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Postpartum pelvic floor weakness -Should I be doing kegel exercises?

By Natalie Whish-Wilson

After the birth of your baby, whether it be via a normal vaginal delivery or cesarean section, you may experience a feeling of weakness in the pelvic floor region. This might involve leaking of urine when you cough or sneeze, laughing, running, jumping or straining on the toilet. Other symptoms can include passing wind from the vagina or rear passage when bending over or lifting.

The pelvic floor can get a bit tired and disconnected (not necessarily always weak) and may become a bit inhibited after the birth of your baby. It can also be influenced by altered function of surrounding regions such as the abdominals, hips, pelvic joints and spine.

The risk of pelvic floor dysfunction is usually greater if you have had

  • multiple births, 
  • a long pushing phase during birth
  • an instrumented delivery (forceps or ventouse) 
  • significant tearing of the perineum or huge babies. 
  • other complications

If on top of all that you become sick resulting in persistent coughing, or are constipated/straining (common if you have sustained a perineal tear) or have an unhealed diastasis (separation of tummy muscles), you are even more at risk of having some problems regaining your pelvic floor function.

Prescribing Kegel exercises might seem like the solution if your pelvic floor is weak but did you know that some women have the opposite problem to an overly “loose” pelvic floor and this requires a different approach to treatment and exercise?

Some women (and men) suffer from what is known as a hypertonic or excessively toned pelvic floor. Sounds like a good problem to have but in fact can be trickier to treat than a hypotonic or under toned pelvic floor. It may be difficult for these people to relax their pelvic floor muscles and therefore when asked to contract their muscles they feel weak because their pelvic floor is already excessively lifted at rest or with loads.

The symptoms of a hypertonic pelvic floor might include;

  • Difficulty initiating urination  
  • Unexplained pain in the lower back, pelvis/SIJ, genitals or rectum 
  • Pelvic muscle spasm, painful intercourse or insertion of tampons 
  • Loss of urine with loads. Increased frequency of UTI (urinary tract infections)
  • Sometimes there is an urge to urinate again not long after emptying your bladder
  • Shallow breathing pattern
  • Constipation

Both problems will respond well to establishing or normalising a good breathing pattern, restoring hip function and restoring balanced abdominal function. Whilst prescribing kegel exercises to a hypotonic pelvic floor can be a good strategy, for someone with a hypertonic pelvic floor it can make their problem even worse.

If you are experiencing some issues with your pelvic floor, whether after a recent birth of your child or even if it was many years since having a child, there are many strategies that you can try to improve your pelvic floor function and avoid some of those unfortunate symptoms. Getting help from an experienced Physiotherapist has been shown in the research to be very effective, especially if you lead an active lifestyle or wish to participate in high load exercise.

In addition to getting clearance by your GP or Obstetrician at 6 weeks postpartum, at In-Balance we recommend that if you are experiencing any issues with your pelvic floor or have an extensive diastasis, that you consult with one of our Physiotherapists before participating in our mums and bubs Pilates classes.

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