The pelvic floor is the sling of muscles that supports the bladder, womb and bowel. Pregnancy and birth stretch and can weaken these muscles, leading to leaking urine, urgency, a feeling of heaviness in the vagina, or difficulty controlling wind or stools. These problems are common after having a baby, but they are not something you have to put up with: pelvic floor muscle training is the first treatment, and specialist physiotherapy is available.
Also known as postnatal incontinence, pelvic floor dysfunction, stress incontinence after childbirth, pelvic organ prolapse
Anatomy: where the problem is
Front view of the abdomen and pelvis. Highlighted in the diagram: pelvic floor muscles.
Symptoms
- Leaking urine when coughing, sneezing, laughing, lifting or exercising
- A sudden, urgent need to pass urine
- A feeling of heaviness, dragging or a bulge in the vagina
- Difficulty controlling wind, or leaking from the bowel
- Pain during sex
- Reduced sensation, or difficulty feeling the muscles tighten
Causes and risk factors
- Pregnancy itself, as the weight of the baby loads the pelvic floor for months
- A vaginal birth, particularly an assisted birth with forceps or ventouse
- A long pushing stage, a large baby or a significant tear
- Constipation and straining
- Being overweight, and a persistent cough
- Returning to high-impact exercise before the muscles have recovered
What the evidence says helps
- NICE recommends supervised pelvic floor muscle training for at least three months as the first treatment for stress urinary incontinence and for symptoms of prolapse.2
- A Cochrane review found that women who did pelvic floor muscle training during pregnancy were less likely to leak urine in late pregnancy and in the first months after birth.1
- For women who already have leaking after birth, the same review found it less clear how much training helps, which is one reason individual assessment by a pelvic health physiotherapist is worthwhile.1
- NICE also recommends general measures: a healthy weight, avoiding constipation, and regular physical activity that includes supervised exercise where needed.2
- Return to running and other high-impact exercise is best delayed until around three months after birth and built up gradually, with the pelvic floor checked first if you have symptoms.3
Things you can try at home
- Do pelvic floor exercises every day: tighten as if stopping wind and urine, hold for up to ten seconds, relax fully, and repeat ten times, three times a day
- Add short, quick squeezes as well as the long holds
- Set a daily reminder, or use a pelvic floor exercise app, to keep the habit going
- Avoid constipation: drink enough, eat fibre and do not strain on the toilet
- Go back to low-impact exercise first, such as walking and swimming once you have healed
- Mention any leaking or heaviness at your six to eight week check: do not wait to be asked
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Heavy bleeding, large clots, or bleeding that suddenly gets heavier: call your maternity unit, or 999 if it is severe
- A fever, a wound that is red, swollen or leaking, or offensive discharge: get same-day medical help
- Chest pain, breathlessness, or a swollen, painful calf: call 999
- A severe headache, vision changes or sudden swelling in the weeks after birth: get urgent medical help
- Feeling very low, anxious or having thoughts of harming yourself or your baby: speak to your GP, midwife or health visitor urgently, or call NHS 111
- Being unable to pass urine, or loss of bladder or bowel control with numbness around the genitals or back passage: go to A&E
How Apollo can help
We are not a specialist pelvic health physiotherapy service, and we will tell you when that is what you need and help you ask your GP for a referral. What we can do is assess your back, pelvis, hips and tummy muscles after birth, explain how to do pelvic floor exercises well, and plan a gradual, pelvic-floor-friendly return to exercise. Reformer Pilates and clinical exercise sessions can be adapted for the postnatal period.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is it normal to leak urine after having a baby?
It is common, affecting about a third of women, but it is not something you should simply accept. It usually improves with pelvic floor muscle training, and if it has not improved by around three months your GP can refer you to a pelvic health physiotherapist.
How long does the pelvic floor take to recover after birth?
Most recovery happens in the first three to six months, and improvement can continue for a year or more with regular exercises. Recovery often takes longer after an assisted birth or a significant tear.
When can I run again after having a baby?
Guidance suggests waiting until around three months after birth and building up through walking and strength work first. If you have leaking, heaviness or pain, have your pelvic floor assessed before you return to running.
References
- Woodley SJ, et al. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2021. View source
- National Institute for Health and Care Excellence (2021). Pelvic floor dysfunction: prevention and non-surgical management. NICE guideline NG210. View source
- Christopher SM, Gallagher S, Olson A, Cichowski S, Deering RE (2022). Rehabilitation of the Postpartum Runner: A 4-Phase Approach. Journal of Women's Health Physical Therapy 46:73-86. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
