Postnatal Physiotherapy: Recovery After Childbirth

Why See a Physical Therapist After Giving Birth?

Physical therapy after childbirth can help reduce certain pains or urinary incontinence and enable you to resume the activities that matter to you. The evaluation examines, as needed, the pelvic floor—the muscles that close off the lower pelvis—and the abdominal muscles, known as the abdominal wall. It may also examine the perineum, the area around the genitals and anus. It identifies the type of urinary incontinence, pain, scar tenderness, or diastasis—a separation between the two rectus abdominis muscles. These findings guide your care.

Childbirth changes your body in ways you may not have anticipated. We often hear that everything should be fine after the postpartum checkup, or that pain is normal after having a baby. These statements leave little room for understanding what’s really happening in your body.

Postpartum physical therapy supports your recovery by helping you understand normal changes, identify what requires special attention, and gradually regain your strength. Depending on your symptoms and goals, an active approach may be recommended and adjusted based on the changes observed.

At Physioactif, our physical therapists who specialize in pelvic floor rehabilitation support new mothers through this transition. The care plan combines an assessment, exercises for the abdominal muscles, management of activity-related pain, and a gradual return to physical activity.

This article explains postpartum physical therapy, when to seek treatment, and how a personalized approach can guide a gradual return to normal activities.

What is postnatal physiotherapy?

Postpartum physical therapy encompasses treatments that help restore physical function and address certain symptoms after childbirth. It may include pelvic floor physical therapy, as well as treatments for the abdomen, back, joints, and scars.

Body changes after childbirth

Your body has adapted to pregnancy and needs time to recover. The main factors to consider are as follows:

Pelvic floor: Its strength, endurance (that is, the ability to sustain effort), coordination, and ability to relax can be assessed based on your symptoms and activities.

Abdominal band: The linea alba is the band of tissue that connects the two rectus abdominis muscles. A gap between the two rectus abdominis muscles, called diastasis, can be measured by ultrasound, a test that uses sound waves to visualize the tissues beneath the skin. No X-rays are used. The measured width varies depending on the specific location along the linea alba and the number of weeks since childbirth¹. The width of the separation alone does not determine treatment. A review of diastasis surgery links the decision to operate specifically to^core strength2^{, 3}.

Muscles and joints: Mobility, strength, and tolerance for new tasks—such as carrying a baby and breastfeeding positions—can be assessed.

Scars: A perineal tear, an episiotomy (a cut made in the perineum to assist with childbirth), or a cesarean section incision may remain sensitive or less tolerant to touch and movement.

What postnatal physiotherapy can treat

Difference from general physiotherapy

Perineal rehabilitation requires knowledge and skills in internal examination, pelvic disorders, abdominal exercises, scarring, and returning to normal activities. Ask your physical therapist what training and experience are appropriate for your situation.

When to see a physiotherapist after childbirth?

A physical therapy appointment may be helpful after childbirth if you are concerned about urinary incontinence, pelvic heaviness, or pain, or if you need help resuming your activities. A sudden or significant difficulty urinating requires prompt medical attention. The urgent symptoms described below should be evaluated immediately, without waiting for a physical therapy appointment.

The best time to consult depends on your symptoms and goals, but there are general recommendations based on research and clinical practice.

Timing of the initial assessment. Uncomplicated vaginal delivery: An initial assessment can be conducted shortly after delivery if you have any concerning symptoms. An appointment for perineal physical therapy will then be scheduled with your doctor or midwife once the immediate recovery period has passed.

In France, prescribed postnatal rehabilitation is covered under the French national health insurance system. In Belgium, the list of covered services includes reimbursable perinatal services. Conditions vary by country. In Quebec, physical therapy may be provided through the public health care system, depending on available services, or at a private clinic, with reimbursement depending on the insurance policy. See the terms and conditions for access in Quebec.

C-section Delivery:

After a cesarean section, the timing and focus of the assessment are tailored to your symptoms, your scar, and the instructions provided by your healthcare team. The exact timing is determined in consultation with your doctor and physical therapist, based on how well your scar is healing and your comfort level.

