Pregnancy and having a baby can change your body in ways you may not have expected.
You may develop back or pelvic pain during pregnancy. You may notice urinary leakage when you cough, sneeze or exercise. You may feel pressure or heaviness through your pelvis. After giving birth, you may wonder when it’s safe to exercise again, whether your abdominal muscles have separated, or why sex has become painful.
These concerns are common—but common doesn’t mean you have to simply live with them.
Pregnancy and postpartum physiotherapy can help you understand what is happening, improve strength and coordination, manage pain and gradually return to the activities that matter to you.
At Restorative Touch Physiotherapy on Hamilton Mountain, our approach is individualized to your symptoms, stage of pregnancy or postpartum recovery, activity level and goals.
This guide explains when physiotherapy may help during pregnancy, what pelvic floor physiotherapy actually involves, what to expect after delivery, and how to safely return to exercise.
What Is Pregnancy Physiotherapy?
Pregnancy physiotherapy is specialized rehabilitation designed to help manage the physical changes and musculoskeletal symptoms that can occur during pregnancy.
As your pregnancy progresses, your body undergoes significant changes in:
- Body weight
- Centre of gravity
- Abdominal wall
- Pelvic floor
- Hip and pelvic mechanics
- Spinal loading
- Joint mobility
- Muscle demands
- Cardiovascular capacity
- Exercise tolerance
These changes can contribute to symptoms such as pelvic pain, low-back pain, hip pain and pelvic floor dysfunction.
A physiotherapist can help you remain active, manage symptoms and prepare your body for the physical demands of pregnancy, delivery and postpartum recovery.
Is Physiotherapy Safe During Pregnancy?
For most people, appropriately modified physiotherapy and exercise can be safe during pregnancy.
However, pregnancy is not a one-size-fits-all situation.
Your physiotherapist should consider your medical history, pregnancy status, symptoms, activity level and any recommendations from your obstetric or medical team.
If you have a high-risk pregnancy or have been given specific activity restrictions, those recommendations should take priority.
A physiotherapist should also know when symptoms are outside the scope of routine musculoskeletal care and when you should speak with your physician, midwife or obstetric provider.
What Can Pregnancy Physiotherapy Help With?
Pregnancy physiotherapy may help with a variety of musculoskeletal and pelvic health concerns, including:
- Low-back pain
- Pelvic girdle pain
- Hip pain
- Pubic symphysis pain
- Tailbone pain
- Rib or thoracic discomfort
- Pelvic floor dysfunction
- Urinary leakage
- Constipation-related pelvic floor problems
- Difficulty exercising
- Abdominal wall concerns
- Postural changes
- Pain with everyday activities
- Preparing for postpartum recovery
The goal isn’t to “fix” your pregnancy.
Your body is supposed to change during pregnancy.
The goal is to help you adapt to those changes and remain as comfortable and functional as possible.
What Is Pelvic Floor Physiotherapy?
Your pelvic floor is a group of muscles and connective tissues located at the bottom of your pelvis.
These muscles contribute to:
- Bladder control
- Bowel control
- Sexual function
- Pelvic organ support
- Core coordination
- Pressure management
- Stability during movement
Pelvic floor physiotherapy isn’t simply about strengthening these muscles.
A pelvic floor can be:
- Weak
- Overactive
- Tight
- Painful
- Poorly coordinated
- Difficult to relax
- Difficult to contract
- Or some combination of these problems
That’s why automatically telling every woman to “do more Kegels” isn’t appropriate.
Sometimes the goal is strengthening.
Sometimes the goal is learning to relax.
Sometimes the goal is improving coordination between the pelvic floor, diaphragm, abdominal wall and hips.
Do You Need Pelvic Floor Physiotherapy During Pregnancy?
Not everyone needs pelvic floor physiotherapy.
However, an assessment may be worthwhile if you’re experiencing symptoms or want help preparing for pregnancy, delivery or postpartum recovery.
