Postpartum pelvic floor exercises: a phased plan from birth to month 6

What’s normal in the first weeks and months

Pregnancy stretches and loads your pelvic floor for months, and birth — vaginal or by c-section — asks a lot more of it. So it’s normal for these muscles to feel weak, heavy, numb or “not there” at first. Some things you may notice:

• Weeks 0–2: soreness, swelling or stitches in the perineum; bleeding (lochia) that slowly gets lighter; needing to pee often; a bit of leaking when you cough, sneeze or stand up.
• Weeks 2–6: swelling settles, and you may start to feel the muscles again when you squeeze. Leaking often improves but may not be gone.
• Weeks 6–12: many women feel mostly back to normal in daily life, but notice leaking or heaviness when they get tired, lift the car seat or try to exercise.
• Months 3–12: strength keeps building if you train. Symptoms that are still there now are worth taking seriously rather than waiting out.

The honest line is: leaking after birth is common, but it isn’t something you just have to live with. NICE, the UK body that writes clinical guidelines, advises that health professionals encourage pelvic floor training at routine postnatal contacts and before discharge from maternity care — not only for women who already have symptoms.

Leaking after birth: why it happens

Your bladder stays shut because the pelvic floor and the muscles around your urethra squeeze it closed, especially when pressure in your belly rises — a cough, a laugh, lifting your baby. After pregnancy and birth these muscles can be stretched, bruised or slower to switch on, so pressure wins and a little urine escapes. This is called stress incontinence, and it’s a very common pattern after birth. Read more in our guide to leaking when you sneeze, cough or laugh.

Some women instead (or also) notice a sudden, strong urge to go and not quite making it — that’s urge leaking, and it responds to slightly different habits. Keeping a 3-day bladder diary helps you and your clinician tell them apart.

When to start kegels after birth

NHS postnatal leaflets say you can start gentle pelvic floor exercises in the first days after birth, whether you had a vaginal birth or a c-section — unless you’ve been told otherwise. If you had a catheter, start after it’s taken out. Light squeezing and releasing may even help with swelling and discomfort in the perineum in the early days, including if you have stitches. Start gently and let pain be your guide.

How to do a gentle postpartum kegel:

1. Lie on your side or back with knees bent, or sit leaning slightly forward. Breathe normally.
2. Gently squeeze as if stopping gas and holding in pee, and lift up and in. Think “close and lift”, not “push”.
3. Hold for 2–3 seconds — or less if that’s all you have. Then fully let go for a few seconds.
4. Repeat a few times, a few times a day. Quality beats quantity.

If you can’t feel anything at first, that’s common. Try again in different positions over the next days. The kegel technique check walks you through the most frequent mistakes.

A phased plan: 0–6 weeks, 6–12 weeks, 3–6 months

This is a general guide, not a prescription. Move to the next phase when the current one feels easy and symptom-free — not just because the calendar says so. If you had a severe tear, a forceps or vacuum birth, or complications, ask for a specialist-guided program; NICE recommends supervised training delivered by a physical therapist or similar professional, tailored to your ability to both contract and relax.

Phase	Focus	What to do	Signs you’re ready to move on
0–6 weeks	Reconnect and heal	Gentle kegels with full release, a few times a day. Relaxed belly breathing. Short walks, building up slowly. Gentle tummy activation (drawing the lower belly in lightly on an out-breath).	You can feel a squeeze and a release; walking is comfortable; bleeding has settled.
6–12 weeks	Endurance and daily use	Build toward longer holds and more reps. Add quick squeezes. Squeeze before you lift, cough or sneeze (“the knack”). Low-impact exercise such as walking, swimming once bleeding has stopped and wounds have healed, or postnatal Pilates or yoga.	Holds feel steady; no leaking in daily life; no heaviness at the end of the day.
3–6 months	Strength and impact prep	Kegels in standing and during movement. Strength work for legs, glutes and core: squats, lunges, bridges, step-ups. Then progress to hopping and jogging drills if you’re symptom-free.	You pass load and impact checks without leaking, heaviness or pain (see below).

A simple daily routine many women can fit into a nap: one set of slow holds (squeeze, hold, fully relax) and one set of quick squeezes, in a position that works for you. For women who are leaking, NICE recommends a supervised program lasting at least 3 months before judging results — see kegels for women for the full routine. Use the kegel timer to pace your holds and rests.

Getting back to exercise and running

The POGP, the UK association of pelvic health physiotherapists, says pelvic floor exercises, pelvic tilts and gentle tummy activation can usually start after a day or two, with walking built up gradually, and that lower-impact exercise such as Pilates or yoga can follow after about 6 weeks if you feel ready.