Depending on your symptoms and goals, the evaluation may include the scar, the abdominal wall, the pelvic floor, and daily activities.

A pelvic floor assessment may also be recommended, because pregnancy itself places strain on the pelvic floor, even without a vaginal delivery. The pelvic floor consists of the muscles that close off the lower part of the pelvis. A meta-analysis combines data from several studies addressing the same issue. A 2020 meta-analysis found no difference in pelvic floor strength in the months following childbirth between cesarean delivery and vaginal delivery in the overall comparison. However, strength was lower after an episiotomy or an instrument-assisted delivery than after a cesarean section. The certainty of the data—that is, the degree of confidence that can be placed in the results—was very low⁹. Stress urinary incontinence is the leakage of urine that occurs when coughing, laughing, or straining. Another review reported that cesarean delivery was associated with less stress incontinence, though it did not eliminate it entirely. The frequency of severe symptoms did not differ clearly according to mode of delivery¹⁰.

Situations Requiring Earlier Consultation:

• Urinary or fecal incontinence that concerns you
• Feeling of heaviness or "something coming down" in the pelvic area
• Significant pain in the perineum, scar, or lower back
• Sudden or severe difficulty urinating: seek medical advice immediately; persistent difficulty passing stool can be evaluated based on other symptoms
• Abdominal separation (diastasis) that concerns you
• Pain when resuming daily activities

Debunking the myth of a return to normal after a follow-up visit:

A postpartum medical checkup does not mean that every symptom or function must have already returned to its previous level. If you are experiencing persistent discomfort, or if it is causing you concern or limiting your activities, it can be evaluated, even if it has been some time since you gave birth.

The follow-up appointment is primarily to check for bleeding, healing, and other symptoms. Increased bleeding, a wound that isn't healing, a fever, or severe pain are reasons to seek medical attention.

Guidelines to follow based on your situation:

• Strength, endurance, and relaxation of the pelvic floor, depending on symptoms and target activities
• The Distance Between the Rectus Abdominis Muscles, Abdominal Wall Tension, Symptoms, and Function
• Mobility, perceived stability, and exercise tolerance, reassessed throughout the follow-up period
• Coordination—that is, how you engage and relax your muscles during the tasks that matter to you
• Tolerance for babywearing, breastfeeding positions, work, and physical activities

Important note: The follow-up visit is a milestone in medical care, not a date by which every symptom or function must have returned to its previous level.

Seek medical advice before or after symptoms appear

A preventive approach, to be discussed based on your questions and goals:

• An evaluation can be discussed right after you’ve recovered if you have any questions, specific goals, or symptoms
• Helps you assess abilities that are useful for your goals, such as pelvic floor control during exertion
• Establishes a plan for a gradual return to activities and exercise
• Allows you to discuss your goals and, if necessary, choose appropriate exercises

Consultation if symptoms are present:

• Consultation only when bothersome symptoms are present
• Some common symptoms can be managed; see a doctor if they bother you or limit your activities
• Can be consulted when symptoms, questions, or goals warrant it
• The duration of follow-up depends on the symptom, its impact on your activities, your goals, and your response to the program

Pelvic floor exercises may be recommended for certain types of urinary incontinence¹¹. A meta-analysis published in 2025 found fewer episodes of leakage with pelvic floor exercises in the first year after childbirth. In seven trials involving a total of 1,930 participants, the odds of leakage decreased by 37%, with an odds ratio of 0.63. Odds ratios compare people who experience leakage to those who do not; this calculation does not equate to a 37% reduction in individual probability. Confidence in this result is moderate, and the studies vary widely from one another¹². Its preventive value after childbirth depends on the population and program under study; routine screening is not a universal recommendation. Cochrane is an international network that reviews studies on treatments. Its 2020 review, which predates this synthesis, deemed the effect of a program offered to all women after childbirth to be uncertain¹³.

What to expect during your first assessment?

