The Role of Pelvic Health Physiotherapy in Postnatal Care

1 day ago
5 min read

Welcoming a new baby is one of life's most profound experiences, but the physical demands of pregnancy and childbirth leave a significant mark on the body, particularly on the pelvic floor. Despite this, postnatal recovery is often reduced to a single six-week GP check-up and a vague recommendation to "do your Kegels." Pelvic health physiotherapy offers something far more comprehensive, and the evidence strongly supports its role as an essential component of postnatal care.

What Is the Pelvic Floor and Why Does It Matter Postnatally?

The pelvic floor is a group of muscles, ligaments, and connective tissues spanning the base of the pelvis. It supports the bladder, bowel, and uterus; contributes to continence; and plays a central role in sexual function, core stability, and movement. During pregnancy, these structures bear the increasing weight of the growing uterus, and during vaginal birth, the pelvic floor is stretched by up to 259%. Even with a caesarean section, the abdominal muscles are surgically divided and repaired, which has its own profound impact on core function and pelvic mechanics.

It is unsurprising, then, that postnatal pelvic floor dysfunction is extremely common. Stress urinary incontinence (leaking with coughing, sneezing, or exercise) affects approximately 30–47% of women in the first 12 months postpartum. Yet many women accept these symptoms as "just part of having a baby." They are common — but they are not inevitable, and they are not something women simply have to live with.

What Conditions Can Pelvic Health Physiotherapy Address?

A pelvic health physiotherapist is trained to assess and treat a wide range of postnatal conditions:

Urinary and Bowel Incontinence

Pelvic floor muscle training (PFMT) is a first-line, evidence-based treatment for urinary incontinence postnatally. It goes well beyond generic Kegel exercises: a trained physiotherapist assesses whether the pelvic floor is weak, overactive, or poorly coordinated, and designs a programme accordingly. Pelvic floor physical therapy, with or without supplemental modalities such as biofeedback or electrical stimulation, has robust evidence supporting its ability to improve or resolve urinary incontinence, fecal incontinence, and peripartum and postpartum pelvic floor dysfunction.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) occurs when the bladder, uterus, or rectum descend towards or into the vaginal canal due to weakened pelvic floor support. It can present as a sensation of heaviness, pressure, or bulging in the perineal region. Pelvic floor rehabilitation, including PFMT, is recommended as a treatment for POP, with evidence suggesting it can reduce symptoms and improve pelvic organ support, particularly in mild-to-moderate presentations.

Diastasis Recti Abdominis (DRA)

Diastasis recti abdominis — the stretching and thinning of the linea alba between the rectus abdominis muscles — is present in virtually all women by 40 weeks of pregnancy and persists in up to 60% of women at six weeks postpartum. It can contribute to core weakness, low back pain, and a persistent abdominal protrusion. Physiotherapy-led rehabilitation, including targeted deep core and pelvic floor activation, progressive loading, and breathwork, is the cornerstone of conservative management. Ultrasound imaging currently offers the best reliability for assessment.

Pelvic Girdle Pain

Pelvic girdle pain (PGP) affects up to 45% of pregnant women, with a significant proportion continuing to experience symptoms postpartum. The first evidence-based Clinical Practice Guideline for PGP in the postpartum population outlines 23 recommendations across six practice domains. Evidence strongly supports patient education and, in combination with other physiotherapy interventions, pelvic belt use. Exercise to stabilise and improve performance of the pelvic floor, back, and hip muscles is central to management.

Pelvic Pain and Dyspareunia

Postpartum changes - including hormonal shifts, perineal scar tissue, birth trauma, and altered muscle tone - can make sexual activity painful or impossible. Pelvic floor physiotherapy can address hypertonic (overactive) pelvic floor muscles, scar tissue mobility, and neuromuscular retraining. Evidence supports intravaginal physiotherapy, myofascial techniques, and PFMT in reducing postpartum dyspareunia.

C-Section Rehabilitation

Caesarean births carry their own rehabilitative needs. Scar sensitivity, restricted scar mobility, core weakness, and altered movement patterns are common. Pelvic health physiotherapy plays an important role in scar tissue management, restoring core function, and supporting safe return to activity following caesarean delivery.

What Does a Postnatal Pelvic Health Assessment Involve?

A comprehensive assessment by a pelvic health physiotherapist goes far beyond a single muscle squeeze. It includes:

Pelvic floor muscle assessment - evaluating strength, tone, endurance, and coordination
Abdominal wall assessment - screening for DRA and assessing core function
Postural and biomechanical assessment - identifying pregnancy-related adaptations that persist postnatally
Functional assessment - evaluating movement patterns relevant to daily activities and goals
A biopsychosocial approach - recognising that postnatal recovery is influenced not only by physical factors but also by fatigue, sleep deprivation, mental health, and psychosocial context

Importantly, an internal pelvic examination is typically deferred until six weeks postpartum to allow tissue healing, but external assessment and education can begin much earlier if needed.

When Should Women Be Referred - or Refer Themselves?

Early intervention consistently produces better outcomes than waiting. Ideally, postnatal pelvic health physiotherapy should be considered for all women following childbirth, regardless of delivery mode. This is standard practice in many European countries, including France, where postnatal pelvic rehabilitation is a universal part of the maternity care pathway.

Women should be prioritised for referral when experiencing:

Any degree of urinary or faecal incontinence
Pelvic heaviness, pressure, or suspected prolapse
Perineal pain, scar discomfort, or pain with intercourse
Persistent low back or pelvic girdle pain
Abdominal doming or suspected diastasis recti
Desire to return to exercise, running, or sport

Returning to Exercise and Running

One of the most common - and most misunderstood - postnatal questions is: "When can I go back to running?" Current guidelines recommend considering a graded return to running at no earlier than 12 weeks postpartum, and only when criterion-based readiness tests are met - not simply based on time elapsed. These criteria assess pelvic floor strength and endurance, single-leg stability, and the ability to tolerate low-impact loading without symptoms.

High-impact exercise increases the risk of pelvic floor dysfunction nearly fivefold compared to low-impact exercise, making a guided, progressive return essential. A pelvic health physiotherapist can design a return-to-running programme that builds pelvic floor and core capacity safely, addressing any symptoms - such as leaking, heaviness, or pain - that arise along the way.

The Bigger Picture: Long-Term Health

The postnatal period is not simply a recovery phase - it is a critical window for preventing long-term pelvic floor dysfunction. Problems that are dismissed or left unaddressed in the weeks and months after birth can persist for years, contributing to ongoing incontinence, prolapse, sexual dysfunction, and reduced quality of life. Pelvic organ prolapse, in particular, can present or worsen many years after childbirth, with risk increasing after multiple deliveries.

By treating postnatal pelvic health as a priority rather than an afterthought, we give women the best possible foundation for long-term health and function.

A Final Word

The six-week postnatal check is a start - but for many women, it is not enough. Pelvic health physiotherapy offers individualised, evidence-based care that addresses the real, often-unspoken challenges of postnatal recovery. Whether a woman is managing incontinence, returning to marathon training, or simply wanting to feel strong and confident in her body again, a pelvic health physiotherapist is an invaluable member of her postnatal care team.

If you are a new mother, or if you are a healthcare professional supporting postnatal women, do not hesitate to seek or recommend a referral to a pelvic health physiotherapist. You do not need to be in pain for it to be worth your while.

Need Support With Postnatal Recovery?

Whether you are recovering from birth, managing leaking, prolapse symptoms, abdominal separation or simply want expert guidance returning to exercise, pelvic health physiotherapy can help.

Book an appointment or learn more about our Postnatal Recovery Classes at GW Pelvic Health.

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