pelvic floor physiotherapy: a complete uk guide

Reviewed by the CK Physiotherapy Clinical Team, Chartered Physiotherapists (HCPC-registered, CSP members)

Published 22 November 2022  ·  Last reviewed 7 July 2026  ·  Next review July 2027

Leaking when you sneeze, a heavy dragging feeling, or a tummy gap that will not close after having your baby is common — but it is not something you simply have to live with. Pelvic floor physiotherapy is the evidence-based, non-surgical way to recover after birth, and NICE recommends a supervised pelvic floor muscle training programme of at least three months as the first-line treatment for stress and mixed urinary incontinence. At CK Physiotherapy in Hanwell, our Chartered Physiotherapists help new mothers across Ealing and West London regain control and confidence — in our calm clinic or at home, so you do not have to leave your baby.

Pelvic Floor Physiotherapy After Birth: A Complete Guide for New Mums in West London

Around one in three women experience urinary incontinence in the months after having a baby, and roughly the same proportion notice a separation in their tummy muscles that persists past six weeks. Yet most mums are never told that a short course of skilled physiotherapy can resolve these symptoms. This guide explains what pelvic floor physiotherapy is, what the evidence shows for postnatal recovery, when it is safe to start exercising and running again, and how to access specialist care through CK Physio — without a long wait.

Sources: NHS England Perinatal Pelvic Health Services; NICE Quality Standard QS77, Statement 4; Cochrane Review CD005654 (Dumoulin et al., 2018).

What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is a specialist branch of physiotherapy that assesses and treats the muscles, ligaments and connective tissue supporting your bladder, bowel and womb. The pelvic floor itself is a hammock of muscles slung between your pubic bone and tailbone. When it is working well, you never notice it. When pregnancy and birth stretch and load it — a vaginal delivery can lengthen these muscles by more than 250% — you may notice leaking when you cough, sneeze, laugh or run; a heaviness or dragging feeling; discomfort during intimacy; or a sudden urgency that dictates your day.

A pelvic floor physiotherapist is trained to work out whether your muscles are too weak (the most common picture after birth) or too tight, because these look similar to you but need opposite treatment. This is why doing endless Kegels on your own is often the wrong approach — the right programme starts with a proper assessment. At CK Physio, our Chartered Physiotherapists tailor every postnatal programme to your body, your birth and your goals, whether that is lifting your baby without pain or getting back to running.

Why does my pelvic floor change after having a baby?

Your pelvic floor changes after birth because pregnancy and delivery place months of sustained load on it, and childbirth itself stretches and can injure the muscles. Vaginal delivery is the single biggest factor, particularly with a long second stage of labour, an assisted (forceps or ventouse) birth, or a larger baby. Importantly, a caesarean birth reduces but does not remove the risk — the nine months of pregnancy load the pelvic floor regardless of how you give birth. This is why everyone can benefit from pelvic floor rehabilitation after having a baby, not only those who had a vaginal delivery.

Other factors that add strain in the postnatal period include constipation and straining (very common after birth), the hormonal changes of pregnancy and breastfeeding, lifting a growing baby and car seat many times a day, and returning to high-impact exercise before the pelvic floor is ready. The encouraging news is that the body is designed to recover, and skilled, progressive physiotherapy is one of the most effective ways to support that recovery.

What does the evidence say works for postnatal recovery?

Supervised pelvic floor muscle training is the gold-standard, first-line treatment for stress and mixed urinary incontinence — and the evidence for it is strong. A landmark Cochrane systematic review of pelvic floor muscle training for urinary incontinence in women found that 56% of women reported their stress incontinence cured after training, compared with just 6% who had no treatment. The National Institute for Health and Care Excellence (NICE) recommends a supervised programme of at least three months as the first thing to try, before any surgical option is considered.

"Supervised" is the key word. Research consistently shows that many women who teach themselves pelvic floor exercises unknowingly squeeze the wrong muscles, brace their tummy, or hold their breath — and so see little change. A short course of skilled physiotherapy to confirm your technique, set the right dose and progress you safely is the highest-value path. The table below summarises what the evidence supports for the concerns new mothers most often raise.

