Short answer: Most new mothers can book a pelvic floor physiotherapy assessment from about six weeks after delivery, whether the birth was vaginal or by caesarean. The first visit is a conversation and an assessment, with any internal examination done only with your consent. Treatment addresses leaking, heaviness, pain, abdominal separation and a safe return to exercise, and most patients see meaningful change within a few months. Here is what to expect, from the pelvic health team at Physio Cottage in Scarborough.
Why the postpartum pelvic floor needs attention
Nine months of pregnancy place a steadily increasing load on the pelvic floor, the hammock of muscles and connective tissue that supports the bladder, uterus and bowel and helps control continence. Delivery, whether vaginal or surgical, adds its own stresses: stretching, tearing or an episiotomy in a vaginal birth; an abdominal incision and scar in a caesarean. The abdominal wall is stretched in every pregnancy and often remains separated along the midline for months afterwards.
The result is that a large proportion of women have symptoms after childbirth: leaking urine when coughing, sneezing, laughing or running; a sense of heaviness or dragging in the pelvis; pain with intercourse; back or pelvic pain; a weak core that makes lifting the baby uncomfortable; or simply the feeling that things do not work the way they used to. These are common. They are not normal in the sense of something you have to live with, and the majority respond well to treatment.
In several countries a postpartum pelvic floor assessment is routine. In Ontario it is not, which means many women are never told that help exists. This guide is for them.
When to book: the six week mark and beyond
Most pelvic health physiotherapists see new mothers from about six weeks after delivery, once the postpartum check with your doctor or midwife is done and the tissues have had their initial healing time. If you have urgent concerns earlier, such as severe pain, an inability to empty your bladder or bowel, or a wound that is not healing, speak to your care provider first; a conversation with a pelvic floor physiotherapist can also help earlier than six weeks for advice and reassurance.
It is never too late. Patients come to us months, years and decades after their last child, and tissue responds to training at any age. If you are reading this with a toddler, a teenager or a grandchild, the advice is the same: book the assessment.
Book sooner rather than later if you have
- Leaking of urine or stool, or difficulty controlling gas.
- A feeling of heaviness, bulging or dragging in the vagina, especially at the end of the day.
- Pain with intercourse, tampon use or examination.
- Persistent pelvic, tailbone, hip or low back pain.
- A gap you can feel along the middle of your abdomen, or a belly that domes when you sit up.
- Urgency, frequency or needing to go at night more than you did before pregnancy.
- A caesarean scar that is tight, numb, painful or pulling.
- Any uncertainty about returning to running, lifting or impact exercise.
What happens at the first visit
The first appointment at Physio Cottage is sixty minutes, in a private treatment room with the door closed, with the same physiotherapist you will see at every visit. It unfolds in three parts.
1. The conversation
We talk through your pregnancy and delivery, any tearing or surgery, your symptoms, your bladder and bowel habits, your sleep, your activity and, most importantly, your goals. Some patients want to stop leaking when they sneeze; others want to run a 10K or return to a sport; others want intimacy to be comfortable again. The plan is built around your goal, in your words. You share as much or as little as you are comfortable with.
2. The assessment
We look at posture, breathing, how your ribs and abdomen move, the abdominal wall and any separation, your hips and low back, and how you lift and carry. An internal pelvic floor assessment, which checks muscle tone, strength, coordination and any prolapse, gives the most useful information, and it is done only if it is clinically helpful and only with your informed consent, explained in full before anything happens. You can decline, and you will still receive a thorough assessment and treatment. Many patients are surprised to learn their pelvic floor is too tight rather than too weak, which changes the plan entirely.
3. The plan
You leave with a clear explanation of what we found, a written or video home program of usually under ten minutes a day, and a schedule, typically every two to three weeks, because the home program needs time to work between visits. We also tell you honestly what we expect and how long it may take.
What treatment involves
- Education: how the bladder, bowel and pelvic floor work together, what is driving your symptoms and the daily habits that help or hurt. For many patients this alone changes things.
- Pelvic floor muscle training: learning to find, contract, hold and fully relax the right muscles, then building endurance and coordination with breathing and movement. Specific to your goal, whether that is a sneeze without leaking or a return to running.
- Relaxation and down training: for overactive pelvic floors, which cause pain, urgency and difficulty emptying. Here the first job is learning to let go, not to squeeze.