Consider an assessment if you experience:
- Urinary leakage
- Pelvic pressure or heaviness
- Pelvic pain
- Pain with intercourse
- Difficulty emptying your bladder or bowel
- Constipation
- Low-back or pelvic pain
- Difficulty exercising
- A feeling that your pelvic floor is constantly tight
- Concerns about returning to exercise after delivery
You can also seek an assessment before symptoms become significant if you want guidance on exercise, pelvic floor coordination or postpartum preparation.
Is Urinary Leakage Normal During Pregnancy?
Urinary leakage is common during pregnancy, particularly with activities that increase abdominal pressure such as:
- Coughing
- Sneezing
- Laughing
- Running
- Jumping
- Lifting
- Changing positions
However, common does not mean you have to accept it as an unavoidable part of motherhood.
Pelvic floor muscle training is recommended during pregnancy for prevention of urinary incontinence in women who are pregnant or at risk of developing it.
If you’re experiencing leakage, a pelvic floor physiotherapist can determine whether you would benefit from strengthening, coordination training, pressure-management strategies or another approach.
Should Everyone Do Kegel Exercises During Pregnancy?
Not necessarily.
Kegels are exercises designed to contract the pelvic floor muscles.
They can be helpful when pelvic floor weakness is contributing to symptoms.
But the pelvic floor also needs to relax.
Imagine trying to lift weights with a muscle that never gets a chance to relax. Eventually, that muscle may become painful, fatigued or poorly coordinated.
Some people experience:
- Pelvic pain
- Pain with intercourse
- Difficulty relaxing the pelvic floor
- Difficulty emptying their bladder
- Constipation
- A feeling of pelvic tension
In those situations, repeatedly performing strong pelvic floor contractions may not be the appropriate first step.
A pelvic floor assessment can determine what your muscles actually need.
Pregnancy Back Pain: Is It Normal?
Back pain is common during pregnancy.
Changes in body weight, posture, movement patterns, muscle demands and activity levels can all contribute.
But you don’t necessarily have to stop being active because your back hurts.
A physiotherapist can help you modify:
- Exercise
- Lifting
- Sleeping positions
- Work activities
- Walking
- Sitting
- Strength training
The goal is to keep you moving safely while managing symptoms.
What Is Pelvic Girdle Pain?
Pelvic girdle pain refers to pain around the joints and structures of the pelvis.
It may be felt around:
- The pubic bone
- Groin
- SI joints
- Buttocks
- Hips
- Lower back
You may notice symptoms when:
- Walking
- Turning in bed
- Getting out of a car
- Climbing stairs
- Standing on one leg
- Putting on pants
- Getting in and out of bed
Pelvic girdle pain can be particularly frustrating because movements that previously felt completely normal can suddenly become painful.
Physiotherapy can help you identify aggravating activities, improve strength and movement strategies and develop an appropriate exercise program.
What Is Pubic Symphysis Pain?
The pubic symphysis is the joint at the front of your pelvis.
During pregnancy, hormonal and mechanical changes can contribute to pain around this area.
Symptoms may include pain with:
- Walking
- Rolling in bed
- Getting dressed
- Getting in and out of a car
- Separating your legs
- Stairs
- Single-leg activities
The pain can be significant and should not simply be dismissed as something you have to tolerate because you’re pregnant.
A physiotherapist can help determine whether your symptoms are consistent with pregnancy-related pelvic girdle pain and provide strategies to make daily activities more manageable.
Can You Exercise During Pregnancy?
For many people, yes.
Current Canadian guidance generally supports physical activity during pregnancy for people without contraindications, with activity individualized according to the person’s health, pregnancy and experience.
Exercise during pregnancy can include activities such as:
- Walking
- Swimming
- Stationary cycling
- Strength training
- Mobility exercises
- Prenatal fitness
- Modified running for experienced runners
Your previous fitness level matters.
Someone who regularly ran before pregnancy may be able to continue running with appropriate modifications.
Someone who was previously sedentary may benefit from a very different starting point.
The goal isn’t to follow someone else’s pregnancy workout routine.
It’s to find an appropriate level of activity for your body and your pregnancy.
Can You Lift Weights While Pregnant?
For many people, resistance training can remain part of a healthy pregnancy.
The appropriate intensity depends on factors such as your previous training experience, pregnancy, symptoms and medical recommendations.
