Physiotherapy After Vaginal Delivery

What a vaginal birth asks of the pelvic floor

As the baby's head crowns, parts of the pelvic floor muscle stretch to roughly three times their resting length. No other muscle in the body is asked to do anything like that. Afterwards the muscles are lengthened, bruised and weak, and sometimes the perineum has torn or been cut.

Most of this recovers on its own over weeks to months. Some of it doesn't: a long pushing stage, a large baby, forceps or vacuum delivery and deeper tears all raise the chance of lasting weakness, leaking or heaviness. Those are the women who benefit most from early pelvic floor physiotherapy.

The first two weeks

• Use a cold pack wrapped in a cloth on the perineum for ten to fifteen minutes at a time in the first days.
• Sit on a pillow or slightly to one side if sitting is painful. Lying on your side to feed takes pressure off completely.
• Hold a clean pad against the perineum when opening your bowels, and avoid straining. A small footstool under your feet helps on a western toilet.
• Start gentle pelvic floor squeezes once passing urine is comfortable. They improve circulation and help swelling settle.
• Walk a little every day, but don't aim for long walks yet.

Leaking, heaviness and wind

Some leaking in the first weeks is expected and usually improves quickly. What isn't normal, although it's very common, is still leaking when you cough, sneeze or pick up your baby at three months. The same goes for struggling to control wind or stool, or a feeling that something is dragging or bulging in the vagina, especially at the end of the day.

These are treatable. Stress leakage after birth responds well to properly taught pelvic floor training (see urinary incontinence). Heaviness can be an early sign of pelvic organ prolapse, and bowel control problems are covered under fecal incontinence. Getting assessed early makes a real difference to how these settle.

Tears, stitches and scar tissue

First and second degree tears usually heal well with basic care. Third and fourth degree tears involve the anal sphincter and should be followed by specialist pelvic floor rehabilitation. If you had one, ask for a referral if it wasn't offered.

Once healed, perineal or episiotomy scars can be tight or tender, and this often shows up as pain with sex. Gentle scar massage, taught at a follow-up visit, and relaxing a guarding pelvic floor usually help. Vaginal dryness while breastfeeding is common because oestrogen levels are low, and a lubricant makes a genuine difference.

Rebuilding core, back and everyday strength

Pelvic floor recovery doesn't happen in isolation. The abdominal wall has been stretched too, and the back is now lifting a baby all day. We check for abdominal separation, build strength through the hips and trunk, and move toward the full postpartum rehabilitation program when you're ready to return to exercise.

How recovery usually runs

• Weeks 0 to 2

  Perineal care, rest positions, gentle pelvic floor squeezes, short walks.

• Weeks 2 to 6

  Pelvic floor training builds, posture for feeding, gentle deep core work.

• Weeks 6 to 12

  Assessment of pelvic floor function, scar work if needed, progressive strength.

• From 12 weeks

  Return to impact and higher-load exercise once the pelvic floor is coping well.

Call your doctor if

• Perineal pain is getting worse rather than better
• The stitches or wound look red, swollen, or are discharging or opening
• You have a fever or a foul-smelling discharge
• You can't control your bowels or can't pass urine
• Bleeding becomes heavy or you pass large clots

Frequently asked questions