The initial postpartum physical therapy evaluation includes a discussion, an examination tailored to your needs, and an explanation of the proposed treatment plan. The physical therapist will ask about your pregnancy, delivery, and symptoms. They may examine your posture, muscles, and joints; your abdominal muscles and diastasis; and any scars. Any pelvic floor examination will be performed with your consent.

Please confirm the appointment duration with the clinic. The time spent discussing your symptoms, goals, informed consent, and initial assessment will depend on your situation.

Discussion of your pregnancy, your symptoms, and your activities

Your physiotherapist will ask you detailed questions about:

Your Pregnancy and Delivery:

• Type of delivery: vaginal, by cesarean section, or with the use of instruments
• Duration of labor and pushing
• Complications (tears, hemorrhage—either significant blood loss or the baby’s shoulder becoming stuck during delivery, known as shoulder dystocia)
• Baby's weight and positioning
• Medical procedures: epidural—medication administered near the nerves in the back to reduce pain; episiotomy; forceps or vacuum extractor—instruments used to assist with delivery

Your Current Symptoms:

• Urinary leakage during physical activity, with a strong urge to urinate, or both
• Bowel or gas incontinence
• Feeling of heaviness or prolapse
• Pain (perineum, scar, back, pelvis, tailbone)
• Constipation or difficulty with bowel movements
• Pain during sexual intercourse

Your Daily Activities:

• Breastfeeding (position, frequency, associated pain)
• Baby carrying (methods, duration, discomfort)
• Sleep and fatigue
• Planned return to work
• Physical activity and sport goals

Physical examination

Assessment of posture, muscles, and joints:

• Observation of your standing and sitting posture
• Assessment of your spine, pelvis, and hip mobility
• Strength tests for your core, hip, and back muscles
• Examination of painful areas using the hands (back, pelvis, tailbone)

Abdominal Wall Assessment:

• Measurement of rectus abdominis diastasis (separation, depth, tension)
• Abdominal function tests (coordination, control)
• Assessment of How to Manage Abdominal Pressure During Exercise
• Observation of your breathing strategy

Pelvic Floor Examination (with your consent):

An internal pelvic floor examination may be recommended if it addresses a clinical concern. Your physical therapist will explain the potential benefits and ask for your consent. You may refuse this examination, postpone it, or ask to stop it at any time. Other ways to evaluate and treat the condition can be discussed.

The internal exam allows us to assess:

• Muscle tone—that is, the resistance of muscles at rest—and the ability to relax are also assessed
• Muscle strength, which can be rated on a scale of 0 to 5 according to the modified Oxford scale
• Endurance (the ability to hold a contraction)
• Coordination (activation, relaxation, speed)
• The presence of tender areas or involuntary muscle contractions
• The condition of scar tissue (tear, episiotomy)
• The degree of organ descent (prolapse)

Examination of the scar, if necessary:

• Cesarean Section: Skin Mobility and Sensitivity in the Area
• Episiotomy or Tear: Healing, Sensitivity, and Discomfort During Movement

Results and Treatment Plan

At the end of the assessment, your physiotherapist will explain:

• The results of the assessment in clear terms (no incomprehensible medical jargon)
• Expected changes and symptoms that require medical attention, depending on your situation
• The recommended treatment plan (frequency, duration, goals)
• Home Exercises and the Right Time to Start
• Modifications to make to your daily activities
• What you can reasonably expect from follow-up care, given the uncertainties specific to your situation

You can ask your physical therapist questions and work with them to set your initial goals.

What treatments are used in postnatal physiotherapy?

Postpartum physical therapy uses exercises, advice, and—if needed—manual techniques tailored to your symptoms. Treatment may focus on the pelvic floor, abdominal muscles, and diastasis, as well as scars or pain during activities. Gradually resuming exercise is part of the plan.

Postnatal physiotherapy uses a variety of techniques tailored to your specific needs. Here are the main approaches.

Pelvic Floor Rehabilitation

Pelvic floor exercises may be included in treatment when warranted by the evaluation, symptoms, or treatment goals. The program is not limited to what are commonly known as Kegel exercises.