You may need to modify:
- Exercise selection
- Load
- Repetitions
- Position
- Range of motion
- Breathing strategy
- Training volume
If a particular exercise produces pain, pelvic pressure, leakage or other concerning symptoms, it may need to be modified rather than pushed through.
What About Running During Pregnancy?
If you were already a runner before pregnancy, you may be able to continue running depending on your individual circumstances.
However, pregnancy can change your tolerance for impact and your pelvic floor may respond differently as your pregnancy progresses.
Pay attention to symptoms such as:
- Pelvic pain
- Heaviness or pressure
- Urinary leakage
- Significant pain
- New musculoskeletal symptoms
You don’t necessarily have to choose between “run normally” and “stop running.”
There is often a middle ground involving adjustments to:
- Pace
- Distance
- Frequency
- Terrain
- Strength training
- Cross-training
A physiotherapist can help you determine what modifications make sense for you.
When Should You Start Postpartum Physiotherapy?
You don’t necessarily need to wait until you have a problem.
Some people benefit from an assessment during the early postpartum period to establish a baseline and understand how to gradually rebuild strength and activity.
The timing should be individualized based on:
- Type of delivery
- Recovery
- Symptoms
- Medical complications
- Pain
- Pelvic floor function
- Activity goals
If you are experiencing significant symptoms, you don’t need to wait for an arbitrary “six-week mark” before asking questions.
Your medical team can advise you about your individual postpartum recovery, while a physiotherapist can help address musculoskeletal and pelvic floor rehabilitation.
What Changes After Giving Birth?
Pregnancy and delivery can affect:
- Pelvic floor muscles
- Abdominal wall
- Core coordination
- Pelvic joints
- Hip strength
- Breathing mechanics
- Bladder and bowel function
- Sexual function
- Exercise tolerance
Your body also has to adapt to a completely new set of physical demands.
Suddenly you’re:
- Carrying a baby
- Feeding
- Lifting
- Bending
- Sitting for long periods
- Getting up repeatedly at night
- Carrying a car seat
- Pushing a stroller
- Returning to work
- Potentially returning to exercise
Postpartum rehabilitation should prepare you for those real-life demands.
What Is Diastasis Recti?
Diastasis recti refers to increased separation or altered tension through the connective tissue between the abdominal muscles.
It’s common during pregnancy because the abdominal wall adapts as the uterus grows.
You may notice:
- A ridge or doming along the middle of your abdomen
- A feeling of abdominal weakness
- Difficulty generating abdominal tension
- Changes in the appearance of your stomach
Importantly, the presence of abdominal separation doesn’t automatically mean something is “wrong.”
The focus should be on function, symptoms and your ability to generate and control abdominal tension.
Rehabilitation can help you progressively rebuild abdominal and trunk capacity.
Do You Need to “Fix” Diastasis Recti?
Not necessarily.
There is a lot of fear-based information online about abdominal separation.
You may have heard that certain movements will “make your diastasis worse” or that you should never perform a particular exercise.
The reality is more nuanced.
Your abdominal wall is designed to adapt to load.
Rather than being afraid of movement, rehabilitation generally involves progressively exposing your body to appropriate levels of loading.
The important questions are:
- Can you generate abdominal tension?
- Can you control movement?
- Are you experiencing symptoms?
- What activities do you want to return to?
- What level of load can you currently tolerate?
Your physiotherapist can help you progress from your current capacity toward your goals.
What About C-Section Recovery?
A Caesarean section is major abdominal surgery, and recovery should be treated accordingly.
Your postpartum rehabilitation may initially focus on:
- Comfortable movement
- Walking
- Breathing
- Gentle mobility
- Managing daily activities
- Gradual return to strength
As healing progresses, your program can become more demanding.
Eventually, rehabilitation may include:
- Core strengthening
- Lower-body strength
- Lifting
- Running
- Jumping
- Sport-specific training
The timeline should be individualized and coordinated with your medical team’s recommendations.
What About Postpartum Pelvic Floor Problems?
Postpartum pelvic floor symptoms can include:
- Urinary leakage
- Urinary urgency
- Difficulty controlling gas
- Constipation
- Pelvic pressure
- Pelvic heaviness
- Pelvic pain
- Pain with intercourse
- Difficulty contracting or relaxing the pelvic floor
These symptoms deserve attention.
