This is the question I hear most often in the practice — usually asked a year or five years too late. The short answer: plan the first visit around week 6–8 after birth, once you have had your gynaecological check-up. But that does not mean there is nothing to do before then, or that it is ever too late.
The first days and weeks: what you can do yourself
Long before you come to the practice, apparently trivial things matter: how you get out of bed, how you sit to feed, how you breathe, avoiding straining when you open your bowels. In those first weeks these either take load off the pelvic floor or overload it, day after day.
If the birth was instrumental, if there was an episiotomy or a tear, or if you had a caesarean section, book straight after your check-up rather than waiting for things to “heal properly”. A scar heals over months, and throughout that time you can influence how it settles.
Why week 6–8
That is the point at which the tissues have healed enough for a full functional examination, including an internal one. Without that examination, therapy is guesswork — because a weak pelvic floor and an overactive one produce very similar symptoms and need exactly the opposite approach.
That distinction is the heart of the matter. A woman who starts “doing Kegels” on her own with an overactive pelvic floor usually makes her symptoms worse, and genuinely does not understand why.
What patients most often come with
- leaking urine when coughing, sneezing, laughing or running
- a feeling of heaviness or of something dropping in the vagina
- diastasis recti and a belly that “will not go down”
- pain from a caesarean or episiotomy scar
- pain when returning to intimacy
- back and hip pain that started in pregnancy and never went away
And if it has been five years?
Therapy still makes sense. Scars, diastasis recti and urinary incontinence respond well long after birth — it simply takes longer, because there is also the compensation the body has built up in the meantime to undo.
The worst option is waiting for it to pass on its own. Urinary incontinence is not a normal consequence of having children and it is not something you have to live with.
What the first visit looks like
We start with a detailed history: how the pregnancy and birth went, what the symptoms are now, what your daily habits look like. Then the examination — posture, breathing, the abdominal wall, and with your consent the pelvic floor. Finally the first hands-on work and a specific programme to take home.
You leave knowing what to do next. That is usually the most important part.
- postpartum
- pelvic floor