The pelvic floor does not get nearly as much attention as it deserves. It is a group of muscles, ligaments, and connective tissues that forms the base of the pelvis, supporting the bladder, bowel, and uterus, enabling bladder and bowel control, and playing a key role in sexual function. Childbirth, particularly vaginal delivery, places enormous demands on these structures. And yet many women are never told what to watch for afterward, or that effective help is available.
At Tidewater Physicians for Women, pelvic floor concerns are part of the postpartum and women’s health care we provide across our Virginia Beach and Norfolk offices. Here is what every postpartum woman should know about pelvic floor recovery, and when it is time to ask for help.
What Happens to the Pelvic Floor During Childbirth
During a vaginal delivery, the pelvic floor muscles stretch to many times their normal length to allow the baby to pass through the birth canal. The levator ani, the primary group of pelvic floor muscles, stretches to accommodate the baby’s head, sometimes beyond what the tissue can fully recover from without support.
Even cesarean deliveries are not entirely protective. The pelvic floor supports the weight of pregnancy throughout all nine months, and hormonal changes during pregnancy, particularly relaxin, loosen the connective tissues that support pelvic organs. Many women who deliver by C-section still experience pelvic floor dysfunction postpartum. Risk factors for more significant changes include:
- Prolonged pushing or a long second stage of labor
- A large baby or occiput posterior position at delivery
- Instrument-assisted delivery with forceps or vacuum
- Perineal tearing or episiotomy
- Multiple vaginal deliveries
- Pre-existing pelvic floor weakness
Common Pelvic Floor Symptoms After Childbirth
Urinary Incontinence
Leaking urine when you cough, sneeze, laugh, or exercise is one of the most commonly reported postpartum symptoms, and one of the most underreported, because many women assume it is simply part of having a baby. It is not something you have to accept and live with. Most women with postpartum stress incontinence respond well to pelvic floor physical therapy, and in cases where therapy is not sufficient, additional treatments are available.
Urge incontinence, a sudden strong need to urinate that may or may not result in leaking, is also common postpartum and can be related to pelvic floor overactivity or nerve changes from delivery.
Pelvic Organ Prolapse
Prolapse occurs when one or more pelvic organs, the bladder, uterus, or rectum, descend into or beyond the vaginal canal due to weakened support structures. It can cause a feeling of pressure or heaviness in the pelvis, a sensation of something falling out, difficulty emptying the bladder or bowel, or discomfort during intercourse. Mild prolapse is extremely common after childbirth and often improves with pelvic floor rehabilitation. More significant prolapse may require further evaluation and in some cases surgical repair.
Pelvic Pain and Perineal Discomfort
Pain at the site of a tear or episiotomy, pain with sitting, tailbone pain, and pain during intercourse are all common postpartum complaints. Most perineal discomfort resolves within weeks, but deeper muscle tension, scar tissue, or nerve changes can persist much longer. Pain with intercourse that extends well beyond the initial postpartum period is worth discussing with your provider. It is not something to push through indefinitely, and pelvic floor therapy is often highly effective.
Bowel Changes
Constipation is nearly universal in the early postpartum period and is usually managed with dietary changes, hydration, and stool softeners. Fecal urgency or incontinence, difficulty controlling gas or stool, can occur after significant perineal trauma and should be discussed with your provider if it persists beyond the first weeks.
The Role of Pelvic Floor Physical Therapy
Pelvic floor physical therapy is the gold standard first-line treatment for most postpartum pelvic floor symptoms. A pelvic floor physical therapist is a licensed PT with specialized training in the muscles, nerves, and connective structures of the pelvic region. Treatment is hands-on, individualized, and evidence-based. Conditions it can address include:
- Stress and urge urinary incontinence
- Pelvic organ prolapse, mild to moderate
- Perineal scar tissue and pain
- Pain with intercourse
- Pelvic heaviness or pressure
- Core and abdominal reconnection after pregnancy
In many countries, postpartum pelvic floor therapy is offered routinely to all women after vaginal delivery. In the U.S., it requires a referral, which your provider can facilitate. If you are experiencing symptoms and have not been offered it, ask.
A Note on Kegel Exercises
Kegel exercises are often recommended postpartum and can be helpful for strengthening a weak pelvic floor. But they are not appropriate for everyone. Women with a hypertonic or too-tight pelvic floor actually need to learn to relax those muscles, not strengthen them further. Doing Kegels in this case can worsen symptoms. This is one of the key reasons a formal evaluation by a pelvic floor physical therapist is so valuable: they assess whether your pelvic floor is underactive, overactive, or some combination, and tailor treatment accordingly.
When to Talk to Your Provider
Do not wait until your 6-week postpartum visit if something feels wrong. Call sooner if you experience heavy bleeding, fever, or signs of infection, significant pain that is not improving, difficulty urinating or incomplete bladder emptying, or visible tissue protruding from the vagina. At your 6-week visit, proactively bring up any pelvic floor concerns, even if they feel minor or embarrassing. This is exactly the right time to have the conversation and get a referral if needed.
Our obstetrics team and women’s health providers are here to support your full recovery. For more complex cases, our in-office procedures and robotic surgery services are available for women who need surgical management of prolapse or other pelvic floor conditions.
Your Recovery Is Worth Investing In
Postpartum pelvic floor changes are common, but they are not something you should normalize and endure indefinitely. Effective treatments exist, and seeking them out is an act of self-care, not self-indulgence. You just grew and delivered a human being. Your body deserves real, active support in recovering from that.
Pelvic Floor Concerns? We Are Here.
Whether you are a few weeks postpartum or several years out from delivery and still experiencing symptoms, our team in Virginia Beach and Norfolk is ready to help you find answers and a path forward.
To learn more or schedule an appointment, Schedule your appointment with Tidewater Physicians for Women today or call us at 757-461-3890.