You don’t have to accept:
“You had a baby. That’s just what happens.”
Pelvic floor rehabilitation can assess what is contributing to the problem and develop an individualized treatment plan.
Why Does Sex Hurt After Having a Baby?
Pain with intercourse after childbirth can have several potential contributors.
These can include:
- Healing tissues
- Scar tissue
- Pelvic floor muscle tension
- Pelvic floor weakness or poor coordination
- Vaginal dryness
- Changes associated with breastfeeding
- Fear or anticipation of pain
- Previous pelvic pain
- Changes in sensitivity
Pain should not simply be pushed through.
A pelvic floor physiotherapist can assess the musculoskeletal components of the problem and work with you on an individualized plan.
Your physician, midwife or other healthcare provider may also need to assess medical or hormonal contributors.
When Can I Start Exercising After Giving Birth?
There isn’t one universal date when every person should return to exercise.
Recovery depends on:
- Vaginal vs. Caesarean delivery
- Complications
- Pain
- Pelvic floor symptoms
- Abdominal wall function
- Previous fitness
- Sleep
- Overall health
- Your exercise goals
The postpartum return should generally be gradual and progressive.
Walking and gentle movement may be appropriate relatively early for many people, while higher-impact activities such as running and jumping require greater tissue capacity.
Don’t judge your readiness by how quickly someone else returned to exercise.
When Can I Start Running After Pregnancy?
Running is a high-impact activity.
Before returning, it can be useful to build capacity through:
- Walking
- Strength training
- Single-leg exercises
- Calf strengthening
- Hip strengthening
- Core and pelvic floor coordination
- Gradual impact exposure
You should also pay attention to symptoms such as:
- Urinary leakage
- Pelvic heaviness
- Pelvic pain
- Abdominal pain
- Significant back pain
- New vaginal bleeding
- Feeling of pelvic instability
A postpartum physiotherapist can assess your readiness and create a gradual return-to-running program.
A Simple Postpartum Return-to-Exercise Progression
A general rehabilitation pathway might look something like:
Stage 1: Reconnect
Focus on comfortable breathing, walking, gentle mobility and awareness of the pelvic floor and abdominal wall.
Stage 2: Rebuild
Introduce progressive strengthening for the:
- Pelvic floor
- Abdominals
- Glutes
- Hips
- Legs
- Back
Stage 3: Load
Gradually increase resistance and functional demands.
This could include squats, lunges, carrying, lifting and single-leg exercises.
Stage 4: Impact
Introduce jumping, hopping or running preparation when appropriate.
Stage 5: Return to sport
Progress toward the specific demands of your chosen activity.
This could mean returning to:
- Running
- Soccer
- Hockey
- Tennis
- Pickleball
- Weightlifting
- Group fitness
- Competitive sport
The important part is that progression is based on capacity rather than an arbitrary calendar date.
What Does a Pelvic Floor Physiotherapy Assessment Involve?
Many people are nervous about their first pelvic health appointment.
Your physiotherapist should explain the assessment process and make sure you understand and consent to anything being performed.
Your assessment may include discussion of:
- Pregnancy and delivery history
- Bladder symptoms
- Bowel symptoms
- Sexual function
- Pain
- Exercise
- Work
- Previous injuries
- Your goals
Depending on your symptoms and consent, the physical assessment may look at:
- Breathing
- Abdominal wall
- Hip strength
- Pelvic movement
- Lumbar spine
- Functional movement
- Pelvic floor muscle function
An internal pelvic floor examination may be considered when clinically appropriate, but it should never be something you’re pressured into.
You can ask questions and discuss alternatives with your physiotherapist.
Do You Need an Internal Pelvic Floor Examination?
No—not automatically.
An internal assessment can provide useful information in certain circumstances, but it isn’t required for every patient or every appointment.
A physiotherapist can often learn a great deal from:
- Your symptoms
- Movement assessment
- Breathing
- Abdominal wall assessment
- Hip and spine examination
- Functional testing
If an internal assessment is recommended, your physiotherapist should explain why it may be useful and obtain your informed consent.