If strength training is recommended: contraction, endurance, and functional use during activities are addressed in appropriate amounts.

If it is difficult to relax: breathing, movement, touch, or relaxation techniques can be tried, depending on the person’s consent and their effectiveness.

Biofeedback: Sensors can display muscle activity in real time on a screen. The feedback shown on the screen may help some people understand how to contract or relax their muscles; its usefulness is being reevaluated. A 2023 review included eight studies conducted within six months after vaginal delivery. The programs incorporated feedback from a physical therapist following a digital examination, device-based feedback, or both. Three studies supported these additions. However, the variable results and insufficient study quality prevent a conclusion regarding a definite additional benefit for urinary or fecal incontinence¹⁴.

Abdominal Wall and Diastasis Rehabilitation

Diastasis recti—a measurable gap between the abdominal muscles—can occur after childbirth³. Certain exercise programs may alter the distance between the rectus abdominis muscles or abdominal function, but the evidence remains limited and responses vary. A review included sixteen trials involving 698 women after childbirth. In six trials involving a total of 161 women, abdominal exercises reduced the separation by an average of 0.43 cm compared with usual care. The authors consider this reduction too small to be clinically significant. It does not directly measure all aspects of daily functioning. Only three of the sixteen trials had a low risk of bias related to their methods¹⁵. Exercises are selected based on function, symptoms, goals, and the observed response. There is no single mandatory sequence for everyone.

Exercises can progress to movements and loads that are relevant to your activities. Symptoms, function, goals, and your response to the program all guide any adjustments.

❌ FALSE: "You should never do partial trunk lifts if you have diastasis"

✓ NOTE: The effect of an exercise depends on how it is performed, the intensity, the symptoms, and the goal. A partial trunk lift, which raises the head and shoulders while lying down, can be tried if it is helpful and well tolerated. Mota’s study observed an immediate narrowing of the gap during this exercise, depending on the measurement and the time since delivery. This immediate change does not prove lasting closure³.

❌ FALSE: "A wide diastasis requires surgery"

✓ NOTE: The width of the gap alone does not determine the course of treatment. Symptoms, function, treatment goals, and the possible presence of a hernia—where tissue protrudes through an opening in the abdominal wall—are all considered; a surgical opinion may be sought depending on the patient’s condition.

❌ FALSE: "If the diastasis hasn't closed after a few months, it will never close."

✓ NOTE: A remaining discrepancy does not, on its own, indicate how you function or how it will change. An evaluation can track symptoms, function, and activities, and then adjust the exercises without promising a complete resolution.

Scar Treatment

A scar from a cesarean section, episiotomy, or tear may remain tender or uncomfortable for some time, and the area may be less tolerant of touch and movement. After a cesarean section, persistent pain in the scar, wound, or abdomen affected 16.7% of people between three and six months postpartum. The review also noted pain lasting one year or longer in 8.8% of participants assessed at that time. The confidence in these two estimates remains very low, and the analysis does not include episiotomy or tear scars¹⁶.

C-section scar treatment:

Once the wound has completely healed—with no scab or open area—gentle massage and skin movements may be recommended. The goal is to make touch more tolerable and improve comfort. Exercises can also focus on strength or a specific activity. Check with your care team to determine when to start; stop if the massage causes pain. Read the tips on massage after a C-section.

Perineal scar treatment:

These steps begin on a healed wound, as advised by your care team, and are adjusted to suit your comfort level.

• Guided self-massage, if well tolerated, to gradually reacclimate the area to touch
• Working on sensitive areas—only on the inside if you consent—to gradually improve tolerance to touch
• Gradual exposure to touch to help you tolerate it better if sensitivity is limiting an activity that is important to you
• Gentle stretches when tissues restrict movement

The goal of scar treatment is to improve comfort and tolerance to touch. You may experience a slight pulling sensation; if you feel pain, you should reduce or stop the treatment and discuss it with your healthcare provider. These treatments do not guarantee the removal of scar tissue.

