Your Pelvic Floor After Birth: Leaking, Heaviness and When to See a Pelvic Floor PT
Short answer: pelvic floor symptoms such as leaking urine, heaviness or pressure are common after pregnancy and birth, whether you had a vaginal birth or a cesarean. They're common, but they're treatable. Pelvic floor muscle training has good evidence behind it: a Cochrane review (Woodley et al., 2020) found that structured pelvic floor training during pregnancy can help prevent urinary incontinence in late pregnancy and the months after birth. If symptoms continue, get worse or stop you from exercising, see a pelvic floor physical therapist.
I'm Asia Rideout, a pregnancy and postpartum strength coach in Alexandria, VA. Pelvic floor-aware training is part of every program I coach, and I'm happy to work alongside your pelvic floor physical therapist.
What your pelvic floor does
Your pelvic floor is a group of muscles at the base of your pelvis. It supports your bladder, uterus and bowel, helps you stay dry, and works together with your breathing and deep core. Pregnancy (the weight of your baby and hormonal changes) and birth both put a lot of load on these muscles.
Common symptoms after birth
Leaking urine when you cough, sneeze, laugh, jump or lift
A strong, sudden urge to pee
Heaviness, pressure or a bulging feeling in your vagina, often worse at the end of the day
Difficulty controlling gas or stool
Pain with sex, or pelvic or tailbone pain
Pelvic floor exercises: squeeze and relax
Sit or lie comfortably and breathe normally.
Gently squeeze and lift as if you're stopping gas and the flow of urine at the same time.
Hold for a few seconds while you keep breathing, then fully let go.
Rest, then repeat. Build up gradually, and practice quick squeezes too.
Relaxing matters as much as squeezing. Some women have pelvic floor muscles that are too tight rather than too weak, which is one more reason an assessment from a pelvic PT is so helpful.
Everyday habits that help
Exhale on effort: breathe out as you lift your baby, stand up or lift weights.
Avoid straining on the toilet: a footstool, fiber and water help.
Build load gradually: lift, then progress weight and impact step by step, watching for symptoms.
Don't hold your breath and bear down during heavy lifts unless you've been cleared for it.
When to see a pelvic floor physical therapist
Book an appointment if:
Leaking, heaviness or pain hasn't improved by a few months after birth, or is getting worse
Symptoms stop you from exercising or doing things you enjoy
You notice a bulge at the vaginal opening
You have pain with sex or pelvic pain
You want to return to running or high-impact exercise and aren't sure you're ready
You can find a pelvic health PT near you with the APTA Pelvic Health PT Locator. Ask your OB or midwife for a referral, and check what your insurance requires.
Can I still lift weights?
Usually, yes. Strength training, with good breathing and gradual progression, is part of pelvic floor recovery for most women. The goal is to find the load and movements you can do without symptoms, then build from there. If a movement brings on leaking or heaviness, lighten it, adjust your breathing or choose a different exercise for now.
Frequently asked questions
Is it normal to leak after having a baby?
It's common, especially in the first months, but you don't have to accept it long term. Most women improve with the right training and care.
Can a C-section affect my pelvic floor?
Yes. Pregnancy itself loads the pelvic floor, so symptoms can happen after a cesarean too.
When can I run again?
Postnatal return-to-running guidelines suggest waiting until at least around 12 weeks after birth, and only once you can do basic strength and impact tests without leaking, heaviness or pain.
Train with a coach who understands your pelvic floor
Our ReBuild to Strength series starts with breathing, core and pelvic floor connection and progresses to full-body strength, for moms after vaginal or cesarean births. Mondays and Wednesdays at 10:00am or 11:15am at One Way Performance, 5400 Eisenhower Ave, Suite A, Alexandria, VA. Babies welcome. It starts with a free 45-minute assessment.
Related: Diastasis Recti: How to Check and What Actually Helps · Postpartum Recovery Timeline · MotherMade Strong Resources
Sources: Woodley SJ et al., "Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women," Cochrane Database of Systematic Reviews (2020); ACOG Committee Opinion No. 804 (2020); Goom T, Donnelly G, Brockwell E, "Returning to running postnatal" (2019); APTA Pelvic Health PT Locator.
This article is general education, not medical advice. Please see your provider or a pelvic floor physical therapist for diagnosis and treatment.
Written by Asia Rideout, Certified Personal Trainer, Certified Pregnancy & Postpartum Athleticism Coach and birth doula, founder of MotherMade Strong in Alexandria, VA.
