Here's a statistic that doesn't get nearly enough attention: 1 in 3 women experience urinary leakage after having a baby. This is not a minor inconvenience that "just happens" to new mothers. It is a sign of pelvic floor dysfunction — and it is almost always preventable and treatable with the right rehabilitation.
The pelvic floor is not a niche topic for specialist clinics. It is the foundation of your physical recovery from birth. And yet most women leave the maternity ward with a vague instruction to "do your kegels" and very little else.
This guide gives you the full picture: what the pelvic floor actually is, what happens to it during pregnancy and birth, and a safe, progressive, week-by-week exercise programme from day 1 through 12 weeks and beyond.
What Is the Pelvic Floor?
The pelvic floor is a bowl-shaped hammock of muscles, ligaments, and connective tissue that sits at the base of your pelvis. It stretches from your pubic bone at the front to your tailbone at the back, and from one sitting bone to the other.
What the Pelvic Floor Does
- Supports your pelvic organs — bladder, uterus, and bowel — against gravity and intra-abdominal pressure
- Controls the openings of the urethra, vagina, and anus
- Contributes to core stability — working in coordination with the deep abdominal muscles, diaphragm, and spinal stabilisers
- Plays a role in sexual function — including arousal and orgasm
What Happens During Pregnancy
Pregnancy places the pelvic floor under sustained load for nine months. The growing uterus, baby, placenta, and amniotic fluid — which can reach 10–12 kg in the third trimester — create continuous downward pressure on the pelvic floor. At the same time, the hormone relaxin loosens pelvic ligaments to prepare for birth, which reduces the structural support around the pelvic floor and increases susceptibility to strain.
What Happens During Birth
During a vaginal delivery, the pelvic floor muscles stretch to approximately 3–4 times their normal length to allow the baby to pass through. This degree of stretch is beyond what most muscles in the body ever experience. Tears, episiotomies, and prolonged pushing all add to the trauma. The muscles, nerves, and connective tissue of the pelvic floor need active rehabilitation to recover — they do not simply spring back.
When Can You Start Pelvic Floor Exercises?
The answer is: as soon as you feel able — even day 1 after birth.
If you had a straightforward vaginal birth or a C-section with no complications, gentle pelvic floor exercises are safe to begin within hours or days of delivery. You will not harm your healing tissue with the gentle contractions described in the early phases below — in fact, gentle movement promotes circulation, reduces swelling, and supports healing.
C-Section: Same Starting Point
Women who had a C-section are sometimes told they don't need pelvic floor rehabilitation because their baby didn't pass through the vagina. This is incorrect. The pelvic floor was under load throughout the entire pregnancy, regardless of birth type. The same day-1 reconnection exercises apply. The only adjustments for C-section recovery relate to abdominal exercises and core loading — which require more caution due to the incision site.
When to Wait
If you had a third or fourth degree tear (extending into the anal sphincter), speak to your midwife, OB, or pelvic floor physical therapist before beginning exercises. If you experienced a significant haemorrhage or have a prolapse diagnosis, get clearance from your OB, midwife, or healthcare provider first.
Days 1–7: Reconnection Phase
Goal: Restore awareness and circulation
The pelvic floor has just undergone significant compression, stretching, or both. Before you can strengthen it, you need to reconnect with it. Many women find in the first days that they genuinely cannot feel their pelvic floor at all — this is completely normal and temporary. The exercises in this phase are about communication, not load.
Diaphragmatic Breathing — The Foundation
Begin here, before any kegel. Diaphragmatic (belly) breathing is the foundation of all pelvic floor rehabilitation because the pelvic floor and the diaphragm move together as part of the core pressure system.
How to do it: Lie on your back, knees bent. Place one hand on your chest and one on your belly. Breathe in through your nose, allowing your belly to rise (your chest should barely move). As you breathe in, your pelvic floor naturally descends slightly. As you breathe out through your mouth, your belly falls and your pelvic floor gently lifts. Practice this for 5–10 breaths, 3–4 times daily.
Gentle Kegel Contractions
How to do it: Imagine you are trying to stop the flow of urine (do not actually practice this while urinating — it can interfere with normal bladder function). Gently squeeze and lift the muscles around the urethra, vagina, and anus. Hold for 3 seconds. Then fully release. This is key: the release is as important as the squeeze. Many women hold residual tension and never fully let go — this can lead to a hypertonic (over-tight) pelvic floor over time.