Running is a bigger step. In 2019, physiotherapists Tom Goom, Gráinne Donnelly and Emma Brockwell published the first return-to-running guideline for postnatal women. Its key points:

• Wait at least 12 weeks after birth before starting a return-to-running program, regardless of how you gave birth.
• Get checked first, ideally by a pelvic health physical therapist, who looks at pelvic floor and tummy recovery.
• Pass load and impact tests before you run — for example walking for 30 minutes, balancing and squatting on one leg, jogging on the spot, hopping and bounding — without leaking, heaviness, dragging or pain.
• Build gradually, and treat symptoms during or after a run as a signal to step back, not to push through.

Other things that affect readiness include sleep, breastfeeding, how your c-section or perineal scar is healing, and whether you have abdominal separation. If your belly still domes or bulges when you sit up, try the diastasis recti self-check and read our guide to diastasis recti.

After a c-section

A c-section spares the pelvic floor the stretch of a vaginal birth, but not the months of pregnancy load. Many women are surprised to leak after a c-section — it’s not unusual. What’s different is that you’re also recovering from abdominal surgery:

• Pelvic floor squeezes can start early, once the catheter is out. They shouldn’t pull on your wound; if they do, go gentler.
• Support your wound with a hand or pillow when you cough, sneeze or laugh, and squeeze your pelvic floor at the same time.
• Lifting: NHS leaflets advise avoiding lifting anything heavier than your baby for the first 6 weeks, then building up gradually toward 12 weeks.
• Exercise: they suggest restarting exercise after your postnatal check, and avoiding running or high-impact exercise until at least 3 months.
• Roll to your side to get out of bed instead of sitting straight up, especially in the first weeks.

When to get help

Book an appointment with your OB-GYN, midwife, family doctor or a pelvic health physical therapist if, at any stage:

• you’re still leaking, or leaking more, after the first few weeks
• you feel heaviness, dragging, or a bulge, especially later in the day
• sex, tampons or exams are painful after you’ve healed
• you can’t control gas or bowels, or have urgency you can’t hold
• kegels hurt, or you can’t feel the muscles working at all

Pain during sex or when squeezing can mean the muscles are guarding or too tight rather than weak. In that case relaxing comes before strengthening — see our guide to pelvic pain and a tight pelvic floor.

For week-by-week questions — “is it normal to leak at 6 weeks?”, “still heavy at 4 months?” — our postpartum guides go deeper into each stage.

Frequently asked questions

How soon after birth can I start kegels?

Most NHS postnatal advice says you can start gentle pelvic floor squeezes in the first days after birth, after either a vaginal birth or a c-section, as long as any catheter has been removed. Start with a few light, short squeezes and full relaxation. If anything hurts, stop and ask your midwife or doctor.

Does leaking after birth go away on its own?

For some women it settles in the first weeks. For others it lingers for months, which is why NICE advises that women are encouraged to do pelvic floor training after birth rather than wait and see. Leaking is common, but you don't have to accept it — training and a specialist check can help.

When can I run again after having a baby?

The 2019 return-to-running guideline by Goom, Donnelly and Brockwell suggests waiting until at least 12 weeks after birth, and only returning once you pass basic strength, load and impact checks without leaking, heaviness or pain. Ideally a pelvic health physical therapist assesses you first.

Do I need pelvic floor exercises if I had a c-section?

Yes. Pregnancy itself loads the pelvic floor for months, so leaking and weakness can happen after a c-section too. You can start gentle squeezes once the catheter is out, and they shouldn't strain your wound. Follow your surgeon's advice on lifting and exercise.

Is it too late to start if my baby is already a year old?

No. Pelvic floor muscles respond to training at any stage. If you still leak, feel heaviness or have pain a year or more after birth, a structured program of at least 3 months — ideally with a specialist check — is still worthwhile.

Sources

1. Pelvic floor dysfunction: prevention and non-surgical management (NG210) — NICE, 2021
2. Pelvic floor exercises (after your baby's birth) — Somerset NHS Foundation Trust
3. Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population — Goom T, Donnelly G, Brockwell E, 2019
4. Fit and Safe: Exercise in the Childbearing Year — Pelvic, Obstetric and Gynaecological Physiotherapy (POGP)
5. Advice and exercises following caesarean section — Milton Keynes University Hospital NHS
6. Urgent maternal warning signs — CDC Hear Her campaign

This page is general education about exercise, not a diagnosis or treatment plan. Talk to a clinician about symptoms that are new, severe or getting worse.