Postpartum Exercise and Your Pelvic Floor: What Every New Mom Should Know

Having a baby is a big change for your body. During pregnancy and birth, the muscles of your core and your pelvic floor stretch, work hard, and become weaker or overworked. After delivery, many parents want to return to exercise, but it can be hard to know when it is safe, what is normal, and how to start again without causing problems. Pelvic floor physical therapy can play an important role during this time by helping your body recover and giving you the support you need to return to exercise with confidence. 

The American College of Obstetricians and Gynecologists (ACOG) offers this guidance: most women may begin exercising again gradually once they feel ready after a vaginal birth. There is no required waiting period, even for activities like running, as long as the birth was uncomplicated and you feel ready. Some women feel comfortable beginning gentle movements, such as walking, within a few days of delivery. 

One of the easiest and first things you can start with is pelvic floor muscle exercise. According to ACOG, this can begin right away, even in the hospital or during the first week at home. These early exercises help you reconnect with your pelvic floor and support healing. 

Stronger activities depend on how your body feels. If you notice increased bleeding, pelvic pressure, pain, or a feeling of heaviness in the vagina, it is important to slow down. Every woman’s recovery looks different, so the return to exercise should be personalized rather than based on a strict timeline. 

ACOG encourages postpartum care with a medical provider within the first 3 weeks after birth, followed by a full, individualized visit by 12 weeks. At these visits, your provider should check your healing, ask about bladder and bowel control, discuss your level of pain, and provide guidance about returning to physical activity. If you have urinary or fecal leakage, pelvic pain, or difficulty knowing how to engage your core, your provider should refer you to pelvic floor physical therapy. This early support helps prevent long-term problems. 

Moms who are breastfeeding may need a few extra tips when returning to exercise. Feeding the baby or pumping before exercising can reduce breast discomfort. Drinking water before, during, and after exercise is also important for hydration and milk supply. 

Running is a high-impact activity, so many people want to know when it is safe to start again. Your personal timeline depends on many factors. Women who ran during pregnancy are much more likely to return to running afterward. In fact, they have nearly three times the odds of running postpartum compared with women who did not run during pregnancy. Women who feel less fear of movement and who do not experience vaginal heaviness tend to return sooner. 

On the other hand, women who had urinary leakage while running before or during pregnancy are more likely to leak during runs after pregnancy. Cesarean delivery seems to protect against running-related leakage, although many women who deliver vaginally return to running successfully after healing. 

A common worry is that returning to exercise too early might strain the pelvic floor or increase the risk of stress urinary incontinence or pelvic organ prolapse. Fortunately, research shows that moderate exercise starting around 6 weeks postpartum does not harm pelvic floor function. It does not make urinary incontinence worse and it does not increase the chance of pelvic organ prolapse at 12 months. 

In fact, women who begin low-impact exercise early often experience less pelvic girdle pain. Their bladder symptoms stay the same or even improve, while women who do not exercise at all sometimes develop worse stress urinary incontinence between 3 and 12 months postpartum. 

Interestingly, the relationship between exercise level and pelvic organ support is not simple. Women with very low or very high levels of moderate-to-vigorous activity tend to have more symptoms, while women in the more moderate range experience fewer problems. This suggests that a balanced, gradual return to activity is ideal. 

Pelvic floor physical therapy is one of the most effective ways to help women return safely to exercise after childbirth. After delivery, the pelvic floor muscles may not tighten or relax the way they should. They may be weak, sore, slow to react during impact activities, or coordinated poorly with breathing and posture. Because running creates repeated downward pressure on these muscles, restoring their strength and timing is important for preventing pain, heaviness, or leaking. 

A pelvic floor physical therapist begins with a detailed assessment. This should include an internal and external evaluation of the pelvic muscles, testing core strength and breathing patterns, checking posture and hip strength, and reviewing your daily movements and exercise goals. Then the therapist creates a treatment plan designed just for you. This often includes strengthening exercises, relaxation techniques, rehabilitative ultrasound of the abdominal wall or pelvic floor for visual feedback, and guidance on breathing and movement. Women also learn how to use their core more effectively so their pelvic floor does not become overloaded during exercise. 

Research shows that pelvic floor physical therapy helps runners by improving pelvic floor strength and endurance. In one study, pelvic floor therapy beginning around 9 weeks postpartum reduced urinary incontinence rates from 82% to 57% by 6 months, while increasing both strength and endurance of the pelvic muscles. Pelvic floor muscle training can also reduce the odds of urinary incontinence by 37% and pelvic organ prolapse by 56%, which helps protect the body during high-impact exercise. 

Pelvic floor and core coordination and strengthening programs work better when supervised rather than done alone. Women who cannot perform a correct pelvic floor contraction should be referred for therapy right away. 

Some physical therapists also use tools like transabdominal ultrasound, which allows you to see your pelvic floor muscles on a screen while you exercise. This visual feedback helps you learn proper muscle activation more quickly and safely. 

Returning to exercise after childbirth is not just about the pelvic floor—it involves the whole body. Many experts now recommend a phased plan that looks at musculoskeletal healing, strength, flexibility, coordination, emotional readiness, and pelvic floor function before progressing to higher-impact activities like running. Addressing problems early—such as fear of movement, feeling of vaginal heaviness, or pre-existing urinary incontinence—helps women return to exercise with more confidence and fewer setbacks. 

Every woman’s return to exercise looks different. Some feel ready to walk or stretch within days. Others need several weeks before they feel comfortable moving again. Pelvic floor physical therapy offers support, guidance, and a customized plan that helps your body heal and prepares you for the activities you love. With the right approach, you can return to exercise safely and feel strong, supported, and confident in your postpartum journey. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.