Your pelvic floor after birth

Leaking pee when you laugh or cough is common after birth. Pelvic floor exercises can help. If they don’t, a GP can refer you to a physiotherapist.

What these muscles do

The pelvic floor muscles support the bladder, the back passage (rectum) and the womb. They help you control when you let out pee, poo and wind. Pregnancy and giving birth can weaken them, and weak muscles can lead to leaks. Pelvic floor exercises are also called Kegel exercises, especially in US guidance.

A heavy feeling between the vagina and anus is another symptom to raise with a GP or health visitor. The NHS says pelvic floor exercises may help, and a clinician can advise you or refer you to a specialist. Describe what you feel and when it bothers you.

Finding a squeeze and a release

You can do the exercises lying down, sitting or standing. Imagine you’re holding in wind. Then gently draw up and squeeze around your vagina and the tube you pee through. Keep breathing. Try to use your pelvic floor, not your tummy or thigh muscles.

Then let go of the squeeze and let the muscles relax fully. NHS guidance describes both longer holds and short squeezes that you let go of straight away. Ask a clinician to help you pick a routine you can manage. NIDDK recommends an exercise plan that fits your needs.

Do the exercises after you’ve finished peeing, rather than stopping the flow again and again. NIDDK warns that doing them often while you pee can stop your bladder emptying fully and raise the risk of infection. The NHS also says to do them after going to the toilet.

Finding a daily routine

The UK Chief Medical Officers advise starting pelvic floor exercises as soon as you can, and doing them every day. NIDDK adds that the exercises don’t suit every situation, so check with your health professional before you start. If you’re unsure how to begin after your birth, ask for advice for you.

Doing more isn’t always better. NIDDK advises against going beyond your plan, because overdoing it can make you strain when you pee or poo. If the routine is hard, ask for it to be reviewed rather than just adding more squeezes.

Pick a reminder that fits your day, such as doing them while you’re sitting comfortably. If you keep notes, write down what you managed and any questions for the physiotherapist.

What a physiotherapist can help with

Many people find it hard to find the right muscles. A doctor, nurse or pelvic floor therapist can check whether you’re doing the movement correctly. This may include an examination while you try the exercises. Ask what the check involves before it starts.

Tell the clinician about bladder leaks, trouble controlling wind or poo, pain in the perineum and pain during sex. The NHS lists these as things to bring up at your postnatal check. You can ask for help sooner if a physical problem is bothering you. The check is just another chance to talk about it.

You could say: “I leak when I cough, and I can’t tell whether I’m doing the squeeze right.” Or: “I get a heavy feeling when I’m up and about.” Add what you’d like to get back to, such as walking comfortably or going to an exercise class.

When to get help

Get urgent medical help now if you can’t pee at all or have severe pain low in your tummy. Contact your maternity unit (UK), obstetric clinician (US), or local urgent service now. Go to emergency care if you can’t be seen quickly.

Contact your midwife or GP today in the UK, your obstetric clinician in the US, or your local doctor or midwife if you can pee but it’s very hard, pain in your perineum is getting worse, or your discharge smells bad. These symptoms need advice about your recovery, not more exercises.

For leaks that carry on, a heavy feeling or painful sex, book a GP or doctor appointment and ask about pelvic health physiotherapy. Explain when the symptoms happen and what they stop you doing.