Pelvic floor after birth: when to start kegels, week by week
Most women can start gentle squeezes within the first few days, even with stitches. Women who trained in pregnancy had a 29% lower risk of leaking 3–6 months after birth.
Updated ·Written by the Dr. Kegel editorial team · clinical review pending
Short answer
Usually within the first few days. After a vaginal birth, you can start gentle squeezes once you can pee normally and it doesn't hurt — even with stitches. After a c-section, start once your urinary catheter is out. Begin with a few soft, short squeezes lying down, and build over weeks. Stop if pain increases.
lower risk of leaking 3–6 months after birth in women who did pelvic floor training during pregnancy (continent women, 5 trials, 673 women) — the earlier you start, the better
Why start kegels early after birth
Pregnancy stretches and loads your pelvic floor for months, and a vaginal birth stretches it further. Early, gentle squeezes don’t build much strength in the first days — but they do three useful things:
- Reconnect your brain with muscles that may feel numb or distant.
- Boost blood flow to bruised and swollen tissue.
- Start the habit before life with a newborn fills every minute.
The evidence favors starting early. A Cochrane review found that women without leaking who trained their pelvic floor during pregnancy had a 29% lower risk of leaking three to six months after birth (Woodley et al.). NICE advises encouraging pelvic floor training during pregnancy and again before you leave maternity care. If you didn’t train during pregnancy, the next best time is now.
When to start: by type of birth
| Your birth | When you can usually start | What to watch |
|---|---|---|
| Vaginal birth, no or small tear | Within the first days, once you can pee normally | Keep it pain-free and gentle |
| Stitches (episiotomy or 2nd-degree tear) | Within the first days, very gently | Stop if stitch pain sharpens |
| 3rd/4th-degree tear (anal sphincter) | Follow your care team’s plan — usually early, gentle work with a physio | Any bowel leaking; NICE advises considering 3 months of supervised training |
| Forceps or vacuum birth | Within the first days, gently | NICE advises considering a 3-month supervised program |
| C-section | Once the catheter is out and you feel ready | Support your scar; avoid straining |
Everyone heals differently. “Usually” means most women — your midwife, doctor or physical therapist may give you a different plan.
How to do your first kegels after birth
- Lie on your side or back with knees bent and a pillow under them. After a c-section, side-lying or a slight recline is often most comfortable.
- Breathe in and let your belly soften.
- Breathe out and gently squeeze as if stopping gas and pee at the same time, then lift a little. Use about a third of your effort.
- Hold for 2–3 seconds, then let go completely for 5–6 seconds. The release is as important as the squeeze.
- Do 5 slow squeezes and 5 quick flicks, two or three times a day. Linking sets to feeds makes them easy to remember.
Not sure you’re doing it right? The kegel technique check takes about a minute. The kegel timer paces holds and rests for you.
Building up week by week
- Weeks 1–2: gentle squeezes lying down; focus on feeling the muscles and fully relaxing. See leaking in the first 2 weeks.
- Weeks 3–6: longer holds (5 seconds and up), quick flicks, add sitting and standing. See 3–6 weeks postpartum.
- Weeks 6–12: strong 10-second holds, squeezes during daily lifts, whole-body strength. See 6–12 weeks postpartum.
- After about 12 weeks: load and impact, if you pass the readiness tests — the postnatal return-to-running guideline advises no running before about 12 weeks.
Expect progress over weeks to months, not days. NICE recommends at least three months of supervised training before judging results.
After a c-section: what’s different
- Start once the catheter is out. Charities such as Tommy’s advise starting pelvic floor exercises when you feel ready after a c-section.
- Protect the scar. Hold a pillow over your wound when you cough, sneeze, laugh or get up, and roll to your side to get out of bed.
- Don’t skip it. A c-section lowers the risk of leaking but doesn’t remove it — pregnancy itself strains the pelvic floor.
- Go gently with your belly. Gentle deep abdominal activation with your out-breath is fine early; crunches and heavy lifting wait.
When kegels aren’t the right first step
Some women come out of birth with a pelvic floor that is tight and painful rather than weak — after a difficult tear, painful stitches, or anxiety about the area. If squeezing hurts or you can’t let go, focus on relaxing first: slow belly breathing with a soft pelvic floor, or the reverse kegel timer. Tell your midwife or physical therapist.
Plan for your week
Two or three gentle sets a day, linked to feeds, with a full release after every squeeze. Add a little each week, and check in with a professional at your postnatal check.
Frequently asked questions
Can I do kegels with stitches?
Usually yes, gently. Light squeezes increase blood flow to the area and can help with swelling. Keep them soft, short and pain-free. If squeezing makes the pain sharper, stop and check with your midwife or doctor. After a more serious tear involving the anal sphincter, follow your care team's specific advice.
When can I start kegels after a c-section?
Once your urinary catheter has been removed and you feel ready — often within the first day or two. Your pelvic floor still carried nine months of pregnancy, so it benefits from training too. Do them lying down or sitting at first, and support your scar with a pillow if you cough or laugh.
What if I can't feel anything when I squeeze?
That's common in the first days and weeks. Swelling and stretched nerves can dull the feeling. Keep trying gently — the brain-muscle connection comes back with practice. If you still can't feel a squeeze by about 6 weeks, ask for a pelvic floor assessment.
Is it ever too late to start kegels after birth?
No. Pelvic floor training helps whether you start in week one, month six or years later. NICE recommends at least three months of supervised pelvic floor training for women with leaking. Starting early simply gives you a head start during natural recovery.
Should I have done kegels during pregnancy?
It helps. A Cochrane review found women without leaking who trained during pregnancy had 29% lower risk of leaking 3–6 months after birth. If you're pregnant again, start now. If you didn't train last time, starting after birth still helps.
Sources
- Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women — Cochrane Database of Systematic Reviews, 2020
- Pelvic floor dysfunction: prevention and non-surgical management (NG210) — NICE, 2021
- When and how to exercise after a c-section (caesarean) — Tommy's
- Returning to running postnatal – guidelines for medical, health and fitness professionals (Goom, Donnelly & Brockwell) — Independent clinical guideline, 2019
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.