You are always allowed to ask questions or decline.
Can Pelvic Floor Physiotherapy Help With Constipation?
It can in some cases.
Constipation isn’t always caused by diet alone.
The pelvic floor muscles need to relax appropriately during bowel movements.
If the pelvic floor is excessively tense or poorly coordinated, it may contribute to difficulty emptying.
Treatment may involve:
- Pelvic floor relaxation
- Breathing
- Toilet positioning
- Coordination
- Behavioural strategies
- Abdominal and hip rehabilitation
Persistent constipation should also be discussed with your physician or other appropriate healthcare provider, particularly when symptoms are new or severe.
Can Pelvic Floor Physiotherapy Help With Prolapse Symptoms?
Pelvic organ prolapse occurs when pelvic organs shift downward and cause symptoms such as:
- Pelvic pressure
- Heaviness
- A bulging sensation
- Difficulty with certain activities
- Urinary or bowel symptoms
Pelvic floor muscle training can be part of conservative management for some women with pelvic organ prolapse.
However, treatment should be individualized.
A pelvic floor physiotherapist can help you understand which activities aggravate your symptoms, how to manage pressure and how to progressively build strength and function.
Can Physiotherapy Help You Prepare for Labour?
Potentially, yes.
Pregnancy physiotherapy can help you understand:
- Pelvic floor contraction
- Pelvic floor relaxation
- Breathing
- Pressure management
- Comfortable positions
- Hip mobility
- Movement strategies
- Postpartum expectations
One important concept is that the pelvic floor needs to be able to contract and relax.
Preparing for childbirth isn’t simply about making the pelvic floor stronger.
Being able to relax and coordinate the pelvic floor is also important.
Your physiotherapist can work alongside the recommendations of your obstetric or midwifery team.
What Should You Do If Pregnancy Exercises Cause Pelvic Pressure or Leakage?
Don’t simply push through it.
Pelvic pressure, heaviness or urinary leakage can be signs that the current exercise is exceeding your body’s present capacity.
That doesn’t necessarily mean you need to stop exercising altogether.
Instead, consider modifying:
- Load
- Repetitions
- Impact
- Breathing
- Exercise selection
- Position
- Training volume
A pelvic floor physiotherapist can help determine what is happening and how to modify your program.
What Exercises Should You Avoid During Pregnancy?
There isn’t a universal list of exercises that every pregnant person must avoid.
Your exercise choices depend on your health, pregnancy, experience and symptoms.
Instead of asking:
“Is squatting bad during pregnancy?”
A better question is:
“Can my body currently tolerate this movement and load?”
An exercise may be completely appropriate for one pregnant person and require modification for another.
If an activity causes significant pain, bleeding, dizziness, fluid leakage, chest pain, unusual shortness of breath or other concerning symptoms, stop and seek appropriate medical advice.
Pregnancy Physiotherapy vs. Pelvic Floor Physiotherapy
These services overlap, but they’re not identical.
Pregnancy physiotherapy can address broader musculoskeletal issues such as:
- Back pain
- Hip pain
- Pelvic girdle pain
- Exercise modification
- Strength
- Mobility
Pelvic floor physiotherapy focuses more specifically on:
- Bladder symptoms
- Bowel function
- Pelvic pain
- Sexual function
- Pelvic organ support
- Pelvic floor strength
- Pelvic floor relaxation
- Coordination
Many patients benefit from addressing both areas.
How Restorative Touch Physiotherapy Can Help During Pregnancy & Postpartum
At Restorative Touch Physiotherapy on Hamilton Mountain, we recognize that no two pregnancies or postpartum recoveries are the same.
Your physiotherapy program may include:
Pregnancy pain management
Helping you remain active while managing back, hip and pelvic pain.
Pelvic floor rehabilitation
Assessing whether your pelvic floor needs strengthening, relaxation, coordination or a combination of approaches.
Exercise modification
Helping you adapt your current workouts instead of automatically telling you to stop.
Postpartum recovery
Gradually rebuilding strength, mobility and confidence after delivery.
Core rehabilitation
Progressively restoring abdominal and trunk strength without unnecessary fear around movement.
