Pelvic floor exercises after birth: a beginner's guide

The pelvic floor is a hammock of muscles that spans the base of your pelvis, from your pubic bone at the front to your tailbone at the back. It supports your bladder, uterus, and bowel. It coordinates with your diaphragm to manage pressure inside your abdomen. It plays a role in stability, sexual function, and bladder and bowel control. And during pregnancy and birth, it does some of the hardest work of your body.

After birth — whether vaginal or by C-section — the pelvic floor needs deliberate care. The standard advice ("just do your kegels") is a starting point, not a programme. Many people doing kegels are doing them incorrectly, or have a pelvic floor that is too tight rather than too weak, or have a complex picture that needs proper assessment.

What the pelvic floor actually does

Three main jobs:

• Support. Your pelvic organs sit on top of the pelvic floor. When the floor is weak or damaged, those organs can shift downward — known as prolapse — causing heaviness, bulging sensations, or visible tissue at the vaginal opening.
• Sphincter control. The pelvic floor wraps around your urethra, vagina, and anus. It opens and closes those passages. When it's not working well, you get leaks (during a sneeze, a laugh, a jump) or urgency.
• Pressure management. When you breathe in, your diaphragm goes down and your pelvic floor lengthens. When you breathe out, both come up. This is the engine of core stability.

How to do a Kegel properly

A Kegel is the conscious contraction and release of your pelvic floor muscles. The tricky part: most people who think they're doing them are actually clenching their glutes, holding their breath, or pushing down rather than lifting up.

1. Find the muscles. Imagine you're trying to stop the flow of urine, or hold in wind. The lift you feel is your pelvic floor.
2. Lift gently. Lift inward and upward, as if drawing a small marble up into your body. Keep breathing — do not hold your breath.
3. Hold for five seconds. Don't grip too hard. Five seconds of moderate engagement is more useful than two seconds of maximum clench.
4. Release fully. The release matters as much as the contraction. Let go completely — feel the muscles drop back down.
5. Repeat ten times, three times a day. Build to ten-second holds over weeks. Add quick flicks (one-second contractions) to build the reflex strength you need for sneezes and laughs.

Why Kegels aren't always the answer

For some people, the pelvic floor is hypertonic — too tight rather than too weak. Doing more Kegels makes it worse. Signs that yours might be tight rather than weak:

• Pain during sex
• Difficulty fully emptying your bladder or bowel
• A constant sense of pelvic tension or aching
• Constipation
• Urinary urgency without leaks

If any of these apply, the work is to release first, then strengthen — and that work is much better done with a pelvic floor physiotherapist than from a generic exercise plan.

Beyond Kegels: building a real programme

A complete pelvic floor recovery programme typically includes:

• Diaphragmatic breathing to coordinate the pressure system.
• Functional movement like squats, bridges, and deadlift patterns — practiced with conscious pelvic floor engagement on the exertion phase.
• Core integration — the pelvic floor doesn't work alone; it works with the deep abdominal and back muscles.
• Daily life integration — the lift on the way up from a chair, the brace before a sneeze, the engagement when picking up your baby.

When to see a pelvic floor physio

If you have any of the following, ask your GP for a referral, or self-refer (this is increasingly possible in the UK and many other countries):

• Leaks of any kind, even occasional ones
• A sensation of heaviness, dragging, or bulging in your vagina
• Pain during sex
• Pain in your scar, perineum, or lower abdomen that persists past six weeks
• Difficulty fully emptying your bladder or bowel
• Persistent diastasis recti
• You're returning to running, jumping, or higher-impact exercise and want to do it safely