Exercises for Healing Your Pelvic Floor
A week-by-week guide to recovering from childbirth.
Expert: Rachel Trotta, NASM, ACE
Many first-time moms are understandably nervous about giving birth and choose to invest their time, energy, and money into preparing for their ideal labor and delivery experience. When I was first pregnant, I bought a few books about labor and took an online birth preparation class with my husband. This education and support helped me to feel empowered during my hospital birth experience because I knew what my options were and what to expect.
But as a personal trainer, I was surprised that compared to birth preparation, postpartum recovery resources were incredibly scarce. This is an issue because many expecting mothers don’t realize how much of an impact the “fourth trimester”—the three months immediately following birth—is going to have on their quality of life. While labor takes a few days at most (I’m in the 32-hour labor club myself), postpartum recovery encompasses several distinct stages, including hormonal states and physical changes, often lasting up to 12 months.
Unfortunately, many women suffer in silence as they navigate common issues that plague new moms during the postpartum period, particularly with pelvic floor recovery. Some of these symptoms, such as incontinence (peeing unexpectedly or with little control), can persist for years or longer after pregnancy. But having a postpartum recovery plan for the pelvic floor that includes specific exercises can improve or eliminate incontinence, as well as lower back pain, painful sex, pelvic organ prolapse, and more.
To help you get started, I’ve outlined an evidence-based, accessible plan for strengthening the pelvic floor, whether you are pregnant, a first-time mom, or a veteran mom who has given birth to multiple kids. And no matter if you enjoy exercises or dread the gym, these simple, effective moves and activities will help you feel like yourself and enjoy more of new motherhood.
What is Postpartum Recovery?
“Postpartum recovery” is a broad term, so I find it helpful to break it into phases. Keep in mind that C-section recovery takes a few weeks longer than a vaginal delivery.
Weeks 1 to 2: Your pelvic floor is at its weakest, your uterus is still high in your abdomen (so you still have a “bump”), and you are likely dealing with wound recovery and significant fluctuations in hormone levels. For C-section moms, you are learning how to take care of your surgical wound and promote healing.
Weeks 2 to 6: Your uterus has assumed its normal position, although it will take a few more weeks to return to pre-pregnancy size. Your wounds are healing, and lochia (post-birth “period” bleeding) is slowing down or has stopped completely if closer to the sixth week.
Weeks 6 to 12: Your diastasis recti (abdominal muscle separation) will close up, and your core strength and pelvic floor will start returning to normal. Diastasis recti occurs in most, if not all, pregnancies, and ideally your core “learns” how to keep the front wall of your abdomen together during this phase of the postpartum period. For severe cases of diastasis recti that do not resolve naturally, additional treatment is required. For C-section patients, wound recovery and healing extend to the sixth week (or more) of postpartum.
Week 12 and beyond: The pelvic floor muscles will continue their journey of healing throughout the first year postpartum, but most (if not all) activities can now be done with confidence and without symptoms. You can run or jump without peeing, you can have sex when the mood strikes, and you can feel strong and pain-free.
What serves new moms most during this time is:
- Finding the balance of doing the right exercises, at the right intensity, and at the right times
- Avoiding the extremes of either over-exercising or being too sedentary
- Getting additional support from health care providers when needed
Whether you had a vaginal birth or a cesarean, you’ll want to get the green light from your doctor before attempting any type of postnatal exercise and follow their instructions throughout the recovery process.
Let’s look at exercises for each phase in detail.
Weeks 1 to 2
In the first few weeks after childbirth, your three most effective moves are:
- Belly breathing (with pelvic floor awareness)
- “Child’s pose” stretch
- Walking
For these three types of movement, it’s helpful to incorporate them naturally into your day with your new baby, rather than thinking of them as “exercise.” For example, if your newborn is doing tummy time on the floor, do some belly breathing for a minute at a time. In the first few weeks postpartum, aim to be relaxed in your approach to movement, to do what you can while you spend time with your baby, and to take your little one outside for physical activity whenever possible.
