Postpartum Care

Postpartum physiotherapy looks at recovery in more depth than the standard six-week postpartum check, which is typically a brief screen for major complications rather than a full assessment of pelvic floor, deep core, and scar tissue function. Whether you are weeks, months, or years past delivery, this care focuses on rebuilding coordinated strength and control in the deep core and pelvic floor, addressing abdominal separation, scar tissue, and symptoms like leaking, urgency, or a sense of heaviness, and guiding a graded return to exercise based on how your body is actually responding — not a fixed calendar.

What changes in the body after birth

Whether birth happens vaginally or by caesarean, the pelvic floor and abdominal wall undergo significant change. Vaginal birth stretches the pelvic floor muscles and connective tissue substantially, and may involve tearing or an episiotomy; caesarean birth involves an abdominal incision through several tissue layers. In both cases, the abdominal wall — stretched throughout pregnancy — needs time and the right kind of loading to regain tension. Hormonal shifts after birth, especially the drop in estrogen that is more pronounced during breastfeeding, can temporarily reduce tissue elasticity and lubrication, which is part of why vaginal dryness or discomfort with intercourse is common in this period. On top of the physical changes, the deep core and pelvic floor need to essentially relearn coordinated timing after months of accommodating a growing uterus — this is a motor control issue as much as a strength one.

Why leaking, heaviness, or separation can persist

Stress incontinence — leaking with a cough, laugh, sneeze, or jump — happens when the pelvic floor cannot generate enough tension quickly enough to counter a sudden rise in abdominal pressure; this is a coordination and timing issue that often does not resolve simply with time or general fitness, because it requires the deep core and pelvic floor to reflexively fire together. Urgency, in contrast, often reflects an overactive bladder and nervous system pattern, sometimes reinforced by habits like going ‘just in case’ or rushing to the bathroom, which can train the bladder to signal urgency earlier than necessary. A sensation of heaviness or bulging can relate to pelvic organ prolapse, where reduced support from the pelvic floor and connective tissue allows the bladder, uterus, or rectum to descend slightly toward or into the vaginal canal; this is common and often manageable, and is assessed carefully rather than assumed. Diastasis recti — separation at the linea alba — can also persist when the connective tissue has not regained the ability to transfer load between the two sides of the abdominal wall, regardless of how narrow or wide the visible gap is.

What postpartum physiotherapy can help with

• Bladder and bowel symptoms: leaking with impact or exertion, urgency, and straining are assessed for their underlying mechanism — coordination, overactivity, or support — rather than treated as a single generic problem.
• Pelvic heaviness or prolapse sensation: education, positioning strategies, and targeted exercise to support pelvic organ function, alongside referral back to your physician when appropriate.
• Abdominal wall changes: structured rehabilitation for diastasis recti, and dedicated assessment and treatment of caesarean scar tissue where relevant.
• Return to exercise: graded loading that respects tissue capacity, whether your goal is walking comfortably, returning to running, or getting back to strength training.
• Ongoing pain: perineal, scar-related, pubic symphysis, or low back pain that has lingered past the initial healing period.

What a thorough assessment involves

Assessment begins with understanding your birth history, current symptoms, and what you care most about functionally — whether that is returning to running, lifting your child comfortably, or simply feeling less pain. Your physiotherapist will assess movement, breathing, and pressure management strategies, along with abdominal wall integrity and scar mobility where relevant. An internal pelvic floor examination can be included to directly assess muscle tone, strength, coordination, and any areas of tenderness or restriction; this is always optional, explained in advance, and performed only with your consent, and a meaningful external assessment is available if you prefer not to proceed internally.

How treatment works

Treatment is progressive and individualized. It often starts with re-establishing basic breath-to-pelvic-floor coordination and gentle deep core activation, then builds toward more functional and higher-load movement as your body demonstrates readiness — readiness being guided by how your body actually responds at each stage, not by a set number of weeks. Manual therapy may be used for scar tissue, muscle tension, or restricted movement; biofeedback can help you feel and coordinate muscles that are difficult to sense on your own; and home programs are built around what fits realistically into life with a new baby. Throughout, physiotherapy is intended to complement, not replace, follow-up with your obstetrician, midwife, or family doctor, particularly for symptoms such as prolapse or ongoing pain that may need broader medical assessment.

Who this can help

• Anyone who has had a baby, whether weeks, months, or years ago — postpartum recovery has no expiry date.
• People noticing leaking, urgency, or heaviness that wasn’t fully addressed at their six-week check.
• Anyone with diastasis recti or a caesarean scar that still feels tight, numb, or restricted.
• People wanting a structured, graded plan to return to running, lifting, or other exercise.
• Anyone with lingering pelvic, back, or perineal pain after birth.

Our team supports every stage of the postpartum journey with hands-on, individualized pelvic health physiotherapy at our High Park, Toronto clinic. You can book an appointment whenever you feel ready — there is no need to wait, and it is never too late to start.