- Manual therapy: hands-on release of tight pelvic floor, hip and abdominal muscles and scar tissue, externally or, with consent, internally.
- Core, hip and breathing retraining: the pelvic floor works with the diaphragm, deep abdominals and hips as a system. Treatment for diastasis recti and back or pelvic pain restores that system.
- Bladder and bowel strategies: timed voiding, urge control techniques, fluid and fibre advice and positioning for easier emptying.
- Scar care: once healed, caesarean and perineal scars benefit from gentle mobilization to reduce pulling, numbness and sensitivity.
- Return to exercise planning: a staged plan for lifting, running, impact and sport with milestones so you know when it is safe to progress.
Caesarean births need pelvic floor care too
A common misconception is that a caesarean spares the pelvic floor. It spares it the delivery, not the pregnancy, which loaded the pelvic floor for nine months. Many women who delivered by caesarean have leaking, heaviness or a weak core afterwards. The abdominal incision adds a scar through several layers of tissue that can tether, pull and alter how the core activates. Postpartum assessment after a caesarean looks at all of this, and scar mobilization, once the incision is fully healed, is one of the most appreciated parts of treatment.
Diastasis recti: the gap along the middle
Diastasis recti is the separation of the two sides of the rectus abdominis muscle along the midline, which happens to some degree in nearly every pregnancy. For most women it narrows in the months after birth; for many it does not fully close, and the question that matters is not the width of the gap but how well the abdominal wall generates tension and supports you. Treatment focuses on breathing, deep core activation and progressive loading, and it includes guidance on which exercises to avoid early on, such as sit ups and front planks that dome the belly. Crunches do not fix a diastasis and can make it worse; a graded program does.
Returning to exercise and running
Returning to exercise after childbirth is a staged process, not a date on the calendar. Walking and gentle pelvic floor and core work can begin early. Low impact strength training usually follows in the first few months as symptoms allow. Running and impact exercise are typically introduced from around three months postpartum and only when the pelvic floor can manage the load, which is assessed by specific tests, such as single leg hops and running on the spot without leaking or heaviness. Returning too early is the most common reason women develop or worsen prolapse and leaking symptoms. A pelvic floor physiotherapist gives you the milestones and the program to reach them.
What progress looks like
Most patients see us less often than they expect. Stress incontinence and general postpartum recovery commonly take four to eight visits over three to four months. Overactive pelvic floor and pelvic pain conditions can take longer, because the first goal is reducing tension and sensitivity before strengthening begins. Prolapse symptoms often improve noticeably within a few months of consistent training, though the program continues longer to hold the gain. At every visit we measure against the goal you set: no leaking during your workout, a comfortable return to intimacy, a run without heaviness. If progress stalls, we revisit the plan or refer you to your doctor or a specialist, and we tell you why.
Myths we hear every week
- Leaking after children is normal. It is common, which is different. Most of it responds to a short course of treatment.
- Just do your Kegels. Many pelvic floors are too tight, not too weak, and squeezing a muscle that cannot relax makes things worse. Assessment tells us which you need.
- You have to stop running or lifting. Usually not. The goal is to return to the activity you love with a plan that builds the capacity to do it.
- A caesarean means the pelvic floor is fine. Pregnancy loads the pelvic floor regardless of how you deliver, and the scar needs care of its own.
- It is too late for me. We regularly see women in their sixties and seventies who improved within months.
- It will be painful or embarrassing. It should be neither. Everything is explained, consented and paced, in a private room, with a physiotherapist who does this every day.
When to see your doctor first
Pelvic floor physiotherapy is safe and does not require a referral in Ontario, and some symptoms need medical assessment before or alongside treatment: blood in your urine or stool, fever with pelvic pain, a wound that is not healing, a sudden change in bladder or bowel habits with no clear cause, a new bulge that appeared suddenly, or numbness in the groin with weakness in the legs. We ask about these at your first visit and coordinate with your doctor or midwife when needed.