Managing Pain Related to Work Positions and Tasks

Symptoms in the neck, shoulders, back, or wrists can be discussed in relation to new activities, such as carrying a baby and breastfeeding positions. Positions, activities, and exercises are adjusted based on what is observed and their effects.

Gradual return to exercise

Returning to physical activity after childbirth is a step-by-step process that depends on your recovery. There is no one-size-fits-all timeline. A consensus is an agreement reached through multiple rounds of questions posed to specialists. An international consensus published in 2024 recommends a personalized and gradual return to activity. The pace of progression is adjusted based on muscle or pelvic pain, sleep, mental health, breastfeeding, and available energy¹⁷. A review published in 2026, focusing on female soccer players after childbirth, also concludes that there is a lack of consistent, evidence-based guidelines¹⁸. Initially, activities are chosen based on your comfort level, medical advice, and symptoms; their duration and intensity are adjusted accordingly. The pace is determined in consultation with your healthcare provider, based on your symptoms and tolerance.

After an uncomplicated delivery, you can start walking gently as soon as you feel ready. The 2025 Canadian guidelines recommend gradually increasing activity to at least 120 minutes per week of moderate-to-vigorous activity, spread over at least four days, including endurance and strength training. Brisk walking is an example of moderate-intensity activity. This goal is built up gradually, after sufficient healing has occurred and provided there is no increase in bleeding. The guidelines aim for a return to activity within the first twelve weeks when circumstances allow; this is not an automatic green light to start running. For running, the 2024 consensus recommends, among other things, alternating between walking and running and adding strength training, depending on symptoms and abilities.

Back to impact: We introduce it gradually, based on your symptoms and tolerance, rather than on a set date. The recommended timeframes vary from one clinical guideline to another because the starting criteria are not the same. We’ll adjust the plan with you as we go. Certain symptoms may indicate that you need to adjust your activity level or seek an evaluation:

• Urinary leakage during or after exercise
• Feeling of heaviness or pelvic pressure
• New or more pronounced abdominal distension during exercise
• Persistent pelvic, back, or tailbone pain
• If bleeding resumes or increases: stop the activity and seek medical advice

If you experience leakage, a feeling of heaviness, or pain related to physical activity, temporarily reduce or modify your activity level and have your progress reevaluated. If bleeding resumes or increases, stop the activity and seek medical advice. Severe pain or any other urgent symptom described below requires immediate medical attention.

How long does it take to recover after childbirth?

Recovery after childbirth takes several weeks and can continue for months, depending on the tissues involved, your symptoms, and the activities you plan to resume. Wound healing, strength, and your return to sports do not all progress at the same pace. The next steps will depend on your response and your doctor’s instructions.

After a C-section, certain activities may remain uncomfortable for about six weeks or longer. The NHS recommends resuming activities based on how you feel and your doctor’s advice. The NHS offers a follow-up visit around six to eight weeks to discuss your symptoms; this does not mean that your recovery is complete.

The Rest of the Recovery

The next phase of the program is designed to strengthen your muscles and introduce more challenging exercises for the activities you'd like to resume. The pace depends on your symptoms, your goals, and the progress you make during each session.

Later in the recovery process, daily functioning stabilizes. A return to high-impact sports is possible. The timing varies from person to person. It depends on symptoms, exercise tolerance, and training progress. These milestones are guidelines, not rules.

Factors influencing recovery

How is the number of sessions determined?

The number of postnatal physiotherapy sessions varies considerably depending on your needs:

Simple preventive assessment:

Follow-up care may include an initial assessment, a home exercise plan, and a follow-up appointment to adjust the plan. The timing of the follow-up appointment is determined in consultation with you, based on your progress. This option may be appropriate if you have no symptoms, your delivery went smoothly, and you’re aiming for a gradual return to basic activities.

Standard Rehabilitation:

After the evaluation, the number and frequency of follow-up visits will be determined in consultation with you, based on your symptoms, goals, and any changes observed.