Belly breathing
Lie on your back with your knees bent and your feet on the floor and place your hand on your abdomen. Take steady breaths in and out, allowing your rib cage to expand your belly to rise with each inhale and gently fall and contract with each exhale. Visualize a 360-degree expansion through the ribs and abdomen, keeping the chest relaxed and low. Pay special attention to the relaxation (“lowering”) of the pelvic floor when you inhale, and the contraction and upward movement when you exhale. A few times a day, take a few minutes to relax and do some gentle belly breathing while you focus on your pelvic floor awareness.
Child’s pose stretch
Start by getting on your hands and knees, and then widen your legs and sit your hips back so that you are sitting on (or close to) your heels. At the same time, allow your hands to reach forward and your arms and shoulders to stretch overhead. Relax on the floor in this position. Hold the child’s pose stretch for 30 to 60 seconds at a time, a few times a day. (If you have had a C-section, avoid any stretching that puts pressure on your C-section scar, including this one.)
Walking
After the first few days of recovery, try to take your baby for a stroller walk for five minutes one day. Then do 10 minutes the next day. Over the first two weeks, try to work up to 15-minute walks, always stopping while you still feel good. These outdoor strolls can be enormously helpful for regaining strength in the body and for preventing postpartum depression. Additionally, light walking is the only type of physical activity approved for C-section moms prior to their post-birth appointment, so it is a great habit to build early on.
Weeks 2 to 6
Even though you’re not formally cleared for exercise by your physician until your postpartum checkup, recent recommendations for ideal recovery advise walking, as well as easy moves like these for women who had a vaginal delivery:
- Bodyweight squats
- Bridges
- Cat/cow
It should be reiterated that if you have had a C-section, you should always wait until you are cleared by your obstetrician before you begin any kind of formal exercise, even equipment-free moves like these.
And whether you have had a vaginal delivery or a C-section, do not attempt at this point in your recovery to perform planks, push-ups, sit-ups, pull-ups, or other exercises that place a high demand on your core. Your abdominal muscles are not ready for the internal pressure, even if you had an uncomplicated vaginal delivery, and you can worsen diastasis recti in the process, or interfere with wound healing from a cesarean. Direct “ab exercises” should be delayed until at least 12 weeks postpartum, and even at that point, they should be reintroduced conservatively, using gentler modifications with a high level of attention to proper form.
Bodyweight squats
Start in a standing position with your feet hip-width or wider. Inhale and relax your pelvic floor as you lower your body, keeping your torso upright and your feet planted on the floor as you squat downward. You can use a chair or bench behind you to guide your squat into the right position. Your knees might move slightly forward, but the primary movement should be the hips moving back and down. Throughout the exercise, both of your feet should stay planted without your heels or toes coming off the floor. Exhale as you stand, allowing your pelvic floor to naturally contract as you exhale. Work up to doing two sets of 10 squats at a time, gradually building your strength and range of motion.
Bridges
Lie on your back with your knees bent and your feet flat on the floor. Your feet should be directly under your knees. Inhale, and allow your pelvic floor to relax. Exhale, contract your glute muscles, and lift your hips about 6 inches off the floor. Inhale as you lower your hips gently to the floor with control. Continue to move in sync with your breathing, allowing your pelvic floor to contract and relax naturally. Work up to two sets of 10 bridges at a time, gradually building your glute strength.
Cat/cow stretch
Start on all fours, with your hands directly beneath your shoulders and your knees directly beneath your hips. Inhale, and allow your belly to drop and relax as you look upward and arch your back downward. Then exhale as you relax your head downward, round your back upward, pull your belly button upward, and tuck your pelvis under. Repeat for several more breaths, allowing your pelvic floor to contract and relax naturally with your breath. Work up to doing two sets of 10 breaths, gradually building more range of motion, lower back control, and pelvic floor strength.
Weeks 6 to 12
By this time, you’ve probably been cleared by your OB for exercise. However, a major issue for postpartum women is that exercise recommendations are incredibly vague, often along the lines of “take it easy and listen to your body.” Most women need something more specific, especially if your main form of exercise is going to group classes where you will need modifications.