Sets/reps: 5–8 contractions, 3 times daily. Stop if you feel pain. If you feel nothing, that's okay — the connection will return.
The pelvic floor often goes into a protective spasm after birth — a survival response to trauma. If you only practice squeezing and never consciously releasing, you reinforce this tension. After each contraction, actively let go: breathe out slowly, imagine the muscles softening and opening. It should feel like putting something down after holding it.
Weeks 2–4: Activation Phase
Goal: Build endurance and begin coordinating movement
By week 2, most women have regained some sensation in the pelvic floor and are ready to increase exercise volume and begin pairing pelvic floor activation with simple movements. Continue diaphragmatic breathing as your warm-up for every session.
- Seated kegels: 10 contractions × 3 sets, daily. Now hold each contraction for 5 seconds before fully releasing. Alternate between short fast pulses (1 second on, 1 second off × 10) and sustained holds to work both fast and slow muscle fibres.
- Pelvic tilts (lying): Lie on your back, knees bent. Gently flatten your lower back against the floor by tilting your pelvis — hold for 3 seconds, then return. This activates your deep abdominals and coordinates with the pelvic floor. 10 reps × 2 sets.
- Heel slides: Lie on your back, knees bent. Exhale and gently engage your pelvic floor, then slowly slide one heel along the floor until the leg is straight — keep your lower back still. Inhale and return. 8 reps each side × 2 sets. This is a gentle introduction to single-leg loading.
- Brief walks: Begin building walk duration from 5–10 minutes to 20 minutes by the end of week 4. Walk on flat surfaces. Stop if you feel pelvic heaviness, dragging, or leaking.
Weeks 4–8: Strengthening Phase
Goal: Build strength through movement patterns
The strengthening phase introduces compound movements that load the pelvic floor in functional positions — the positions you actually use in daily life. The key principle is "exhale and engage": activate your pelvic floor on the exhale, and during any effort or load.
- Glute bridges: Lie on your back, feet flat, hip-width apart. Exhale and lift your hips off the floor, squeezing your glutes at the top. Your pelvic floor should naturally engage on the lift. Hold for 3–5 seconds at the top, then lower slowly. 10 reps × 3 sets. Avoid this if you have pubic symphysis pain.
- Bird-dog: On hands and knees (quadruped position), maintain a neutral spine. Exhale and simultaneously extend your opposite arm and leg — reaching them long without rotating the pelvis. Hold for 3 seconds. This exercise trains the pelvic floor as part of the deep core system. 8 reps each side × 2 sets.
- Sit-to-stand kegel: Practice your everyday sit-to-stand from a chair with pelvic floor awareness. As you begin to rise, exhale and activate the pelvic floor. On the way down, release. This functional exercise builds the habit of "lifting before loading" that protects your pelvic floor during activities throughout the day.
- Walking: Build to 30 minutes at a brisk pace by the end of week 8. If comfortable, begin gentle hills.
Weeks 8–12: Progression Phase
Goal: Challenge the pelvic floor through varied loading and positions
The 8–12 week phase moves from floor-based exercises to standing and position-varied training. The pelvic floor should now be coordinating reliably with movement, and you're building the capacity for normal daily activities — including carrying a growing baby.
- Side-lying clamshells: Lie on your side with knees bent at 45°. Keep feet together and rotate your top knee upward like a clamshell opening — without rolling your hip backward. This targets the hip abductors, which work with the pelvic floor as part of the wider pelvic girdle support system. 15 reps × 3 sets each side.
- Standing kegels: Practice kegels in standing — the position where gravity is working against your pelvic floor. Begin with 10 contractions × 3 sets, holding each for 5–7 seconds. Graduate to kegels while walking slowly.
- Bodyweight squats with exhale-engage: Stand feet shoulder-width apart. Inhale as you lower into the squat. As you rise, exhale and consciously lift the pelvic floor. Begin with 10 reps × 2 sets. Stop if you feel pressure or leaking — this is a loading exercise that should be symptom-free.
- Lateral band walks: Use a light resistance band around your ankles. Step sideways with control, keeping hips level. 15 steps each direction × 2 sets. These target hip abductors and external rotators, which provide critical stability to the pelvis.