Intensive rehabilitation:

When symptoms are more limiting or goals are more demanding, follow-up care can be adjusted—more frequently, less frequently, or in collaboration with the doctor—as needed.

The number of sessions is determined based on your needs and your progress. Insurance coverage may affect the costs you can expect, but it does not, on its own, determine your clinical needs. Check the reimbursement terms with your insurer.

What are the common myths about postnatal recovery?

Myths about postpartum recovery often portray urinary incontinence as inevitable and the resumption of exercise as automatic. Others concern Kegel exercises, the progression of diastasis, the protection offered by a C-section, or a supposed fault on the mother’s part.

Myth 1: "Urinary leaks after having a baby are normal"

Fact: Urinary leakage can occur after childbirth. If it bothers you or limits your activities, an evaluation can help determine the type of leakage and your treatment options. Pelvic floor exercises may help some people; results vary.¹⁹

"Common" doesn't mean "acceptable" or "inevitable." If your friends are experiencing incontinence and tell you that "that's just how it is after having a baby," know that an evaluation can help determine the type of incontinence and the appropriate options. You can seek help to find strategies that work for you.

Myth 2: "You shouldn't do Kegels if you have leaks"

Fact: Pelvic floor exercises can help with certain types of incontinence. The contraction, relaxation, and intensity of the exercises are tailored to the individual, because the same exercise isn't suitable for every situation.

This is why a professional assessment is important: your physiotherapist will tell you if you are contracting correctly and if it's the right strategy for you.

Myth 3: "Diastasis either closes on its own or never, there's nothing you can do"

Fact: The abdominal separation and abdominal function may change after childbirth. These changes vary from person to person, and the available data do not support the claim that any specific program will close the separation.

Some exercise programs may alter the abdominal gap or function, but the data do not support a promise of closure or identify a superior program²⁰. Instead, goals are defined based on function and the targeted activities.

Myth 4: “I can go back to the gym as soon as I feel better.”

Fact: When to resume physical activity depends on your symptoms, your abilities, the demands of the activity, and medical advice. An assessment can help you determine a suitable progression plan if you have symptoms, concerns, or challenging goals.

Before resuming intense or high-impact activity, an evaluation may be helpful if you have symptoms, concerns, or demanding goals. An evaluation can test certain tasks and help you choose a progression plan, though it cannot predict with certainty what will happen during the race.

Myth 5: “A C-section always protects the pelvic floor.”

Fact: A cesarean section does not guarantee the absence of urinary incontinence or pelvic symptoms after childbirth. A 2021 meta-analysis compared the two modes of delivery. Pelvic floor disorders were more common after vaginal delivery, but they also occurred after cesarean section²¹. An evaluation may be discussed if you have symptoms, questions, or specific goals.¹⁰

After a C-section, an evaluation may be helpful if the scar is tender, if your activities are limited, or if you have questions about your recovery.

Myth 6: "If I have a pelvic floor problem, it's my fault (I pushed too hard, didn't do enough Kegels during pregnancy, etc.)"

Reality: Symptoms may occur despite your best efforts. Their presence does not point to a single cause or imply that you have done anything wrong.

Pelvic floor exercises during pregnancy may reduce the risk of certain types of urinary incontinence after childbirth, depending on the population and the program studied²². Among pregnant women who had not yet experienced incontinence, the 2020 Cochrane review found a 29% lower risk between three and six months after childbirth. The confidence in the 29% estimate was high¹³. Symptoms may still occur; they do not indicate a lack of effort or any fault on your part.

What are the frequently asked questions about postnatal physiotherapy?

Frequently asked questions about postpartum physical therapy include the types of care provided, signs of an emergency, breastfeeding, diastasis, sexual intercourse, urinary incontinence while running, persistent symptoms, exercises during pregnancy, and first steps.

What does Physioactif offer in postnatal physiotherapy?

At Physioactif, the assessment may focus on the pelvic floor, diastasis, scars, or returning to exercise, depending on your symptoms, goals, and consent. The plan takes into account fatigue, breastfeeding, babywearing, and your personal constraints; you are welcome to bring your baby with you.