It can be helpful at this time to have a consultation with a pelvic floor physical therapist (PT), a health care provider who specializes in women’s pelvic and abdominal health. A pelvic floor PT can assess your core and pelvic floor and provide individualized recommendations and targeted exercises. A pelvic floor physical therapist can also help with C-section scar mobilization to help flatten the scar and improve wound healing.
Women who were active before pregnancy can generally resume their regular workouts at the six-week mark but should start slowly with a mindset of rebuilding their fitness instead of trying to pick up where they left off. Special attention should still be given to proper breathing, pace, and intensity during any kind of exercise. At this point in recovery, I continue to recommend that women avoid planks, sit-ups, push-ups, or other exercises that create intense intra-abdominal pressure. If you had a C-section, you may need to wait a few more weeks for your scar to fully heal, and your return to exercise may occur around eight weeks with clearance from your physician.
Three exercises I suggest during this phase include:
- Vigorous walking
- Single-leg bridges
- Heel slides
Vigorous walking
The latest research suggests holding off on running and other types of high-impact exercise until at least 12 weeks postpartum. Vigorous walking, however, improves conditioning in preparation for running and provides excellent cardiovascular exercise. During this time, a brisk 30-minute walk a day with the stroller or baby carrier, or hiking or treadmill incline walking, is better for the pelvic floor than running and will improve general fitness just as well.
Single-leg bridges
Lie on your back with your knees bent and your feet flat on the floor. Extend one leg straight up, so that your foot is pointed at the ceiling. Inhale fully and relax your pelvic floor, then push your hips up as you exhale, using only one leg. Inhale as you return to the floor. Stay aware of your pelvic floor contraction and relaxation. Start with just a few, then build up to two sets of 10 per side over the course of a month.
Heel slides
Lie on your back with your knees bent and your feet flat on the floor. Keeping one foot firmly on the floor, inhale fully as you straighten the other leg and extend the foot, gently sliding the heel along the ground to full extension. Then exhale and bring the foot back to the starting position. At the same time, keep your lower back close to the ground throughout the entire movement, avoiding your ribs from rising or your lower back from arching. Build up to two sets of 10 per side, adding variations like hovering the foot (instead of sliding it on the floor) as you get stronger.
Week 12 and Beyond
Once you’ve graduated from the fourth trimester, most of your physical postpartum recovery is complete. While it will take several more months for your pelvic floor to reach its full strength potential, you can begin your normal exercise routine again, including heavier weightlifting, distance running, circuit classes, etc. This is also an ideal time to begin introducing short, well-controlled core exercises like planks and crunches if you can perform them with good form (without your belly poking up), and without pelvic floor symptoms like heaviness or discomfort.
Additional tips for this period include:
- Increase intensity gradually, starting with modified versions of exercises so that you can be observant of good form and pelvic sensations.
- Don’t go on a crash diet to lose pregnancy weight quickly, but instead fuel physical activity with balanced nutrition.
- Stay vigilant of weak pelvic floor symptoms like leaking urine, sensations of heaviness and dragging, pain or discomfort in the uterus, lower back pain, sexual dysfunction, or feeling like there is a tampon inserted where there isn’t.
- See a pelvic floor physical therapist as soon as possible if you continue to experience pelvic floor symptoms, or if they worsen.
- Be realistic and patient about physical changes, and give your body time to heal.
- Remember that doing pelvic floor exercises and seeing a pelvic floor physical therapist are both appropriate at any point on your journey, whether you’re two weeks or two years postpartum.
Most importantly, my advice to moms is to remember that every situation is unique. Not every woman recovers from childbirth on the same timeline. But with the right support, education, and awareness, women can empower themselves to recover effectively after pregnancy. Just as with childbirth preparation, knowing what to expect, what to avoid, and what options you have available to you means you don’t have to settle for what’s perceived as normal after having a baby. You can enjoy life—and your new baby—more when your self-care is a priority.
Always check with your health care provider before beginning a new exercise routine after baby arrives.
