“The literature shows that women who do proper pelvic floor exercises postpartum, experience less leaking, less pain, and less prolapse,” says Marcy Crouch, DPT, WCS. (Pelvic floor prolapse occurs when the muscles and tissues supporting the pelvic organs weaken, causing these organs to descend into the vaginal or rectal areas.) “It’s important that we rehab these muscles the correct way, especially after they just held up a growing baby for nine months, and then had to do the opposite for birth. Muscle tears, C-sections, and other physical trauma need to be thought of the same way we are thinking about shoulder and knee surgery.”
The pelvic floor muscles are located at the bottom of the pelvis and support all of the organs in this region including your bowel, bladder, urethra, and more. You can think of them as creating a hammock under these muscles, and when they are strong, they help to keep in urine and feces, support sexual function, and also help to support a baby during pregnancy. Just like any other muscle in our body, your pelvic floor can be conditioned and strengthened.
The benefits of doing postpartum pelvic floor exercises
Most women are cleared for sex and exercise at six weeks postpartum, once all the tissues have healed, but you can begin some pelvic floor exercises, like breathwork, well before this timeframe.
“I really encourage rest for the first three days, just really rest,” says Jami Wilson, PT, DPT, pelvic floor physical therapist and co-founder of Empower Physical Therapy. “Really the first week would be ideal where we’re just taking that time for our body to heal and recover, but we can immediately start doing some breathwork, to engage back into our diaphragm or abdominal muscles of our pelvic floor.”
While breathwork is great, jumping into any exercise without giving your body proper time to heal can have risks; however, pelvic floor physical therapy when practiced correctly, is safe and effective, and can usually be implemented a few weeks after birth. Performing postpartum pelvic floor exercises can aid recovery and help address any pelvic floor dysfunction you may have developed during pregnancy, which is common. This can present itself in the form of painful sex, pelvic pain, incontinence, or a feeling of heaviness or bulging, which can be a sign of pelvic organ prolapse.
If you’re unsure about any pain or discomfort, a pelvic floor physical therapist can perform an assessment of your pelvic floor to determine its strength and function and work with you to retrain and reinforce those muscles.
“When these muscles are not working properly, we tend to see pain, leaking urine, pelvic organ prolapse, constipation or fecal incontinence, sexual dysfunction, and other problems,” says Dr. Crouch. “We hear a lot about these muscles being strong, but strength is only one piece of the puzzle, they also have to be able to lengthen, release, and work with other muscles properly in our core.”
But once you’ve been given the green light by your doctor to return to exercise, slowly incorporating pelvic floor work into your daily routine can help reengage your core muscles that you have not been using for months. The best approach is to start slow and listen to your body.
So, if you’re curious about what pelvic floor exercises you can incorporate into your postpartum routine, Dr. Wilson compiled a list of just a few of her favorites. She recommends gradually building up to doing them daily.
6 postpartum pelvic floor exercises a physical therapist recommends
None of these exercises require equipment, and the timeframe for when you can begin is a rough estimate and depends on how you are feeling. You should always consult with your doctor or pelvic floor physical therapist if you’re experiencing any pain or discomfort before or during these exercises.
1. Diaphragmatic breathing
This can be practiced immediately after giving birth and all through your postpartum journey. It can be done lying down on your back, on your side, or on hands and knees.
Breathe deep into the belly, all the way down through the pelvis. Use your fingers around your lower rib cage to help you by breathing into them on your inhale. As you inhale, relax your pelvic floor, and on your exhale take notice of the slight recoil or lift up of your pelvic floor. You can imagine your pelvic floor is a jellyfish (go with it) and that it’s spreading out as you breathe in and then contracts or closes pushing itself upward as you breathe out. Continue inhaling and exhaling at an even pace.
Complete one set, for three minutes, once a day.
2. Supine heel slides
This can be practiced beginning at roughly two weeks postpartum.
Laying on your back with your knees bent, feet flat on the floor, arms long at your sides, and palms pressing into the floor, inhale to prepare your belly, sides, and back for movement. As you exhale, draw your abdominals up and in, as you slide one leg out straight and back—if full leg extension feels too far, start with going out halfway or three-quarters of the way straight and work up from there. Repeat on the other leg. Your body (including your pelvis, glutes, and hips) should remain on the floor with just one leg moving at a time. That’s one rep.
Repeat 10 reps, once a day.
3. Bridge
This can be practiced beginning at roughly two weeks postpartum.
Laying on your back with your knees bent, feet flat on the floor, arms long at your sides, and palms pressing into the floor, inhale deeply, and as you exhale, engage your pelvic floor, draw your bellybutton toward your spine to brace your core, and squeeze your butt as you lift your hips off the floor—this could be a few inches or all the way up until your body forms a straight line from your knees to shoulders. Then slowly lower your back down.
Repeat 10 times, once a day.
4. Bird dog
This can be practiced beginning roughly at four weeks postpartum.
Begin on your hands and knees with a neutral spine. Inhale deeply and as you exhale, engage your deep abdominal muscles by drawing your belly button toward your spine, then slowly extend your right arm and left leg at the same time, pressing through your opposite hand and knee to maintain balance and stability. Hold the position for a few seconds, set both limbs down, and repeat on the other side. If this is too challenging, only lift your leg, not your arm. This is one full rep.
Repeat five times, once a day, four times a week.
5. Side plank with clamshell
This can be practiced beginning roughly six weeks postpartum.
Start by laying down on your right side, propped up on your right forearm, elbow under shoulder, knees in front of hips and left knee atop right, shoulders inline with one another. Inhale deeply and as you exhale, press into your forearm and lift your hips into the air, while opening the top leg up to the ceiling like a book without letting your heels separate.
Repeat 10 times on each side, once a day, four times a week.
6. Squats
This can be practiced beginning roughly six weeks postpartum.
Stand with feet shoulder-width apart and toes pointed forward or slightly turned out. Inhale deeply and as you exhale, press hips back, bend knees, and lower butt toward the floor. Only go as deep as you feel comfortable. Allow your glutes to lengthen as you sit back into the squat, and squeeze them as you stand back up. To ensure proper knee alignment, keep them above your ankles and press them out in line with second and third toes—don’t let them buckle toward one another.
Repeat 10 times, once a day, four times a week.
Dr. Wilson adds that once you’ve completed 10 repetitions, see how you feel and increase the number of squats if you’re comfortable and have no pain.