When to See a Doctor Instead of a Physiotherapist?

In the year following childbirth, seek medical care immediately if you experience chest pain, difficulty breathing, heavy bleeding, severe and persistent abdominal pain, fainting, vision problems, severe or persistent headache, or a fever of at least 38 °C. A leg that is painful, red, or swollen; extreme swelling of the hands or face; severe vomiting; or sudden, unusual exhaustion also require prompt evaluation. Even a single symptom may be cause for concern. Review the signs of a medical emergency after pregnancy. Call 911 in case of immediate danger or if you cannot safely reach medical care.

Report immediately any sudden or significant difficulty urinating, new loss of bladder or bowel control, a lump on the vulva, pain that is getting worse, or a sore that is becoming redder, more painful, swollen, or oozing. The vulva is the external part of the genital organs. After a cesarean section, also report any new leakage or pain when urinating. Read about the signs to watch for after a cesarean section.

If you have thoughts of suicide or of harming your baby, seek help immediately. If there is an immediate danger to you or your baby, call 911. Otherwise, call 1-866-APPELLE (277-3553), text 535353, chat online at suicide.ca, or contact Info-Social 811. Severe confusion, hallucinations—such as hearing or seeing things that others do not perceive—or a loss of touch with reality require an urgent medical evaluation on the same day. Call 911 if safety is compromised.

For pelvic heaviness, fecal incontinence, or persistent pelvic pain, collaboration between physical therapy and the medical team may be recommended.

Can I exercise while breastfeeding?

Physical activity can continue during breastfeeding, with a return to exercise tailored to your recovery. A review of 46 studies found no difference in milk quantity or quality or in infant growth between the active and control groups²³. Infant development also showed no differences²³. These results are reassuring; however, they do not replace an evaluation of your specific situation if any concerns arise.

• Breastfeed or pump before exercising if it makes you more comfortable
• Choose a bra that's right for the activity
• Drink according to your thirst and your doctor's instructions
• Gradually adjust your activity level based on your symptoms, your recovery, and your doctor's instructions

A refusal to nurse does not necessarily mean that sweat is the cause. A study of 24 mothers found no decrease in the acceptance of expressed milk offered in a bottle one hour after exercise. This time frame was for measurement purposes only; it was not a recommendation to wait that long before feeding the baby. Read the study on milk acceptance after exercise. If you are concerned about your milk supply or your baby’s growth, consult a healthcare professional.

My diastasis is 3 fingers wide. Do I need surgery?

A measurement in fingers is not enough to decide whether to proceed with surgery. The discussion takes into account the physical examination, symptoms, function, goals, and the possibility of a hernia:

• The tension in the linea alba, the band of tissue between the rectus abdominis muscles
• Your function (can you perform your activities without symptoms?)
• A protruding abdomen during exercise
• Your personal goals

The width of the gap alone is not sufficient to predict function or determine the need for surgery. The decision to proceed with surgery can be discussed based on symptoms, function, goals, the presence of a hernia, risks, and patient preferences. The 2021 review on diastasis repair links the decision to operate to how the core functions. The ten studies, involving 780 participants, reported improvements in certain abilities after surgery. However, the studies’ varying measurement tools and limitations make it impossible to guarantee individual benefit². Swedish national guidelines reserve surgery for individuals with impaired function and also take into account the presence of a hernia or significant bulging²⁴.

• Symptoms or limitations that remain significant after trying and reassessing various treatment options
• Associated hernia evaluated by the medical team
• Significant concern about appearance, discussed without assuming a course of treatment

How long after childbirth can I resume sexual intercourse?

You can consider resuming sexual activity when you feel ready and comfortable, while allowing time for healing and following your healthcare team’s instructions. The NHS does not set a standard timeframe for everyone. After a tear or a cesarean section, discuss the specific precautions for your wound. Stop if you experience pain or bleeding.

