Postnatal Recovery and Pelvic Floor Physiotherapy in Howick: What to Expect After Birth

Pregnancy and birth are hard on a body, and recovery doesn't end when you leave the maternity ward. This is the companion piece to our guide to chiropractic and physiotherapy care during pregnancy — this one picks up where that leaves off, covering what actually happens to your pelvic floor and core after birth, what a postnatal physiotherapy assessment involves, and what the research does and doesn't support. At Velca, this is Amal's area: she's a senior physiotherapist with postgraduate training in women's health, and postnatal recovery — vaginal birth or caesarean, six weeks or six years ago — is a routine, no-referral-needed part of what she sees.

What Actually Happens to Your Body After Birth

Whatever kind of birth you had, your pelvic floor and abdominal wall have been under real load for months, and birth itself adds another layer on top of that. After a vaginal birth, the pelvic floor muscles and connective tissue have been stretched, and sometimes torn or cut (an episiotomy); after a caesarean, you're recovering from major abdominal surgery, and the pelvic floor has still carried the weight of pregnancy even though it wasn't directly involved in delivery. Either way, some degree of abdominal wall separation (diastasis recti) is a normal, expected part of how the body accommodates a growing baby — it isn't automatically a sign that something has gone wrong, and most people have some separation immediately postpartum.

None of this means damage that can't be worked with. It means the muscles and tissues that used to support your spine, pelvis, and internal organs are, for a while, doing that job less effectively than before — and a structured, individual approach to rebuilding that function is what postnatal physiotherapy is actually for.

Common Postnatal Physical Concerns

These four come up constantly, and every one of them is common — which is different from saying they're something you just have to live with:

• Leaking or urgency with coughing, sneezing, laughing, running, or jumping (stress or urge incontinence)
• A heaviness, dragging, or "something's not quite right" sensation in the vagina or pelvis, particularly by the end of the day or after standing for a while
• A visible or palpable gap or doming down the midline of the abdomen, especially noticeable when sitting up from lying down (diastasis recti)
• Ongoing lower back, hip, or pelvic girdle pain that either started in pregnancy and hasn't resolved, or has appeared new since birth

Research suggests these are genuinely common rather than rare complications — but common doesn't mean untreatable, and it doesn't mean you're expected to just adapt around them indefinitely.

Pelvic Floor Function After Birth

A postnatal pelvic floor assessment is more specific than being told to "do your kegels." It typically involves checking whether you can actually contract and, just as importantly, fully relax your pelvic floor muscles, assessing their strength and endurance, and identifying whether symptoms are coming from weakness, from tension or overactivity, or from a combination of both — because the right approach is different depending on which of those is actually going on.

The evidence base here is genuinely solid: a 2020 Cochrane systematic review of pelvic floor muscle training in pregnant and postnatal women found that structured, supervised pelvic floor muscle training reduced the risk of urinary incontinence in women who were continent at the start of treatment, and improved symptoms in women who already had incontinence, compared with usual care. That's a meaningfully strong evidence base for a common postnatal problem — but it's also worth being precise about what it shows: benefit from a structured, individually-assessed program, not a guarantee that any amount of generic pelvic floor exercise fixes any presentation. Some people are already tensing rather than weak, and for them, more clenching is the wrong instruction entirely — another reason a proper assessment matters more than following generic advice from an app or a pamphlet.

Diastasis Recti: What the Research Actually Shows

Diastasis recti — separation of the two sides of the rectus abdominis muscle along the midline — gets a lot of attention online, not all of it accurate. Here's an honest summary of where the evidence currently sits:

• Some inter-recti separation is normal and expected in pregnancy and the early postpartum period; it isn't, by itself, an injury or a sign that something has gone wrong.
• For many people, the gap narrows naturally over the first several months without any specific intervention.
• A recent (2025) systematic review and meta-analysis of conservative approaches to postpartum diastasis recti found that structured exercise programs — particularly those combining deep core activation with general abdominal strengthening — were associated with a greater reduction in inter-recti distance than no intervention, though the certainty of the evidence varied and results weren't uniform across all studies.
• Gap width alone doesn't reliably predict who will have pain or functional problems and who won't — some people with a persistent gap have no symptoms at all, while others with a smaller gap have real functional difficulty. This is why assessment focuses on function (can your core actually do its job under load) at least as much as measuring the gap itself.

Where a claim like "this program guarantees your gap closes" or "you must fix this before you can exercise again" shows up online, it's overstating the evidence. What research does support is that individually guided exercise, started appropriately and progressed appropriately, is a reasonable and generally low-risk approach that may help — not a certainty, and not the only variable that matters.

Pelvic Organ Prolapse: A Common but Under-Discussed Postnatal Issue

A heaviness or dragging sensation, or a feeling like something is "sitting lower" than it used to, can be a symptom of pelvic organ prolapse — where the bladder, uterus, or bowel descends slightly into or towards the vaginal wall due to reduced pelvic floor support. This is common after vaginal birth in particular, though it can occur after caesarean birth too, and it ranges from very mild and barely noticeable through to more significant.

The reason we're including it here rather than leaving it out of a general recovery article is straightforward: a lot of people experience these symptoms, feel embarrassed or assume nothing can be done, and simply don't mention it to anyone. Conservative management — pelvic floor muscle training, guidance on lifting technique and intra-abdominal pressure management, and sometimes a pessary fitted by a specialist — is typically the first-line approach and can meaningfully improve symptoms for many people, particularly with milder prolapse. It isn't a guarantee of full resolution for every degree of prolapse, and more significant cases are usually co-managed with a gynaecologist, but it's very much worth raising at an assessment rather than assuming it's just something you now live with.

