Supporting pelvic health through pregnancy, birth & postpartum

 

The pelvic floor does much more than “Kegels.”

These muscles help with bladder and bowel control, pelvic organ support, sexual function, pressure management, movement—and birth.

 

A healthy pelvic floor isn't simply strong. It needs to be able to:

Contract • Relax • Lengthen • Coordinate

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As a doula, you don't need to diagnose or treat pelvic floor dysfunction.

You can make a meaningful difference by noticing symptoms, opening the conversation, offering supportive education, and helping clients access appropriate care.

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Kegel or No Kegel? • Pelvic Floor Symptom Referral Guide • Caring for Your Perineum After Birth

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Kegel or No Kegel?

Kegels can be helpful—but they aren't for everyone.

A Kegel is a pelvic floor muscle contraction. Pelvic floor muscle training can be an important part of preventing or treating some types of pelvic floor dysfunction.

But “just do more Kegels” isn't individualized pelvic health advice. And can often make matters worse.

Some people need to build strength or endurance. Others need help relaxing or lengthening their pelvic floor. Many need better coordination between the pelvic floor, breathing and movement.

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Think beyond the Kegel

A well-functioning pelvic floor should be responsive to daily life and function. Often during pregnancy and postpartum, the pelvic floor muscles are overworked and doing too much. It's best to help the pelvic floor muscles 'reset' rather than have them contract more. 

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When might “more Kegels” not be the best starting point?

Consider individualized pelvic floor assessment if someone experiences:

• Pelvic or vaginal pain

• Pain with penetration or sex

• Difficulty relaxing the pelvic floor

• Difficulty emptying the bladder or bowel

• Persistent constipation or straining

• Pelvic pressure or heaviness

• Symptoms that worsen when doing pelvic floor exercises

• Uncertainty about whether they are contracting or relaxing correctly

 

Doula takeaway: You don't need to decide whether someone needs Kegels. If the answer isn't obvious, pelvic floor physiotherapy can help determine what their pelvic floor needs.

 

Pelvic Floor Symptoms & Referral Guide

Three words to remember

LEAKING • HEAVINESS • PAIN

 

These symptoms may be common during pregnancy and postpartum, but common doesn't mean they should be ignored.

 

Listen for clients saying things like:

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“I pee when I cough, sneeze or exercise.”

“I feel pressure or heaviness down there.”

“It feels like something is falling out.”

“Sex still hurts.”

“I'm scared to poop because it hurts.”

“My scar or perineum is still really painful.”

“I can't get back to exercise without symptoms.”

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These are useful opportunities to suggest pelvic floor physiotherapy.

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Consider a pelvic floor physio referral for:

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• Urinary or bowel leakage

• Vaginal or rectal pressure, bulging or heaviness

• Persistent pelvic, vaginal, vulvar, perineal or tailbone pain

• Pain with sex or penetration

• Difficulty emptying the bladder or bowel

• Persistent constipation or straining

• Concerns about perineal or cesarean scar recovery

• Difficulty returning to walking, exercise, running or other activities because of pelvic symptoms

• Questions about pelvic floor contraction, relaxation or coordination

• Birth preparation when individualized support would be useful

 

Clients do not need to wait until symptoms become severe—or necessarily wait until a routine postpartum check—to ask whether pelvic floor physiotherapy is appropriate.

 

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NOTE: PFPT or urgent medical care?

Pelvic floor physiotherapy is not an emergency service.

Seek prompt or urgent medical assessment for concerning postpartum symptoms such as significant or unexpectedly increasing bleeding, fever or signs of infection, concerning wound changes, chest pain, shortness of breath, suspected blood clot, fainting, severe or rapidly worsening symptoms, severe headache, blurred vision or other acute deterioration.

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When you're unsure about the urgency of a client's symptoms, encourage them to contact their maternity or medical care team.

 

Caring for Your Perineum After Birth

 

Your perineum—the area between your vaginal opening and anus—may feel swollen, tender or sore after giving birth, especially if you had a tear, stitches or an episiotomy.

Healing takes time. In the early days, the goal is simple: keep yourself comfortable, keep the area clean, make bowel movements easier, and notice how your recovery is progressing.

 

Keep it clean

Gently wash the area with plain water and pat dry rather than rubbing.

Change maternity pads regularly and wash your hands before and after changing your pad or using the toilet.

You generally don't need soaps, scented products, creams or oils on a healing wound unless your healthcare provider has specifically recommended them.

 

Ease soreness

Tenderness and swelling are common during the first days after birth.

A wrapped cold pack can feel soothing. Never place ice directly against your skin.

If urine stings, try pouring lukewarm or body-temperature water over your perineum while you pee.

Experiment with positions for feeding, resting and sitting. Side-lying may be more comfortable when sitting puts pressure on your perineum.

Use pain medication according to the advice you received from your maternity or medical care team.

 

Make bowel movements easier

It's very common to feel nervous about your first bowel movement—especially if you have stitches.

Try to keep your stool soft by drinking regularly, eating fibre-rich foods and responding when you feel the urge to go.

Putting your feet on a small stool while sitting on the toilet can help. Breathe rather than holding your breath and straining.

Having a bowel movement should not cause a correctly repaired perineal wound to come apart.

If you've been prescribed a stool softener or laxative after a significant tear, take it according to your healthcare provider's instructions.

 

Rest—and gently move

Your body needs recovery time, but you don't have to remain completely still.

Start with comfortable everyday movement and short periods of walking, gradually doing more as your body allows.

Let comfort, symptoms and energy help guide your progression.

You do not need to “bounce back.”

 

Is it getting better?

Some soreness, swelling and tenderness are expected after birth.

One of the most useful things to notice is the direction your symptoms are going:

 

Is it gradually getting better—or getting worse?

Contact your midwife, maternity unit, doctor or other appropriate healthcare professional if you notice:

• Pain that is becoming worse rather than better

• Increasing swelling or redness

• Fever, chills or feeling generally unwell

• Pus or unpleasant/foul-smelling discharge from the wound

• New bleeding coming from the wound itself

• Your stitches or wound appear to be opening

• You are increasingly concerned about how the area looks or feels

• Pain is not improving as expected or you need increasing amounts of pain relief

 

Seek urgent medical care if you have severe or rapidly worsening symptoms, significant or unexpectedly heavy bleeding, difficulty breathing, chest pain, fainting, or other signs that you may be seriously unwell.

If something doesn't feel right, you do not need to wait for your routine postpartum appointment to ask for help.

 

What about pelvic floor physiotherapy?

Once the immediate healing period is underway, a pelvic floor physiotherapist can help if you experience:

Persistent pain • Painful sex • Scar discomfort • Leaking • Pelvic heaviness or pressure • Bowel difficulties • Difficulty returning to exercise or everyday activities

You can also see a pelvic floor physiotherapist simply because you have questions about your recovery—you don't need to wait until there is a major problem.

 

After a third- or fourth-degree tear

Follow the specific advice and follow-up plan given by your maternity team. Let your healthcare provider know about difficulty controlling wind or stool, bowel urgency, persistent pain, or other new bowel symptoms.

 

A gentle reminder

Birth recovery is not a race.

Keep it clean. Keep yourself comfortable. Keep bowel movements soft. Move gradually. And pay attention to whether things are getting better or worse.

If you're worried about your recovery, reach out..

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This handout provides general information and does not replace individualized medical or physiotherapy advice.

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​For doulas: Bookmark or share this page with clients whenever pelvic floor questions come up.

This resource provides general education and does not replace individualized medical or physiotherapy assessment. Recommendations may differ depending on pregnancy, birth history, symptoms and medical circumstances.