Sources: Cochrane Review CD005654 (2018); NICE NG210 (2021); Chartered Society of Physiotherapy.

When can I start pelvic floor exercises after birth?

You can begin gentle pelvic floor exercises within a day or two of giving birth, as soon as you feel able — there is no need to wait for your six-week check. The NHS and the Pelvic, Obstetric and Gynaecological Physiotherapy network (POGP) advise starting early and gently, because reconnecting with these muscles in the first weeks helps prevent the slide into longer-term, harder-to-treat problems. Early on, the first "wins" are awareness and confidence rather than symptom change.

A simple, evidence-based starting routine is to combine long holds with short, quick squeezes. Below is the approach NHS pelvic health teams and the Chartered Society of Physiotherapy recommend. If anything feels painful, or you cannot feel your muscles working, that is exactly the point at which a pelvic floor physiotherapist can help — it usually means the technique needs adjusting, not that you are doing something wrong.

Source: NHS — ways to stop leaks; Tommy's pelvic floor exercises. General guidance only — not a substitute for individual assessment.

Many mums find it helpful to use the Squeezy app alongside physiotherapy — it is the NHS-endorsed pelvic floor app designed with Chartered Physiotherapists, and it sends reminders and lets you personalise your programme. It works best when your physiotherapist has first confirmed your technique and set your starting dose.

How long does it take to recover after birth?

Most new mothers notice meaningful change between six weeks and three months of consistent, guided practice, with the majority reporting clear improvement by around 12 weeks. This mirrors the NICE recommendation of a minimum three-month supervised programme before reviewing progress. In the first couple of weeks the goal is simply reconnecting with the muscles and building a daily habit. Between weeks three and six, strength and endurance start to build and some mums see early reduction in leaking. By weeks six to twelve, most experience clinically meaningful change.

Recovery is not a race, and every birth is different. A longer or assisted labour, a significant perineal tear, or a tummy separation may mean recovery takes longer — and that is normal. What matters is a programme that meets your body where it is and progresses at the right pace. This individual tailoring is exactly what a Chartered Physiotherapist provides that a generic online routine cannot.

What is diastasis recti (the "mummy tummy") and will it close?

Diastasis recti is a normal widening of the gap between the two halves of your tummy muscles during pregnancy, and for most women it narrows on its own — supervised, progressive exercise is the recommended way to help it along. A well-known longitudinal study found the separation was present in about 60% of women at six weeks after birth, falling to around 45% at six months and roughly one in three (33%) at 12 months. So while it is very common early on, it continues to improve well into the first year, especially with the right rehabilitation.

Physiotherapy for diastasis recti focuses on rebuilding deep-core control and whole-body strength, and on how you manage everyday load — lifting your baby, getting out of bed, carrying the car seat. The evidence does not support quick fixes such as binders or taping as a stand-alone solution, and it is not about "closing the gap" at any cost; it is about a tummy that works well and supports you. If you can see or feel a persistent gap, doming or bulging when you sit up, a CK Physio assessment can tell you where you are and give you a clear, progressive plan.

When can I run again after having a baby?

Current expert guidance recommends not returning to running or other high-impact exercise until at least 12 weeks after birth, and only once you can meet key strength and pelvic floor milestones. The widely used "Returning to running postnatal" guidelines, developed by UK physiotherapists and reinforced by a 2024 international expert consensus, stress that return should be individual and symptom-guided rather than tied to a fixed date. Going back to impact too early raises the risk of leaking and of prolapse, because the pelvic floor and connective tissues are still recovering.

Before you run, a physiotherapist can screen your "run readiness" — checking that your pelvic floor has the strength and endurance to cope with impact, and that your hips, calves and core are ready for load. Between six and twelve weeks, low-impact options such as walking, swimming (once any bleeding has stopped and wounds have healed), Pilates and the static bike are ideal. If you are keen to get back to a running club, parkrun or the gym in Ealing, a postnatal readiness assessment with CK Physio gives you a safe, personalised path back to the activity you love.

What about perineal tears, stitches and C-section recovery?

