Evolving STRENGTH: Caring for you pelvic floor after birth & beyond

Welcome back to part two of my conversation with licensed pelvic floor therapist Melissa McEnroe. In this segment, we shift our focus to life after birth—navigating the postpartum period, perimenopause, and the years that follow. Melissa shares valuable insight into how our pelvic floor continues to change and what we can do to support long-term strength, function, and well-being through every season of womanhood.

What are some things a momma recovering from a c-section can expect in regards to her pelvic floor?

It’s important to know that you may need to see a pelvic floor specialist after a c-section just as you would if you had a vaginal delivery. Once we have given that scar time to heal, we want to start mobilizing the tissue around the scar and then when appropriate, the scar itself. Because of the location of the incision, it has the potential to impact the ability of the deep core muscles to coordinate and create a strong contraction. So in conjunction with hands-on work, when cleared to do so, we want to get back to that 360 breath and reestablishing that core connection before jumping right back into routine when we’re cleared.

After childbirth, when should women start postpartum pelvic floor exercises, and what should they focus on first?

You can start immediately with breathwork. Laying down, knees bent so you are supporting your low back and reconnecting to your breath. Hands on the rib cage, getting some expansion in that space and exhale letting things recoil. Once you get more connected to the breathing, you can work toward the inner thighs. Start by placing a pillow between your thighs and make those exhales with your breath a little more active and incorporate the muscles of that area.

After the 6 week mark, most women can start to incorporate some upright movement, some safe resistance, all with the focus of reconnecting to the core and pelvic floor. Just watch for any coning, doming or increased pressure. If you notice any increase in pressure or bleeding when you start back exercising, you are probably doing a little more than your body is ready for.

What are some sneaky signs that your pelvic floor might need attention, even years after having kids?

If you are feeling any type of pressure or heaviness within your pelvis, have any degree of leakage, or notice an increase in pressure when you are exerting yourself such as coughing, exercising, laughing, or if you have a specific discomfort deep within your hips that you can’t quite pinpoint, these could be signs that your pelvic floor is needing some attention. If you have tailbone pain with prolonged sitting. Pain with sex is also another one that isn’t often talked about! Some of these things might seem really common, but they are not something you should have to deal with!

As women age, how does pelvic floor health change, and what are some maintenance exercises or practices you recommend?

Hormones are always going to play a role as it relates to pelvic health. Yes, strength and mobility of those muscle, but also the integrity of the tissues. Some women may notice some dryness, so making sure we are keeping the tissue externally healthy. As we age, we also never want to undervalue targeted strengthening work and breathwork. Breathwork is always accessible, so that is something we can practice as we age. Staying on top of our health, bowel & bladder habits, and hydration. Being our own advocate if we notice any changes and seeking help accordingly.

Are there any red flags where women should seek help from a pelvic floor specialist rather than trying to manage it alone?

Yes! If a woman has any leakage for any reason. Just because it is common, it does not mean it is normal. So any experience with leakage, I would recommend seeing a specialist. Pain with sex/intimacy is also a red flag. Sex should never be painful. It could be any position with any degree of insertion, pain is not normal and should be discussed with a provider. This could have to do with the muscles of the pelvic floor being too tight. But it could really be a multitude of causes.

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I hope this conversation with Melissa offered you deeper insight into how important it is to care for your pelvic floor. Whether you’re newly postpartum or approaching perimenopause, it’s never too late to connect with this vital part of our bodies.