A typical course, in practice
Here is a typical example of the kind of case we see every week, with details changed. A first time mother in her early thirties from Wexford delivered vaginally four months ago with a small tear that healed well. She has started leaking a little when she sneezes or picks up the car seat, feels a heaviness at the end of long days, and wants to get back to the running she did before pregnancy but is nervous about it. Her doctor said everything looked fine at the six week check. At her first visit we talk through the delivery and her goals, assess her breathing, posture, abdominal wall and hips, and, with her consent, assess the pelvic floor internally. We find a mild abdominal separation that generates tension well, a pelvic floor that is slightly weak but coordinates poorly with her breathing, and a habit of holding her breath and bearing down whenever she lifts. We explain all of this plainly, and she leaves with a seven minute daily program of breathing, pelvic floor coordination and deep core work, plus a different way to lift the car seat.
At the three week follow up the leaking with sneezing has mostly stopped and she has started brisk walking and low impact strength work. Over the next two visits the program progresses to single leg work, impact preparation and a walk run plan. At the fourth visit, three months after she started, she passes the return to running tests without leaking or heaviness and begins a graded running program. She finishes with a short maintenance routine and the knowledge that she can book again if anything changes, which is what we aim for: a confident return to the life she wants, not a dependence on the clinic.
Daily habits that protect the postpartum pelvic floor
- Breathe when you lift. Exhale as you lift the baby, the car seat or the laundry, and avoid holding your breath and bearing down. This single change reduces leaking and heaviness for many women.
- Do not hover and do not rush. Sit fully on the toilet, take your time and avoid straining. Hovering and straining both load the pelvic floor badly.
- Go when you need to, not just in case. Emptying the bladder too often trains it to signal early. Normal is roughly every two to four hours during the day.
- Manage constipation. Fibre, fluids and a small footstool under the feet on the toilet make emptying easier and protect the pelvic floor and any perineal repair.
- Vary your positions. Feeding, carrying and rocking all day in one posture strains the back and pelvis. Switch sides, use support and get up and move.
- Rest the pelvic floor too. Lying down for ten minutes in the afternoon, when possible, lets the tissues recover from gravity. Heaviness that builds through the day usually eases with this.
- Pace the return to exercise. Walking and gentle core work early, low impact strength next, running and impact only when the pelvic floor is ready.
What about prolapse?
Pelvic organ prolapse is when the bladder, uterus or bowel descends into the vaginal wall because the supporting tissues have stretched. It is common after childbirth and is the usual cause of the heaviness, dragging or bulging sensation many women describe. The word frightens people, but most postpartum prolapse is mild, and the symptoms respond well to pelvic floor training, lifting and toileting habits and a sensible return to exercise. Your pelvic floor physiotherapist assesses the degree of prolapse, explains it in plain terms and builds the plan around it. Where a pessary, a supportive device fitted by a doctor or trained physiotherapist, would help, we discuss it; where a specialist opinion is needed, we refer. Surgery is rarely the first step and is a decision for later, if ever, after conservative care has been tried.
Intimacy, pain and partners
Pain with intercourse after childbirth is common and rarely talked about. It can come from scar tissue, from an overactive pelvic floor that tightens in anticipation of pain, from hormonal changes during breastfeeding that affect tissue, or from a combination. It is treatable. Treatment focuses on relaxing and desensitizing the pelvic floor, mobilizing scar tissue once healed, and graded, patient paced return to intimacy, sometimes with advice on lubrication and positions. Partners are welcome at appointments if you wish, and many patients find it helpful for their partner to hear the explanation directly. Nothing about this part of recovery should be endured in silence.
Lifting and carrying your baby without hurting your back or pelvic floor
Babies get heavier every week and parents lift them dozens of times a day, often from awkward heights: the crib, the floor, the car seat, the change table. Bend at the hips and knees rather than the back, bring the baby close to your body before lifting, exhale as you lift, and avoid twisting while loaded. Alternate the side you carry on, and use a carrier that spreads the load rather than a hip hold for long periods. Car seats are the worst offender: carry them with the handle in the crook of your elbow close to the body, or leave the seat in the car and carry the baby. A few minutes of this advice at your assessment prevents a great deal of back and pelvic pain over the first year.
Pelvic health at Physio Cottage
Pelvic floor physiotherapy at our clinic at Victoria Park and York Mills takes place in a private treatment room with the door closed, with the same physiotherapist each time and with as much or as little hands-on assessment as you are comfortable with. The first visit is a full hour. Because the clinic also offers physiotherapy, massage therapy, chiropractic care and acupuncture, related problems such as low back pain, hip tightness, caesarean scar sensitivity and postpartum neck and shoulder strain from feeding are treated under one roof and one chart. Direct billing to most extended health plans, evening and Saturday hours and on-site parking make it realistic to complete a course of care with a baby in tow. Our pelvic floor physiotherapy page explains the service in full.