Returning to Exercise and Running Safely

"When can I start running again?" is one of the most common postnatal questions, and the honest answer is that it depends more on what your body is actually doing than on the calendar. Widely used clinical guidelines on postnatal return to running (Goom, Donnelly & Brockwell, 2019) recommend a minimum of around three months postpartum before returning to running specifically — not because running itself is dangerous, but because that's roughly how long meaningful tissue healing and the rebuilding of load tolerance through the pelvic floor and core tends to take.

More important than the three-month figure, though, is the readiness checklist those guidelines set out. Before returning to running, you should generally be able to, without symptoms:

• Walk briskly for 30 minutes
• Perform single-leg balance and single-leg squats without pain, heaviness, or leaking
• Jog on the spot, and perform small hops or jumps, without leaking, heaviness, or a dragging sensation

If any of these produce leaking, heaviness, dragging, or pain, that's useful information, not a failure — it's a sign to build capacity further before adding impact, and it's exactly the kind of thing a postnatal assessment is designed to work through with you, at your own pace, rather than against a generic timeline.

When a Postnatal Physiotherapy Assessment Is Worth Booking

A postnatal check is commonly done around six weeks after birth, but "six weeks" is a common starting point, not a strict window — it's genuinely useful whether you're six weeks, six months, or several years postpartum, because pelvic floor and core function don't heal on a fixed schedule, and a lot of people simply never had this kind of assessment offered to them the first time around. An initial women's health physiotherapy assessment with Amal runs 60 minutes, with 30-minute follow-ups, and no referral is required. It typically covers your birth history, current symptoms, a pelvic floor and abdominal wall assessment, and an individualised plan for rebuilding strength and returning to whatever activity matters to you — whether that's picking up a toddler without your back complaining, getting back to the gym, or training for your first postpartum run.

The Physical and Emotional Overlap

Recovering physically while adjusting to life with a new baby, on broken sleep, is genuinely a lot — and it's worth saying plainly that the physical and emotional sides of this period aren't separate from each other. If you're finding the adjustment overwhelming, that's common, and support exists specifically for this stage: PlunketLine (0800 933 922) offers free, 24/7 advice for parents of children under five, your GP or midwife is a good first point of contact, and Velca's own counselling service is available if talking things through with someone would help alongside the physical side of recovery.

When to Seek Urgent Postnatal Care

Postnatal physiotherapy and chiropractic care sit alongside your midwife, GP, and obstetric team, not in place of them. Contact your midwife, GP, or nearest emergency department promptly — rather than booking a routine physio or chiropractic appointment — if you experience:

• Heavy vaginal bleeding (soaking a pad within an hour) or passing large clots
• Signs of infection — fever, or increasing redness, warmth, swelling, or foul-smelling discharge from a caesarean or perineal wound
• Severe headache, visual disturbances, or sudden swelling in your face, hands, or feet (postpartum pre-eclampsia can occur for several weeks after birth, not only during pregnancy)
• Calf pain or swelling in one leg significantly more than the other, or chest pain and shortness of breath
• Severe or worsening abdominal pain
• Thoughts of harming yourself or your baby, or feeling unable to cope — these are medical concerns that deserve urgent, judgment-free support, not something to push through alone

What to Expect at Velca

If you're dealing with leaking, heaviness, an abdominal gap, or ongoing pain since having a baby — whatever your baby's age now — women's health physiotherapy with Amal is a reasonable starting point, and no referral is needed. Book online or call 09 950 6801 to get started.

Frequently Asked Questions

Is it too late for a postnatal assessment if my baby is already a toddler, or older?
No. Pelvic floor and core function don't have an expiry date on when they can be improved, and it's genuinely common for people to seek this kind of assessment years after birth, often once symptoms have become bothersome enough to finally act on. There's no cut-off after which it's "too late" to be assessed.

I had a caesarean — do I still need a pelvic floor assessment?
Generally, yes. Your pelvic floor carried the load of pregnancy regardless of how you gave birth, and abdominal wall recovery after major surgery is its own process worth assessing properly, in addition to pelvic floor function.

Will pelvic floor symptoms go away on their own?
For some people, mild symptoms do improve over time without specific intervention. For others, they persist or worsen, particularly with a return to higher-impact activity. Since there's no reliable way to know in advance which category you're in, an assessment is a more useful approach than waiting to see.

Is diastasis recti dangerous?
Not inherently. Some degree of separation is a normal and expected part of pregnancy. It's worth assessing when it's associated with functional problems (a weak-feeling core, back pain, doming under load) rather than treating the gap measurement itself as the main concern.

Does breastfeeding affect treatment or exercise recommendations?
It doesn't change the fundamentals of pelvic floor or core rehabilitation, though hormonal changes during breastfeeding can affect ligament laxity for some people, which your physiotherapist can factor into how your program is progressed.

Do I need a referral to see a women's health physiotherapist?
No, you can book directly.

What if my symptoms don't match anything described here?
This article can't cover every individual presentation. If something feels off or doesn't fit a familiar pattern, it's reasonable to raise it with your GP, midwife, or book a physiotherapy assessment rather than trying to work it out from general information alone.

References

• Woodley SJ, et al. "Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women." Cochrane Database of Systematic Reviews, 2020. cochranelibrary.com
• Goom T, Donnelly G, Brockwell E. "Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population." 2019. pubmed.ncbi.nlm.nih.gov
• "Effects of conservative approaches for treating diastasis recti abdominis in postpartum women: A systematic review and meta-analysis." 2025. pmc.ncbi.nlm.nih.gov
• PlunketLine — Whānau Āwhina Plunket. plunket.org.nz

Last reviewed September 2026. This article is general information and isn't a substitute for individual assessment or advice from your midwife, GP, obstetrician, or a registered health practitioner. If you have any of the urgent symptoms listed above, seek medical care promptly rather than waiting for a routine appointment.