Pelvic health physiotherapy also supports recovery from perineal trauma and caesarean birth. Most tears are minor and heal well, but more significant tears — known as third- or fourth-degree, or obstetric anal sphincter injuries (OASI) — benefit from specialist follow-up, and pelvic health physiotherapy is a core part of that care. If you experienced a severe tear, the charity MASIC and your NHS perineal or OASI clinic are important sources of support, and CK Physio can work alongside that care.

After a caesarean, your pelvic floor still needs rehabilitation — the pregnancy loaded it for nine months regardless of how you gave birth — and your abdominal wall and scar also need gentle, progressive recovery. Physiotherapy helps with scar sensitivity, deep-core strength, posture and a graded return to exercise. Whatever kind of birth you had, you do not need to wait until something feels wrong to seek help; a proactive assessment gives you reassurance and a clear plan.

How does postnatal recovery affect how I feel?

Physical recovery and emotional wellbeing after birth are closely linked. Ongoing leaking, pain or a body that does not feel like your own can affect confidence, sleep, exercise and mood — and the Royal College of Psychiatrists estimates that postnatal depression affects between 10% and 15% of mothers. Feeling able to move without worrying about leaks, to lift your baby without pain, and to get back to activities you enjoy is part of feeling like yourself again.

At CK Physiotherapy we take a whole-person view: recovery is about your life, not just your symptoms. Our Chartered Physiotherapists listen first, explain clearly, and build a plan around what matters to you. If you are struggling with your mood as well as your recovery, please also speak to your GP or health visitor — support is available, and asking for it is a sign of strength, not weakness.

NHS versus private pelvic health physiotherapy in West London

NHS pelvic health care for new mothers is real and improving, but access can be uneven and waits can be long — private physiotherapy offers faster access, more frequent sessions and the option of home visits. Since 2024, every area of England has been asked to commission a Perinatal Pelvic Health Service, and in many areas you can now self-refer for an assessment around six to eight weeks after birth. This is a genuinely positive development. However, availability still varies by area, and follow-up appointments can be spaced too far apart to build momentum.

Private pelvic floor physiotherapy in London typically costs between £60 and £120 per session, with home visits usually around £85 to £120 in the West London market. Many private health insurers, including BUPA and AXA Health, cover a course of physiotherapy sessions each year following appropriate referral, subject to your policy. The main advantages of private care are speed (often seen within days), weekly sessions early on when they help most, longer appointment times, the choice of a female clinician, and — for a clinic like CK Physio — home visits that remove the biggest barrier for new mums: getting out of the house with a newborn.

Sources: NHS England Perinatal Pelvic Health Services; GOV.UK pelvic health announcement. Prices and insurer cover are indicative and vary by clinic and policy.

How CK Physiotherapy treats postnatal pelvic health in West London

At CK Physiotherapy, our Chartered Physiotherapists provide private postnatal and pelvic health assessment and treatment from our Hanwell clinic and at home across Ealing and West London — typically within days, not months. We have cared for West London families since 2003, are registered with the Health and Care Professions Council (HCPC), and are members of the Chartered Society of Physiotherapy (CSP).

Your first session is a thorough, unhurried assessment in a calm, private treatment room, or in the comfort of your own home. We take a full history, listen to your goals, and — only ever with your informed consent — carry out any assessment needed to understand your pelvic floor and tummy recovery. From there we build a programme around your real life as a new parent: a daily routine you can actually fit in around your baby, hands-on technique coaching, a graded plan for tummy separation and return to exercise, and clear milestones. Home visits are especially valuable for new mothers, because the practical hurdle of leaving the house with a newborn is so often the thing that stops mums getting help. We are registered providers for BUPA and AXA Health, so for many families care is covered.

When should I seek urgent medical help?

Pelvic floor physiotherapy is highly effective for most postnatal symptoms, but a small number of symptoms need prompt medical assessment rather than exercises. Contact your GP, call NHS 111, or attend A&E for any of the following, and always follow the advice of your maternity team.

Chartered Physiotherapists are also trained to screen for these warning signs during your assessment and will refer you on appropriately when needed. Working with an HCPC-registered, CSP-member physiotherapist is a safety net as well as a treatment.

