Postpartum Pelvic Floor Recovery: What Nobody Tells You — and What Actually Helps
By Kelly Brown Gross, PT, MPT, WCS | Ashworth Chiropractic, Physical Therapy & Acupuncture | West Des Moines, Iowa
You grew a human. You delivered a baby. And then — somewhere around six weeks postpartum — the world kind of expects you to just… get back to normal.
But your body doesn’t work that way. And for a lot of women, the things that don’t feel right after delivery never fully get addressed — not because they can’t be fixed, but because nobody asks about them. Women quietly deal with leaking when they laugh. With pain during sex that they assume is just how things are now. With a belly that feels disconnected no matter how many crunches they do.
I’m writing this because these things are real, they’re common, and they are treatable. You don’t have to just live with them.
What Your Body Actually Goes Through
During pregnancy and delivery, your pelvic floor — the hammock of muscles, ligaments, and connective tissue at the base of your pelvis —
absorbs an enormous amount of stress. It supports the weight of your growing uterus for nine months. It stretches during delivery to accommodate your baby. It works overtime whether you deliver vaginally or via C-section (yes, even cesarean delivery affects the pelvic floor).
At the same time, your core changes. Your abdominal muscles stretch and separate to accommodate your growing baby — a condition called diastasis recti abdominis (DRA). Your posture shifts. Your ligaments become looser due to the hormone relaxin. Everything that supports your trunk, pelvis, and spine is different than it was before you were pregnant.
A six-week checkup and a clearance to resume normal activity doesn’t undo any of that. It just tells you that your incision has healed or your bleeding has stopped. It says very little about whether your pelvic floor is functioning, whether your core is intact, or whether you’re actually ready to jump back into exercise.
In many European countries, postpartum pelvic floor physical therapy is standard of care — every new mother receives it automatically. In the United States, most women are sent home without it. That gap in care is one of the main reasons so many women spend years managing symptoms that could have been resolved early.
What You Might Be Dealing With — and Not Talking About
In over 15 years of working with postpartum women, I’ve heard the same things over and over. Women come in months or years after delivery — sometimes decades — having quietly managed symptoms they assumed were just part of having had a baby.
These are the things I want you to know are not normal, not permanent, and not something you just have to accept:
- Leaking urine when you cough, sneeze, laugh, jump, or exercise
- Urgency — the sudden, desperate need to get to a bathroom that doesn’t give you much warning
- Pelvic heaviness or pressure, especially by end of day — a sign that your pelvic floor may not be supporting your organs adequately
- Pain during sex after delivery — common, often dismissed, entirely treatable
- A belly that feels weak, disconnected, or looks different even after you’ve lost the pregnancy weight — often diastasis recti
- Low back pain or hip pain that started during or after pregnancy and hasn’t fully resolved
- Difficulty returning to exercise — things that used to feel easy now cause leaking, pain, or pressure
Any of these sound familiar? You’re not alone. And more importantly, you don’t have to stay there.
What the Research Shows
The evidence for pelvic floor physical therapy in the postpartum period is solid and growing. Based on articles retrieved from PubMed:
Urinary Incontinence — Structured Rehab Makes a Real Difference
A 2020 randomized controlled trial published in Acta Obstetricia et Gynecologica Scandinavica (Johannessen et al.) followed 722 women through a structured pelvic floor muscle training program. Women who completed the program had significantly lower rates of urinary incontinence at three months postpartum — 29% compared to 38% in the standard care group. Among women who were already leaking during pregnancy, the difference was even more pronounced: 44% continued leaking in the rehab group versus 59% in the control group.
Johannessen HH, et al. Acta Obstet Gynecol Scand. 2021;100(2):294-301. DOI: https://doi.org/10.1111/aogs.14010
Pelvic Floor Training Prevents and Treats Stress Incontinence
A 2024 systematic review published in Actas Urológicas Españolas (Mantilla Toloza et al.) reviewed 7 randomized controlled trials covering 1,401 pregnant and postpartum women. The review found that pelvic floor muscle training applied with appropriate methodology can prevent or cure stress urinary incontinence — the kind that causes leaking with physical exertion. The authors noted that prevalence of stress urinary incontinence in the postpartum period ranges from 30 to 47% in the first 12 months after delivery.
Mantilla Toloza SC, et al. Actas Urol Esp (Engl Ed). 2024;48(4):319-327. DOI: https://doi.org/10.1016/j.acuroe.2024.01.007
Pelvic Floor PT as First-Line Treatment for Postpartum Dysfunction
A 2019 review from Stanford University published in Current Opinion in Obstetrics & Gynecology (Wallace, Miller & Mishra) concluded that pelvic floor physical therapy has robust evidence-based support as a first-line treatment for most pelvic floor disorders — including urinary incontinence, prolapse, pelvic pain, sexual dysfunction, and peripartum and postpartum pelvic floor dysfunction specifically. The authors noted it can improve or cure symptoms across the full spectrum of pelvic floor conditions.
