Can a Chiropractor Help With Postnatal Pelvic Floor Problems?
If you're a few months postpartum and still leaking when you sneeze, run, or pick up your baby — and you've been quietly hoping it will resolve on its own — this post is for you. The answer is: probably not without help, but yes, postnatal pelvic floor recovery is treatable. Too many women are told at their six-week check that everything is fine and sent away without the specific support they actually need. The leaking, weakness, or pressure you're experiencing isn't something you have to accept as your new normal.
What Happens to Your Pelvic Floor During Pregnancy and Vaginal Birth?
Your pelvic floor is a group of muscles, ligaments, and connective tissue forming a hammock between your pubic bone and tailbone, it supports your bladder, uterus, and bowel. During pregnancy, this structure carries the additional load of a growing baby, placenta, and extra fluid, while hormonal changes soften connective tissue throughout your body.
During vaginal birth, the pelvic floor muscles stretch to a degree that would, in any other context, be considered a significant soft tissue injury. Research shows that at six weeks postpartum following vaginal delivery, pelvic floor muscle strength and endurance are reduced by over 50% compared to mid-pregnancy values, and at 12 months postpartum, full recovery is still not guaranteed.
For women who've had a C-section: The changes to pelvic floor loading occur throughout pregnancy, not only during labour, so surgical delivery doesn't mean your pelvic floor escaped unaffected. Additionally, your abdominal scar affects tissue mobility and how load transfers through your core, both of which impact pelvic floor function.
A 2025 study found that around half of women experience at least one pelvic floor dysfunction within ten years of birth — and the vast majority never seek help, either because they've been told it's normal or because they don't know support is available locally.
What Symptoms Tell You Your Pelvic Floor Needs Support?
There's an important distinction between what is common after birth and what is normal. Leaking, pressure, and weakness are common — but they're treatable.
Signs your pelvic floor needs professional assessment:
Stress urinary incontinence — leaking when you cough, sneeze, laugh, jump, or run
Urge incontinence — sudden, strong need to urinate that's difficult to defer
Pelvic heaviness or pressure — sensation of something bulging downwards (especially after activity; may indicate prolapse)
Pain during sex — common early postnatally but should improve; persistent pain warrants assessment
Lower back or pelvic girdle pain that didn't resolve after birth
Difficulty activating your core or feeling disconnected from your abdominal muscles
Seek urgent care if you notice: heavy bleeding during or after exercise, a visible or palpable bulge at the vaginal opening, or significant pelvic pain.
Why Your Six-Week Check Isn't a Full Pelvic Floor Assessment
I hear this constantly from patients at my prenatal and postnatal clinic: "My six-week check was fine — why do I still have symptoms?"
The six-week postnatal check covers a wide range of postpartum health markers in a short appointment — it was not designed to assess pelvic floor muscle function in detail. Many women leave without any specific evaluation of pelvic floor strength, and without clear guidance on when it's safe to return to higher-impact exercise.
Evidence-based guidance has moved well beyond the idea that six weeks is the benchmark for postnatal recovery. Goom, Donnelly, and Brockwell's 2019 guidelines for returning to running after birth recommend waiting until at least 12 weeks postnatal before running or higher-impact activity — and only after passing functional criteria including a pelvic floor assessment. The rationale is straightforward: tissues involved in birth take four to six months (sometimes longer) to regain meaningful strength and integrity.
NICE guideline NG210 (Pelvic floor dysfunction: prevention and non-surgical management, 2021) recommends pelvic floor muscle training as first-line intervention and states that healthcare professionals should discuss pelvic floor health with women at every postnatal contact — not just once. If you haven't had that conversation, you're not alone.
Diastasis Recti and the Core-Pelvic Floor Connection
Diastasis recti (DR) is a separation of the rectus abdominis muscles — the two vertical columns running down your abdomen — at the linea alba, the connective tissue band between them. Some separation is normal in the third trimester; the issue arises when the gap fails to close adequately or when the connective tissue remains too lax to transfer load effectively.
The functional truth about diastasis recti: It's less about the size of the gap and more about the tension and load-bearing capacity of the tissue. A wide gap with good tissue tension can function well; a narrow gap with poor tension can cause real problems.
