Sneeze, laugh, jump on the trampoline with your kids, and… oops. If that sounds familiar, you’re in very good company. Pelvic floor symptoms are incredibly common after pregnancy and birth. But common doesn’t mean normal, and it definitely doesn’t mean you have to live with it. Let’s talk about the muscles nobody explained to us, in plain words.
Meet your pelvic floor
Picture a hammock, or a trampoline, stretched across the bottom of your pelvis. It runs from your pubic bone at the front to your tailbone at the back, and from one sit bone to the other. That hammock is a group of muscles and connective tissue called the pelvic floor.
It has a few big jobs:
Support
It holds up your bladder, uterus, and bowel against gravity and against the pressure inside your belly.
Continence
It helps keep urine, stool, and gas in until you’re ready to let them go, and relaxes so you can go.
Stability
It works as a team with your deep abdominal muscles, back muscles, and diaphragm to stabilize your trunk and pelvis.
Sexual function
These muscles play a role in sensation and orgasm, and they need to relax for comfortable intercourse.
Three openings pass through the pelvic floor: the urethra (pee), the vagina, and the anus. The muscles wrap around these openings and need to be able to both tighten and let go. Pregnancy and birth ask a lot of them. You carry months of increasing weight, experience hormonal changes that affect connective tissue, and, with a vaginal birth, these muscles stretch dramatically to let your baby through. A cesarean birth spares the stretch of delivery, but the pregnancy itself still loads the pelvic floor.
Your pelvic floor and your breath: the “piston”
Here’s the part that changes how most women think about pelvic floor training. Your pelvic floor doesn’t work alone. It moves together with your diaphragm, the dome-shaped breathing muscle under your ribs. Many physical therapists describe the two as a piston:
- When you inhale, your diaphragm moves down, your belly and ribs expand, and your pelvic floor gently lengthens and drops.
- When you exhale, your diaphragm rises and your pelvic floor gently lifts back up.
This is why breathing is the foundation of pelvic floor work. It’s also why holding your breath and bearing down during a hard lift, or while straining on the toilet, can push down on the pelvic floor again and again.
Symptoms that deserve a pelvic floor PT visit
A pelvic floor physical therapist (sometimes called a pelvic health physiotherapist) specializes in assessing and treating these muscles. In many countries, like France, postpartum pelvic floor rehabilitation is routine. In the U.S. you often need to ask. Consider asking your provider for a referral if you notice any of these:
- Leaking urine when you cough, sneeze, laugh, run, or jump (stress urinary incontinence)
- A sudden, urgent need to pee, sometimes with leaking before you reach the toilet
- Leaking stool or difficulty controlling gas
- A feeling of heaviness, dragging, pressure, or “something falling out” in the vagina, often worse at the end of the day (possible signs of pelvic organ prolapse)
- Pain with intercourse, tampon use, or pelvic exams
- Ongoing pelvic, tailbone, or perineal pain, or pain at a C-section or tear scar
- Constipation or needing to strain to empty your bowels
- Trouble starting a pee stream or feeling like your bladder doesn’t empty fully
- Low back or hip pain that isn’t improving, or a separation along your midline (diastasis recti)
Evidence note
A Cochrane systematic review (Woodley et al., 2020) found that pelvic floor muscle training during pregnancy likely reduces the risk of urinary incontinence in late pregnancy and in the months after birth for women who were continent to begin with. It can also help treat postnatal incontinence. The UK’s NICE guideline on pelvic floor dysfunction (2021) recommends supervised pelvic floor muscle training for women with symptoms and encourages pelvic floor exercise as part of prevention.
How to do a proper pelvic floor contraction
Many women are simply told to “do your Kegels,” and it turns out that brief verbal instruction often isn’t enough. A classic study by Bump and colleagues (1991) found that many women given simple verbal instructions did not perform an effective contraction, and some actually bore down instead. That’s why a hands-on assessment from a pelvic floor PT is so valuable. In the meantime, here’s how to start.
The pelvic floor contraction (“the lift”)
- Get comfortable lying on your side, sitting tall on a firm chair, or lying on your back with knees bent (early postpartum or not pregnant).
- Take a relaxed breath in, letting your belly and ribs widen and your pelvic floor soften.
- As you breathe out, gently squeeze and lift as if you’re stopping the flow of urine and holding in gas at the same time. Think “squeeze, then lift up and in.”
- Keep your glutes, inner thighs, and jaw relaxed. Your lower belly may gently draw in, which is normal, but you shouldn’t be sucking in hard or tucking your pelvis.
- Hold for 3–5 seconds while breathing normally, then fully release.
Make it easier: Try a few quick “flicks” (squeeze and release in one second) before working on holds, or use imagery like picking up a blueberry with your vagina. Make it harder: Gradually build toward 10-second holds, then practice the lift in sitting, standing, and during movements like squats.
The full release (“the let-go”)
- After each contraction, let the muscles completely return to rest. Don’t just stop squeezing. Actively let go.
