal birth places significant demands on the pelvic floor. During the second stage of labour, the pelvic floor muscles must stretch to allow the baby to pass through the birth canal — stretching, in some cases, to three times their resting length. Tears, episiotomies, instrumental deliveries (forceps or ventouse), and prolonged pushing can all cause additional trauma to the perineal tissue and the muscles themselves.
Caesarean section is often assumed to spare the pelvic floor. This is partly true — the baby is not born through the vaginal canal — but the pelvic floor still sustains load throughout pregnancy, and the surgical incision through the layers of the abdominal wall can affect how the abdominal and pelvic floor muscles work together. Postnatal pelvic floor rehabilitation is still important after a caesarean.
Even without any apparent tearing or instrumental delivery, the structural changes of pregnancy — increased weight, hormonal changes, altered posture, and a shifted centre of gravity — affect pelvic floor function and require active rehabilitation.
It is important to know that many symptoms of pelvic floor dysfunction are treatable and should not simply be accepted as the inevitable price of motherhood:
Stress urinary incontinence: Leaking urine when coughing, sneezing, laughing, jumping, or running. This is extremely common postpartum — studies suggest up to 50 per cent of women experience it — but it is not normal in the sense of being acceptable. It is a sign of pelvic floor weakness or coordination failure that can be treated.
Urgency incontinence: Sudden, strong urge to urinate that is difficult to defer, sometimes with leakage before reaching the toilet. This may be accompanied by frequent urination.
Pelvic organ prolapse symptoms: A sensation of heaviness, dragging, or pressure in the vaginal area, particularly at the end of the day or after prolonged standing. Some women feel or see a bulge at the vaginal opening. Prolapse is graded by severity — early prolapse is very common postpartum and responds well to rehabilitation; significant prolapse may need specialist management.
Pelvic pain: Pain in the pelvis, tailbone, or perineal area, particularly during sitting or sex.
Bowel symptoms: Difficulty controlling wind or stool, urgency with bowel movements, or pain during bowel movements.
If you experience any of these, they should be discussed with your GP or midwife, ideally with a view to referral to a women's health physiotherapist.
Kegel exercises — pelvic floor contractions — are the cornerstone of pelvic floor rehabilitation, but they are frequently done incorrectly. One study found that a majority of women given verbal instructions alone performed them incorrectly, often bearing down rather than lifting.
To find the pelvic floor: Try to stop the flow of urine midstream — the muscles you use to do this are part of the pelvic floor. Do not practise this regularly (stopping urine flow is not the exercise, just a way of identifying the muscles), but use it to understand what you are trying to contract.
Performing a Kegel: Sitting or lying comfortably, breathe in, and on the exhale, gently draw up and in — as though you are trying to prevent passing wind and stop the flow of urine simultaneously. You should feel a lifting sensation deep within the pelvis, not a squeezing or tightening of the buttocks or thighs.
Hold for up to 10 seconds if you can, then fully release. The release is as important as the contraction — a pelvic floor that is constantly held tight is as problematic as one that is weak.
How often: Aim for three sets of 10 contractions per day. Begin with shorter holds (3 to 5 seconds) if 10 seconds is difficult and build up gradually.
When to start: Gentle pelvic floor exercises can begin within 24 hours of birth, once any catheter has been removed and the initial soreness allows. Starting early is beneficial and does not interfere with healing.
Kegel exercises at home are valuable, but they are not a substitute for professional assessment if you have symptoms. A women's health physiotherapist can assess the strength, coordination, and tone of your pelvic floor, check for diastasis recti, and give you a personalised programme.
Signs that you should seek physiotherapy promptly rather than simply continuing home exercises:
Your pelvic floor supported your baby for nine months and participated in one of the most demanding physical events of your life. It deserves targeted care.
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