The right time to resume depends, in particular, on:

• Healing of tears or an episiotomy, assessed with the medical team as needed
• No bleeding
• Physical comfort and no pain
• Emotional readiness and desire
• A birth control method chosen together with your healthcare team if you wish to avoid another pregnancy

If you experience pain during sexual intercourse (dyspareunia), a physical therapy evaluation may be one of your options, and consultation with a healthcare provider may be recommended for:

• Scars that are sensitive or restrict movement
• Pelvic floor muscles that remain contracted, including in certain conditions where penetration becomes painful or impossible
• Pressure-sensitive areas of the pelvic floor
• Vaginal dryness, which may be associated with breastfeeding and hormonal changes. A 2025 review compiles studies on urinary and genital symptoms that occur after childbirth and are associated with breastfeeding. Vaginal dryness affected 53.6% of breastfeeding individuals, and the authors attribute it to the drop in hormones associated with milk production²⁵.

Don't dismiss pain during intercourse as normal. An evaluation can help identify possible causes and treatment options.

Is it normal to experience urine leakage when I run after giving birth?

Urinary leakage may occur after childbirth. If it bothers you or limits your activities, an evaluation can help clarify your options, including perineal rehabilitation when indicated.

If you experience leaks while running:

• Temporarily reduce or adjust the stroke if leaks increase or become a nuisance
• Consult a pelvic floor physiotherapist
• Determine whether strength, coordination, or relaxation exercises are appropriate
• Adjust your return to running based on any leaks, other symptoms, function, and your goals

Leakage during a run can be caused by several factors. If it increases or bothers you, adjust your training plan and ask for an evaluation.

It's been quite a while since I gave birth, and I'm still experiencing symptoms. Is it too late to see a doctor?

Even long after childbirth, an evaluation may still be appropriate. Pelvic floor rehabilitation may be recommended even when symptoms have persisted for a long time, depending on the clinical presentation.

Follow-up is adjusted based on symptoms, function, goals, and the observed response, even when the delivery took place a long time ago.

The goals for follow-up are based on what is bothering you right now and the activities you'd like to resume.

Are pelvic floor exercises safe during pregnancy?

Pelvic floor exercises can be recommended during pregnancy if your healthcare team has not identified any contraindications. Of the 46 trials reviewed by Cochrane, two participants in a small trial stopped the exercises due to pelvic pain, and the other trials reported no adverse effects. The 46 trials primarily measured the program’s effectiveness, not its safety, which limits the scope of this finding¹³. The program involves contracting and relaxing the muscles in an appropriate manner. Pain, bleeding, or any unusual symptoms warrant stopping the exercises and seeking medical advice.

Pelvic floor exercises during pregnancy may reduce the risk of certain types of urinary incontinence after childbirth in some participants²². The evidence is less clear regarding the prevention of tears. Perineal tears can affect the skin and muscles between the vagina and the anus. A meta-analysis of nine trials did not show that pelvic floor exercises prevent perineal tears overall²⁶. Another meta-analysis of thirty trials, involving pelvic floor exercises alone or as part of a physical activity program, reported fewer third- and fourth-degree tears—the deepest types. No measurable effect was observed on episiotomy, the incision made as the baby is born²⁷. The results therefore depend on the type of injury being studied.

What should you do now for a good recovery?

If you have just given birth or are pregnant:

• Don't wait until you have serious problems. You can discuss scheduling an evaluation after your initial recovery if you have any symptoms, questions, or specific goals.
• Listen to your body without comparing yourself to others. Every recovery is unique. See also our guide to women's health in physical therapy.
• Do not dismiss symptoms (leakage, heaviness, pain) as normal. An evaluation can help identify possible causes and treatment options.
• Be patient. The pace of recovery varies depending on the individual, their symptoms, and the activities they plan to resume.
• Ask for help if needed. You don't have to manage everything on your own.

To schedule an appointment at Physioactif, you can see a therapist without a referral. However, your insurance provider may require one for reimbursement. Please bring comfortable clothing, a list of your symptoms, and any relevant information about your insurance.

References

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