In the first year of giving birth, 40% will have constipation, 35% will have symptoms of prolapse, 27% will have discomfort/pain during sex, 25% will have urinary incontinence and 3% will have faecal incontinence (1).


The type of delivery you had will impact on the recovery of your pelvic floor e.g., an uncomplicated vaginal delivery with no assistance will recover differently from someone who had a c-section or someone who experienced an episiotomy with forceps.  

It is crucial to get checked out by a pelvic health physiotherapist if at all possible, even if you do not have any pelvic floor dysfunction or lingering abdominal separation. Pregnancy and childbirth are a huge undertaking for the body and for that reason, a full check up on your entire core is hugely beneficial. The ideal time for the check up is anytime from when the baby is eight weeks old, but it’s actually never to late to book in for a postnatal check, even if your baby is years old! 

Due to the mix of hormones that are involved in the postnatal time period, including if you are breastfeeding, it naturally results in temporary vulval and vaginal changes. These include; less natural lubrication (meaning that sex can feel uncomfortable if you do not use extra lubricant), less elasticity and more sensitivity (again adding to sexual discomfort and/or potential pain from any scar tissue), more stretchy muscles and tissues (meaning that pelvic floor muscle & core training is so crucial).  

A c-section is major abdominal surgery, so whilst there is less physical trauma to the pelvic floor than what may happen in a vaginal delivery, the recovery should still not be undertaken lightly. And, of note, it is still possible for sex to feel uncomfortable due to the postnatal hormonal changes mentioned above.

Pelvic floor muscle training is safe to be started in most cases straight away or if applicable, whenever the catheter is removed.  

  • After a vaginal delivery, it is very normal to have some generalised swelling and tenderness and perhaps some pain where any stitches may be. Doing some slow gentle pelvic floor muscle squeezes a few times per day can really aid the healing process. Build up to 10 short and 10 long, two to three times a day, by the time you are six weeks postnatal, remembering to do a full breath in and out in between every single squeeze or hold. It’s been shown that there is on average a 54% reduction in pelvic floor muscle strength at six weeks after a vaginal delivery (2), this is one of the reasons that pelvic floor muscle dysfunction rates are quite high after having a baby. This is also another reason why pelvic floor muscle training is so crucial at this time too. 
  • If you have had a c-section delivery, then pelvic floor muscle training can just be continued straight away.   
  • It is recommended to complete daily PFMT at this level until at least six months postnatal, or until at least you are fully back at the level and intensity of sport/exercise that you want to be, with no issues being experienced.  

It is really beneficial to do scar massage to where any tear or episiotomy happened during delivery (the exact same also applies to c-section scars). Wait until the scar is fully formed, this usually takes at least six weeks but might be longer if there has been any delay, e.g., infection. Once it has fully formed, then using any plain oil, apply firm pressure to the scar in different directions. For example, you can draw small circles in the scar, zig zag across it, run your finger up and down the scar, or across the scar at 90 degrees. Do this for approximately two minutes twice per week, for a few weeks, and it will really help with mobility and sensitivity of the scar tissue.


Protect your pelvic floor postnatally by; 
  • Respecting the healing process (it takes at least six weeks for physical healing to be complete, and then the work begins to full physical recovery! (Also of note, fascia and connective tissue in the pelvic floor (and abdominal wall) take at least up to six months to really fully recover)  

  • Avoid straining on the toilet at all costs! This can be done by aiming for a 10 minute walk each day, eat lots of different types of plant-based fibre, go on the first natural urge, keep hydration levels high, and when on the toilet keep feet up on step and wait for stool to pass whilst doing deep breaths into the abdomen. 

  • Beginning pelvic floor muscle training again as soon as you can and gradually build back up again depending on where you are at  

  • Don’t go back to high intensity/volume training too quickly – this timeline will differ


References

Dasikan et al (2020). Pelvic floor dysfunction symptoms and risk factors at the first year of postpartum women: a cross-sectional study. Contemporary Nurse, 2020  

Hilde et al (2013). Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208(1):50.e1–7.