Return to running and sport
Building the strength and impact tolerance needed to return to higher-level activities.
Education
Helping you understand what’s happening to your body and what you can realistically expect during recovery.
The goal isn’t to get your body back to exactly how it was before pregnancy.
It’s to help you build a strong, capable body for the next stage of your life.
Frequently Asked Questions About Pregnancy & Postpartum Physiotherapy
Do I need a referral for pelvic floor physiotherapy in Ontario?
Private physiotherapy generally does not require a physician referral in Ontario. However, individual insurance plans may have different reimbursement requirements, so check your benefits before booking.
When should I see a pelvic floor physiotherapist?
You can seek an assessment during pregnancy or postpartum if you’re experiencing symptoms such as leakage, pelvic pain, pressure, pain with intercourse or difficulty returning to exercise. You can also seek guidance proactively.
Is pelvic floor physiotherapy only for women who have had a baby?
No. Pelvic floor physiotherapy can help people with a wide variety of pelvic health concerns regardless of pregnancy or childbirth history.
Is urinary leakage after pregnancy normal?
It is common, but it doesn’t mean you have to accept it as something you simply live with. Pelvic floor rehabilitation can help identify contributing factors and appropriate treatment.
How long does postpartum recovery take?
Recovery varies significantly depending on the individual, delivery, symptoms, medical history and goals. Recovery isn’t a race.
When can I return to running after giving birth?
Return to running should be gradual and based on your symptoms and physical capacity rather than simply reaching a particular number of weeks postpartum.
Can physiotherapy help after a C-section?
Yes. Physiotherapy can help with gradual return to movement, abdominal and trunk rehabilitation, strength and eventually return to exercise, subject to appropriate medical recovery.
Can pelvic floor physiotherapy help painful sex?
It can help address musculoskeletal contributors to painful intercourse, including pelvic floor muscle tension and coordination problems. Other medical or hormonal contributors may also need assessment.
Can pelvic floor muscles be too tight?
Yes. Pelvic floor dysfunction can involve excessive muscle tension rather than weakness. Treatment may therefore focus on relaxation and coordination rather than strengthening alone.
Do I need to do Kegels after having a baby?
Not automatically. Some people benefit from pelvic floor strengthening, while others may need to work on relaxation, coordination or other factors first.
Can I exercise while pregnant?
For many people, yes. Exercise recommendations should be individualized based on your pregnancy, health, previous activity and symptoms.
Can physiotherapy help with pregnancy back pain?
Yes. A physiotherapist can help identify contributing factors and modify exercise, daily activities and movement strategies to reduce symptoms while maintaining appropriate activity.
When Should You Speak With Your Doctor or Midwife?
Physiotherapy is appropriate for many musculoskeletal and pelvic floor concerns, but it isn’t a substitute for obstetric or medical care.
During pregnancy or postpartum, seek medical advice for symptoms such as:
- Vaginal bleeding
- Fluid leakage
- Severe or persistent abdominal pain
- Chest pain
- Significant shortness of breath
- Fainting
- Severe headache
- New neurological symptoms
- Significant swelling or other concerning symptoms
- Any symptom that feels unusual or medically concerning
If you’re unsure whether a symptom is appropriate for physiotherapy, it’s better to ask your medical provider.
Pregnancy & Postpartum Physiotherapy in Hamilton
Your body goes through enormous changes during pregnancy and after giving birth.
Back pain, pelvic pain, urinary leakage, pelvic pressure and difficulty returning to exercise are common—but you don’t have to simply accept them as your new normal.
Whether you’re pregnant and struggling with pain, preparing for birth, recovering from a C-section or vaginal delivery, experiencing pelvic floor symptoms or trying to return to running and exercise, physiotherapy can provide a structured path forward.
At Restorative Touch Physiotherapy on Hamilton Mountain, we provide individualized pregnancy, postpartum and pelvic floor physiotherapy designed around your symptoms, your body and your goals.
You don’t need to wait until something becomes severe.
Book a pregnancy, postpartum or pelvic floor physiotherapy assessment in Hamilton and take the next step toward feeling strong and confident in your body.