Diastasis recti and pelvic floor dysfunction frequently appear together because they're part of the same pressure management system. Your deep core — comprising the diaphragm, transversus abdominis (deep abdominals), multifidus, and pelvic floor — functions as a unit. When your abdominal canister is compromised by a diastasis, the pelvic floor absorbs the excess pressure.
I assess for diastasis recti as part of every postnatal chiropractic assessment because the two conditions are linked, and addressing one without the other often produces incomplete results.
How Chiropractic Care Supports Postnatal Recovery
Chiropractic is not a direct pelvic floor treatment in the way specialist pelvic floor physiotherapy is — I want to be transparent about that. What chiropractic does exceptionally well is address the structural and neurological context in which your pelvic floor tries to recover.
During and after pregnancy, your pelvis, sacrum, and lumbar spine often shift out of optimal alignment. When pelvic mechanics are compromised, the muscles attaching to the pelvis — including the pelvic floor — cannot function as they should.
What a postnatal chiropractic assessment includes:
Full postpartum assessment — spinal and pelvic joint function, diastasis recti screening, posture, and thorough birth and recovery history
Chiropractic treatment — spinal manipulation or mobilisation for joint restriction, soft tissue work for muscle tension, and gentle rehabilitation for deep stabilisers
Progression to postnatal Pilates — once the structural foundation is restored, our postnatal Pilates course provides progressive, specific pelvic floor and core rehabilitation
Research by Haavik, Murphy, and Kruger has explored links between spinal manipulation and pelvic floor function, though this evidence is early-stage. What I find consistently in the clinic is that women struggling to activate their pelvic floor or core often have significant restriction in the sacroiliac joints or lumbar spine. Restoring normal movement creates the conditions for pelvic floor rehabilitation to actually take hold.
When Can You Safely Return to Running and Higher-Impact Exercise?
If you gave birth in winter or early spring and summer feels like the moment to return to running, fitness classes, or swimming — this section is for you.
The desire to return to activity is healthy and completely understandable. Exercise is one of the most powerful things you can do for postnatal mental and physical wellbeing. But timing and sequencing matter enormously for women with under-recovered pelvic floors.
Functional checklist before returning to running or higher-impact exercise:
At least 12 weeks postpartum — This is the minimum tissue healing threshold established in research (Goom et al. 2019).
No leaking during walking or low-impact activity — Running produces ground reaction forces 2.5× your body weight. Your pelvic floor must manage this load without symptoms before adding impact.
Can walk briskly for 30 minutes without increased symptoms — This establishes your functional baseline and helps predict readiness for faster-paced activity.
Single-leg balance for 10 seconds each side — This indicates adequate pelvic stability and proprioception.
No pelvic heaviness or dragging after activity — This rules out prolapse-related contraindication, which would need assessment before returning to high-impact exercise.
For swimming: Generally lower risk and can often reintroduce earlier than running. For C-section recovery, confirm with your midwife or GP before your first swim postpartum.
If you want to return to exercise this summer and aren't sure whether you're ready, book a postnatal assessment at The Honor Oak Wellness Rooms in Forest Hill or SE23. I'll give you a clear answer based on what I actually find, not a generic timeline.
Why Postnatal Pilates Is Different — and Why It Works
The postnatal Pilates course at HOWR is specifically designed for women at the stage where initial healing has happened but your deep core and pelvic floor aren't yet functioning as they should.
Postnatal Pilates differs from standard Pilates in critical ways:
Starts from rehabilitation, not fitness — exercises are sequenced to progressively load the pelvic floor and deep core without overwhelming a system still recovering
Breath mechanics and intra-abdominal pressure management are built into every exercise from the beginning — the foundation most general classes skip
Diastasis recti and pelvic floor considerations are factored into every movement choice
Small class sizes allow individualised cuing and progression
For many of my patients, the combination of chiropractic care to address structural alignment and postnatal Pilates to rebuild functional strength produces results that neither approach achieves alone.
Ready to Book?
If you're in Forest Hill, Honor Oak, Brockley, East Dulwich, or anywhere across SE23 or South London and want to know whether your pelvic floor recovery is on track — or you're ready to get real support — I'd love to have a chat. We offer a free 10-minute phone consultation, no obligation, so you can find out whether we're the right fit before committing to anything.