Frequently asked questions
Is pelvic floor physiotherapy covered by insurance?
It is billed under the physiotherapy benefit of most extended health plans, and we direct bill. Bring your insurance card. A doctor’s referral is not required to book, though some plans ask for one for reimbursement.
Can I bring my baby?
Yes. Many patients do. Bring the stroller or car seat; the treatment room is private and we work around feeds.
Does the first visit always include an internal exam?
No. It is offered when clinically helpful and done only with your informed consent. You can decline and still receive thorough assessment and treatment.
Can I come while breastfeeding?
Yes. Hormonal changes during breastfeeding can affect tissue, and your physiotherapist takes that into account in the plan.
How soon after a caesarean can I start?
From about six weeks for assessment and gentle work. Scar mobilization begins once the incision is fully healed, usually from six to eight weeks, and progresses as the tissue tolerates it.
Do I need special equipment at home?
Rarely. Most programs need nothing more than a mat and a few minutes a day. Where a device helps, we explain how to use it and where to buy it; we do not sell them.
Can I come during my period?
Yes. Treatment can go ahead, and we can keep the session external if you prefer.
Can pelvic floor physiotherapy help during pregnancy too?
Yes. Pelvic girdle and back pain, leaking, and preparation for delivery are all treated during pregnancy, and a visit in the second or third trimester sets you up for an easier recovery.
Glossary: terms you will hear at a pelvic health assessment
- Pelvic floor: the layer of muscles and connective tissue spanning the base of the pelvis that supports the bladder, uterus and bowel and controls continence.
- Stress incontinence: leaking with coughing, sneezing, laughing, lifting or impact, caused by a pelvic floor that cannot hold against the pressure.
- Urge incontinence: a sudden strong need to go, sometimes with leaking before reaching the toilet, driven by an overactive bladder signal.
- Overactive pelvic floor: muscles that are too tight and cannot fully relax, causing pain, urgency, constipation and difficulty emptying. Treated with relaxation and release, not strengthening.
- Diastasis recti: separation of the abdominal muscles along the midline after pregnancy, assessed by how well the wall generates tension rather than by width alone.
- Pelvic organ prolapse: descent of the bladder, uterus or bowel into the vaginal wall, felt as heaviness or bulging and usually mild and manageable after childbirth.
- Pelvic girdle pain: pain around the sacroiliac joints or pubic symphysis during or after pregnancy, treated with stabilization and movement retraining.
- Pessary: a removable supportive device fitted inside the vagina to support prolapse, an option alongside physiotherapy for some women.
- Return to run assessment: a set of tests of pelvic floor and lower limb capacity performed before impact exercise is reintroduced.
- Down training: teaching an overactive pelvic floor to relax through breathing, positioning and release work.
Before you book, have these ready
- The date and type of delivery, and any tearing, episiotomy or caesarean details you know.
- A note of your symptoms, when they happen and what makes them better or worse.
- Your goals, in your own words, from stopping leaks to running a race.
- Your extended health insurance card for direct billing.
- Any questions you have been hesitant to ask. This is the place to ask them.
Book a confidential postpartum assessment in Scarborough
Physio Cottage offers pelvic floor physiotherapy in private treatment rooms at 2231 Victoria Park Ave, Unit #5, Scarborough, ON M1R 1V8, with on-site parking and evening and Saturday hours. We see pelvic health patients from across Scarborough, North York, East York and Markham, and we direct bill most extended health plans. Call (416) 445-5353 or book online and ask for a pelvic floor assessment.
Related reading: Pelvic floor physiotherapy in Scarborough · Physiotherapy in Scarborough · Massage therapy.
About the author and clinical reviewer
Dr. Maryam Ahankoob, Registered Physiotherapist at Physio Cottage, 2231 Victoria Park Ave, Unit #5, Scarborough, ON M1R 1V8. Questions about this article or your own symptoms? Call (416) 445-5353 or learn more about our clinic.
This article is general information, not a diagnosis. Please book an assessment for advice about your situation.