Pelvic floor physiotherapy at every life stage

While this guide focuses on new mothers, pelvic floor physiotherapy is a lifespan treatment. At perimenopause and menopause, falling oestrogen thins and weakens the tissues, and supervised muscle training remains highly effective — often alongside options you can discuss with your GP. Female athletes commonly experience leaking in high-impact sport and assume it is normal; targeted training plus breathing-mechanics coaching usually restores confident, dry performance. Men also benefit, particularly after prostate surgery or with chronic pelvic pain, where structured pelvic floor rehabilitation is an evidence-based part of recovery. And for older adults, pelvic floor physiotherapy at home — combined with bladder training and falls prevention — protects dignity and independence. Whatever your stage of life, CK Physio can help.

Frequently asked questions

How long does it take for your pelvic floor to recover after birth?

Most new mothers notice improvement within about six weeks and clear, meaningful change by around 12 weeks of consistent, guided pelvic floor training. NICE recommends a minimum three-month supervised programme before reviewing progress. A longer labour, a significant tear or tummy separation can mean recovery takes longer, which is normal — consistency matters more than intensity.

Is it normal to leak urine after having a baby?

Leaking urine when you cough, sneeze, laugh or run is common after birth — around one in three women experience it three months after having a baby — but common does not mean you have to live with it. Supervised pelvic floor muscle training resolves symptoms for the majority of women, and the earlier you start, the better.

When can I start running after giving birth?

Expert guidelines recommend waiting until at least 12 weeks after birth before returning to running or high-impact exercise, and only once your pelvic floor and strength can cope with impact. Return should be individual and symptom-guided, not fixed to a date. A physiotherapy "run readiness" assessment gives you a safe, personalised plan.

Do I need pelvic floor physiotherapy if I had a caesarean?

Yes — a caesarean reduces but does not remove pelvic floor strain, because pregnancy loads these muscles for nine months regardless of how you give birth. After a caesarean you also have an abdominal wall and scar to rehabilitate. Everyone can benefit from pelvic floor and core recovery after having a baby.

What happens at a postnatal physiotherapy assessment?

A postnatal physiotherapy assessment at CK Physio is a thorough, unhurried session in our Hanwell clinic or at your home. Your Chartered Physiotherapist takes a full history, discusses your goals, and — only with your informed consent — assesses your pelvic floor and tummy recovery, then builds a personalised programme with clear milestones for leaking, tummy separation and return to exercise.

How much does pelvic floor physiotherapy cost in West London?

Private pelvic floor physiotherapy in London typically costs between £60 and £120 per session, with home visits usually around £85 to £120. CK Physio is registered with BUPA and AXA Health, so for many families a course of sessions is covered following referral. Check your policy or ask us at booking, as cover varies by insurer and plan.

Related reading from CK Physio

Continue your recovery with these related guides: postnatal recovery and restoring your post-pregnancy body shape, how physiotherapy helps urinary incontinence, managing discomfort during pregnancy, and the role of physiotherapy in women's sport. You can also explore our main physiotherapy treatment page or browse the conditions we treat.

References and further reading

1. NICE Quality Standard QS77, Statement 4: Supervised pelvic floor muscle training (last updated 2021).
2. NICE NG123: Urinary incontinence and pelvic organ prolapse in women — management (2019, reviewed 2025).
3. NICE NG210: Pelvic floor dysfunction — prevention and non-surgical management (2021).
4. Dumoulin C et al. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, CD005654 (2018).
5. NHS England: Perinatal Pelvic Health Services.
6. GOV.UK: National pelvic health service to support women.
7. NHS: Ways to stop urine leaks (pelvic floor exercises).
8. Tommy's: Pelvic floor exercises during and after pregnancy.
9. Royal College of Obstetricians and Gynaecologists: Perineal tears and episiotomies in childbirth.
10. Royal College of Psychiatrists: Postnatal depression.
11. Pelvic, Obstetric and Gynaecological Physiotherapy (POGP).
12. MASIC Foundation (support after severe birth injury).
13. Squeezy: the NHS-endorsed pelvic floor app.

This article is for general information and education and does not replace individual assessment or advice from a qualified healthcare professional. If you are worried about any symptom, please speak to your GP, midwife, health visitor, or book an assessment with a Chartered Physiotherapist.