Wallace SL, Miller LD, Mishra K. Curr Opin Obstet Gynecol. 2019;31(6):485-493. DOI: https://doi.org/10.1097/GCO.0000000000000584
Diastasis Recti — What the Research Shows
Diastasis recti abdominis affects a significant number of postpartum women — research suggests more than half of women have some degree of abdominal separation at six weeks postpartum. A 2018 randomized controlled trial published in Physical Therapy (Gluppe et al.) found that 55% of women in both the intervention and control groups had diastasis at six weeks postpartum — underscoring just how common this condition is. The study evaluated structured exercise programs including pelvic floor training, and while it found that general exercise alone was insufficient to resolve DRA, it confirmed the high prevalence and the need for specific, targeted rehabilitation rather than generic core exercise.
Gluppe SL, et al. Phys Ther. 2018;98(4):260-268. DOI: https://doi.org/10.1093/ptj/pzy008
What Postpartum Pelvic Floor PT Actually Looks Like
A lot of women have no idea what a pelvic floor physical therapy evaluation actually involves.
Your first appointment is typically an hour. We talk about your delivery, your symptoms, your goals, and your life — because the right rehab plan depends on whether you’re trying to get back to running, pick up your toddler without leaking, or just feel like yourself again.
A pelvic floor assessment can include an internal examination — this is how we actually evaluate the strength, coordination, and tension of the pelvic floor muscles. It’s similar to a gynecological exam. It’s always explained in advance, always your choice, and always done with your full comfort in mind.
From there, your treatment plan is built around what we actually find — not a generic set of exercises. It might include:
- Specific pelvic floor muscle strengthening and coordination training
- Manual therapy to address scar tissue, tension, or restricted movement
- Core rehabilitation — the kind that’s appropriate for your body, not a generic program
- Guidance on returning to exercise safely — including the order of progression and what to watch for
- Education on what’s normal, what’s not, and what you can do at home between sessions
The goal is always the same: get you to a place where you have the tools to stay well on your own — not a forever patient.
When Should You Come In?
The short answer: sooner than you think, and you don’t need a referral.
Iowa is an open-access state for physical therapy, which means you can book directly with me without a doctor’s referral. You don’t need to wait until your OB clears you for exercise, though we’ll always coordinate with your other providers.
Ideally, postpartum PT starts around 6 to 8 weeks after delivery — once the initial healing has occurred. But if you’re further out than that — months or even years postpartum — it is never too late. I regularly work with women who delivered years ago and are still dealing with symptoms they assumed were permanent. They’re usually not.
Come in if you have any of the following:
- Leaking of any kind — urine or stool — during activity or at rest
- Urinary urgency that feels out of control
- Pelvic pain, pressure, or heaviness
- Pain during or after sex
- A belly that doesn’t feel right or looks like it did right after delivery
- Back or hip pain that started during or after pregnancy
- Anxiety about returning to exercise after delivery
Any of the above. All of the above. You don’t have to have a diagnosis. You just have to feel like something isn’t right.
Questions I Hear a Lot
Isn’t this just kegels? I can do those at home.
Kegels — pelvic floor contractions — are one tool. But they’re not always the right tool, and doing them incorrectly or when your pelvic floor is actually too tight can make things worse. A lot of the women I see have a pelvic floor that’s overworked and tense, not weak. Strengthening a tense muscle doesn’t help. Evaluation tells us which direction we actually need to go.
I had a C-section — do I still need pelvic floor PT?
Yes. Your pelvic floor spent nine months supporting a pregnancy. The muscles, ligaments, and connective tissue are all affected regardless of how you delivered. C-section also adds a layer of abdominal scar tissue and nerve changes that benefit from specific treatment.
My baby is two years old. Is it too late?
No. Your pelvic floor is muscle and connective tissue — it responds to targeted rehabilitation at any point. I work with women who delivered five, ten, even twenty years ago. The issues are treatable. It just takes the right approach.
This feels embarrassing to talk about.
I know. Most of the women who come to see me waited longer than they needed to because of this. Bladder leakage, pelvic pain, and sexual dysfunction are medical conditions — not something to be ashamed of. My job is to make the conversation feel normal, because it is. What you’re dealing with is common. Getting help for it should be too.
Ready to feel like yourself again?
Call us at (515) 225-4002 or visit ashworthchiro.com to schedule with Kelly.
No referral needed. Iowa is open access.
Clinical References
The following peer-reviewed studies were retrieved from PubMed and cited in this article.
- Johannessen HH, et al. Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum. Acta Obstet Gynecol Scand. 2021;100(2):294-301. DOI: https://doi.org/10.1111/aogs.14010
- Mantilla Toloza SC, et al. Pelvic floor training to prevent stress urinary incontinence: A systematic review. Actas Urol Esp (Engl Ed). 2024;48(4):319-327. DOI: https://doi.org/10.1016/j.acuroe.2024.01.007
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-493. DOI: https://doi.org/10.1097/GCO.0000000000000584
- Gluppe SL, et al. Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis. Phys Ther. 2018;98(4):260-268. DOI: https://doi.org/10.1093/ptj/pzy008
About Kelly Brown Gross
Kelly Brown Gross, PT, MPT, WCS is a physical therapist at Ashworth Chiropractic, Physical Therapy & Acupuncture in West Des Moines, Iowa. She holds the Women’s Health Certified Specialist (WCS) designation — one of fewer than 700 in the United States, and one of only about five in Iowa. Kelly has over 15 years of experience in pelvic health, orthopedics, postpartum rehabilitation, and vestibular therapy. She sees one patient at a time, every visit.