After 12 Weeks: With Medical Clearance
At the 12-week mark — with clearance from both your GP and ideally a pelvic floor physical therapist — you can begin to explore return to higher-impact activity. This is a general guideline; individual readiness varies significantly.
What You Can Consider Starting
- Swimming: Excellent low-impact cardiovascular exercise with no pelvic floor loading
- Cycling: Low-impact cardio — use a padded seat and build duration gradually
- Reformer Pilates: Controlled, progressive core and pelvic floor training in a supervised environment
- Yoga: Restorative or hatha yoga; avoid hot yoga until fully hydrated and recovered
What to Hold Off On Until Cleared
Running, jumping, and HIIT — these are high-impact activities that place significant load on the pelvic floor. Returning to them before adequate rehabilitation is a leading cause of long-term pelvic organ prolapse and persistent leaking. Most pelvic floor physical therapists recommend a minimum of 12 weeks before attempting even a run/walk programme, and formal clearance before sustained running. Heavy weightlifting (deadlifts, barbell squats, loaded carries) should similarly wait for physical therapist clearance.
Diastasis Recti: What It Is and Why It Matters
Diastasis recti (DR) is a separation of the two halves of the rectus abdominis (the "six-pack" muscle) along the linea alba — the connective tissue running down the midline of the abdomen. It is present in approximately 60% of women at 6 weeks postpartum and resolves spontaneously in most by 6 months. However, in some women it persists and can affect core stability and pelvic floor function.
How to Check Yourself
Lie on your back with knees bent. Place two fingers horizontally just above your navel. Slowly lift your head and shoulders slightly off the floor — as if doing a crunch. Feel along the midline with your fingers. A gap of more than 2 finger widths (approximately 2 cm), or a gap where the tissue feels very soft or "spongy" (poor tension), may indicate significant diastasis recti. Stop any exercises that cause the midline to dome or tent.
Exercises That Make It Worse
In the early weeks postpartum, avoid:
- Sit-ups, crunches, or any forward flexion of the trunk
- Planks (even modified) until the gap is less than 2 finger widths and has good tension
- Double leg lifts from lying
- Oblique twisting exercises
- Heavy lifting with breath-holding
All of the exercises in this programme's progression are safe for women with diastasis recti, provided they are symptom-free. If you have a significant gap with poor tension, seek referral to a pelvic floor physical therapist (PFPT) rather than continuing with self-directed exercise.
Exercise Progression at a Glance
| Phase | Timing | Key Exercises | Duration/Volume |
|---|---|---|---|
| Reconnection | Days 1–7 | Diaphragmatic breathing, gentle kegels (3s hold + release) | 5–8 reps × 3 sets daily |
| Activation | Weeks 2–4 | Seated kegels, pelvic tilts, heel slides, gentle walking | 10 reps × 3 sets; walks to 20 min |
| Strengthening | Weeks 4–8 | Glute bridges, bird-dog, sit-to-stand kegels, brisk walking | 10 reps × 3 sets; walks to 30 min |
| Progression | Weeks 8–12 | Clamshells, standing kegels, bodyweight squats, lateral walks | 15 reps × 3 sets; varied terrain |
| Return to Impact | 12+ weeks (cleared) | Swimming, cycling, reformer Pilates, gentle yoga | Build gradually; symptom-free |
Signs You Need a Pelvic Floor Physiotherapist
Self-directed exercise is a great starting point, but some situations require specialist assessment. Seek a referral to a Women's Health or Pelvic Floor Physiotherapist if you experience:
- Leaking urine when coughing, sneezing, laughing, or jumping — at any point, but especially if it persists past 12 weeks
- Urgency incontinence — rushing to the toilet and not always making it in time
- A feeling of heaviness, dragging, or pressure in the pelvic region — a possible sign of prolapse
- Visible or palpable bulging at the vaginal opening
- Pain during sex that persists past 8–10 weeks of resuming sexual activity
- Pelvic or lower back pain that isn't resolving
- Inability to feel any pelvic floor contraction by week 3
- Anal incontinence or difficulty controlling wind or stool
If you are still leaking urine at 12 weeks postpartum — when laughing, sneezing, coughing, or exercising — please see a pelvic floor physical therapist. Leaking is not "just what happens after having a baby." It is a symptom of pelvic floor dysfunction that responds well to treatment. You do not have to accept it as permanent.