Book your chiropractic consultation here
Frequently Asked Questions
Q: When is it safe to start pelvic floor exercises after giving birth? Gentle pelvic floor activation — simply contracting and releasing the muscles — can begin within days of birth, assuming you're comfortable and there are no complications. Starting early helps restore circulation to the area and begin the neural reconnection that many women lose after birth. More structured pelvic floor training and any return to impact exercise should wait until at least 12 weeks postnatally and ideally be guided by a professional assessment. At The Honor Oak Wellness Rooms, Emma can assess your pelvic floor function as part of a full postnatal chiropractic assessment.
Q: I leak when I sneeze or run — is that normal after having a baby? Stress urinary incontinence (leaking under sudden pressure) is extremely common postnatally, but it's not something you have to accept. With the right assessment and rehabilitation, it's highly treatable. The key is not assuming it will resolve on its own if it hasn't improved by three to four months postpartum. NICE guideline NG210 recommends pelvic floor muscle training as first-line care for this symptom. Emma & Simon at The Honor Oak Wellness Rooms can assess what's driving it and build a rehabilitation plan addressing the cause.
Q: What is diastasis recti and how do I know if I have it? Diastasis recti is a separation of your two vertical abdominal muscles at the midline. It's common in later pregnancy and often persists postnatally to varying degrees. You may notice a ridge or "doming" down your abdomen when you sit up, or feel weakness or instability through your core. A simple manual assessment confirms whether you have a diastasis and — more importantly — whether the connective tissue between the muscles has adequate functional capacity. Emma screens for diastasis recti as standard in every postnatal assessment at HOWR, because it frequently co-exists with pelvic floor dysfunction and affects how rehabilitation should be sequenced.
Q: Can a chiropractor help with pelvic floor problems after birth? Chiropractic is not a direct pelvic floor treatment like specialist pelvic floor physiotherapy, but it plays a valuable supporting role. Pelvic and sacroiliac joint restriction after birth can interfere with how well surrounding muscles — including the pelvic floor — function. Emma's postnatal assessments address pelvic and spinal alignment alongside diastasis recti screening, creating the structural foundation for pelvic floor rehabilitation to work effectively. For many patients, chiropractic care followed by progressive postnatal Pilates produces significantly better results than either approach alone.
Q: The six-week check said I was fine — why do I still have symptoms? The six-week postnatal check covers a wide range of postpartum health markers in a short appointment and isn't designed to be a comprehensive pelvic floor assessment. Being given the all-clear doesn't mean your pelvic floor has fully recovered — research shows that pelvic floor strength and endurance are still significantly reduced at six weeks after vaginal birth and can take four to six months or longer to approach pre-pregnancy levels. If you're still experiencing leaking, pressure, or weakness after your six-week check, that signals your recovery needs more specific support — it's not a sign something unusual is wrong.
Q: When can I safely return to running after having a baby? Evidence-based guidelines (Goom, Donnelly and Brockwell, 2019) recommend waiting until at least 12 weeks postnatal before returning to running, and only after passing functional criteria including a pelvic floor assessment. Running generates approximately 2.5 times your body weight through ground reaction forces — your pelvic floor needs to manage that load without symptoms before adding impact. Returning too early is one of the most common drivers of ongoing leaking and prolapse symptoms. Book a postnatal assessment at The Honor Oak Wellness Rooms in SE23 for a clear, personalised answer on when you're ready.
Q: I had a C-section — do I still need pelvic floor recovery? Yes. Many women who've had C-sections assume their pelvic floor is unaffected because they didn't push during labour. In fact, your pelvic floor undergoes significant change throughout pregnancy itself — carrying the growing baby and adapting to hormonal changes in connective tissue — regardless of how birth happens. Additionally, your abdominal scar affects load transfer through the core, which affects pelvic floor function. Emma routinely works with women who've had both vaginal and surgical births and can tailor postnatal assessment and care accordingly.
Q: How many sessions will I need — chiropractic and Pilates? For postnatal chiropractic care addressing pelvic and spinal alignment alongside diastasis recti assessment, most patients need four to eight sessions depending on findings and response. The postnatal Pilates course runs over a set number of weeks and is designed as a complete programme. Emma will give you a specific estimate after your initial assessment. The two approaches work well in parallel — many patients begin Pilates as their structural function improves through chiropractic care.