- Take a slow breath in and imagine your sit bones widening and your pelvic floor gently blossoming or dropping.
- Rest for at least as long as you held the contraction, ideally twice as long, before the next rep.
Make it easier: Practice in child’s pose or a deep supported squat, where the pelvic floor naturally lengthens. Make it harder: Pay attention to the release during everyday moments, like at red lights or while nursing, to notice if you’re holding tension.
How do I know I’m doing it right?
- You may feel a gentle lift and tightening around the vaginal and anal openings.
- Using a hand mirror, you may see the perineum (the skin between the vagina and anus) draw slightly inward and up. If it bulges down, you’re bearing down. Stop and try again with less effort.
- Stopping your pee midstream once can help you identify the muscles, but don’t use it as a regular exercise, because it can interfere with normal bladder emptying.
Why relaxing is just as important as squeezing
Here’s the twist: not every pelvic floor problem comes from weakness. Some women have pelvic floor muscles that are overactive, meaning tense and unable to fully let go. That can contribute to pain with sex, constipation, urgency, and pelvic pain. For these women, endless Kegels can make things worse. It’s another reason why an individualized assessment is so worthwhile, and why we always practice the release as carefully as the lift.
A simple starting routine
| Exercise | Sets × Reps | Rest | Coaching cues |
|---|---|---|---|
| 360° breathing | 1 × 5 breaths | — | Hands on lower ribs. Breathe into your sides and back and feel the pelvic floor soften on the inhale. |
| Slow holds | 2 × 8–10 | 30 sec between sets | Exhale to lift, hold 3–5 seconds while breathing, full release, rest for double the hold time. |
| Quick flicks | 2 × 10 | 30 sec between sets | Squeeze and fully let go in about one second each. Helps the muscles react to sneezes and coughs. |
| “The Knack” practice | 5 reps | — | Lift your pelvic floor just before a pretend cough or as you stand up from a chair. |
| Relaxation breaths | 1 × 5 breaths | — | In child’s pose or side-lying, focus only on letting the pelvic floor soften and widen. |
Most guidance suggests doing pelvic floor training most days, and research programs have often run for at least three months. Consistency beats intensity. Pair your practice with an existing habit like brushing your teeth, a nursing session, or your morning coffee.
Everyday habits that help
- Exhale on exertion. Breathe out as you lift the car seat, stand up, or push the stroller up a hill.
- Don’t strain on the toilet. Put your feet on a small stool so your knees are higher than your hips, relax your belly, and breathe. Eat enough fiber and drink water to keep stools soft.
- Don’t “just in case” pee constantly. Going too often can train the bladder to hold less. Aim for about every 2–4 hours during the day unless your provider says otherwise.
- Return to impact gradually. Running and jumping place high loads on the pelvic floor. Build strength first, and get assessed if you have symptoms.
Call your provider promptly if you notice:
A bulge you can see or feel at the vaginal opening, fever or foul-smelling discharge after birth, worsening perineal or wound pain, inability to pee, or severe constipation. These need medical attention rather than exercise alone.
Your pelvic floor is the foundation of every postpartum movement plan. Our women’s exercise programs build on these basics, and our 12-week postpartum roadmap walks you from breath and pelvic floor work all the way back to confident strength training, one phase at a time.
Frequently asked questions
When can I start pelvic floor exercises after birth?
Gentle breathing and pelvic floor contractions can often begin within the first days after an uncomplicated birth, as long as they’re comfortable. If you had a significant tear, a catheter, or a cesarean, check with your provider first and let pain be your guide.
Is some leaking just part of being a mom?
It’s common, but it’s treatable. Pelvic floor muscle training is a first-line treatment for stress urinary incontinence, and a pelvic floor PT can help at any stage, whether that’s six weeks or sixteen years after birth.
Do I need to do pelvic floor work if I had a C-section?
Yes, it’s still worthwhile. Pregnancy itself loads the pelvic floor for months, and the deep core system works as a team. Breathing and pelvic floor work are a gentle, useful starting point after a cesarean, too.
A gentle reminder
This article is educational and is not medical advice, and it isn’t a substitute for an individual assessment. If you have pelvic floor symptoms, please talk with your healthcare provider and ask about a referral to a pelvic floor physical therapist. See our medical disclaimer.
Sources & further reading
- Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 2020.
- National Institute for Health and Care Excellence (NICE). Pelvic floor dysfunction: prevention and non-surgical management (NG210). NICE, 2021.
- Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology, 1991.
- Miller JM, Ashton-Miller JA, DeLancey JOL. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. Journal of the American Geriatrics Society, 1998.
- American College of Obstetricians and Gynecologists. Physical Activity and Exercise During Pregnancy and the Postpartum Period. Committee Opinion No. 804. 2020.
- Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 2018.
Mom, designer and founder of Steady & Strong Wellness. Katelyn researches every article from official guidelines and peer-reviewed studies, and always encourages readers to partner with their own healthcare providers.
@steadyandstrongwellness
