Postpartum Hormone Changes and How They Affect Your Pelvic Floor

After giving birth, your body doesn’t just “bounce back.” It rebuilds hormonally, neurologically, and physically.

Postpartum recovery is often framed as muscle healing or core strength, but hormones play a major role in how your pelvic floor feels and functions after pregnancy. Understanding these changes can help you recognize what’s normal, what deserves support, and how pelvic floor therapy can guide recovery safely.

Whether you’re weeks postpartum or years out and still noticing symptoms, hormone-related pelvic floor changes can persist longer than most women are told.

What Happens to Hormones After Birth?

Immediately after delivery, levels of estrogen and progesterone drop sharply. This hormonal shift is one of the fastest changes the body ever experiences.

Medical research shows that postpartum hormone fluctuations influence:

• tissue healing

• muscle tone

• joint stability

• nervous system sensitivity

• vaginal and pelvic tissue hydration

• bladder and bowel function
  

If you are breastfeeding, estrogen levels may remain lower for longer, which can extend some of these effects.

This is not a failure to recover it’s physiology.

How Postpartum Hormones Affect the Pelvic Floor

1. Vaginal Dryness and Tissue Sensitivity

Lower estrogen levels can cause vaginal redness, dryness, thinning of tissues, and increased sensitivity. Some women experience discomfort with sex, tampon use, or internal exams. This can often be confused for inflammation due to the redness and pain. 

From a pelvic floor perspective, sensitive tissues often trigger muscle guarding. When muscles stay protective for too long, they can become tight and painful.

Pelvic floor therapy helps restore circulation, relaxation, and tissue tolerance gradually and safely. Your pelvic floor therapist can also guide you on topical estrogen use and holistic products to improve vulvar healing. 

2. Urinary Leakage and Bladder Changes

Postpartum women frequently report:

• leaking with coughing or exercise

• urgency

• incomplete emptying

• increased frequency

Hormones influence connective tissue elasticity and muscle coordination. Combined with pregnancy strain and delivery, this can temporarily disrupt bladder support.

Pelvic floor therapy focuses on coordination, not just strengthening, to retrain how the bladder and pelvic muscles work together. Pelvic floor therapists can also recommend internal support devices to provide a little extra lift while your tissues are still healing. 

3. Pelvic Heaviness or Pressure

Some women feel a sensation of heaviness, bulging, or pressure postpartum. Hormonal changes affect collagen and tissue integrity, which influences pelvic support.

This does not always mean prolapse, but it is a sign your body may need guided recovery. Especially if that heaviness worsens at the end of the day or the day after higher activity levels.

A pelvic floor therapist assesses muscle function, pressure management, breathing patterns, and movement strategies to protect healing tissues.

4. Pain With Intercourse

Painful sex after childbirth is common but often under-discussed. Hormonal dryness, scar tissue, and muscle tension can all contribute.

Pelvic floor therapy addresses:

• tissue mobility

• scar sensitivity

• nervous system responses

• muscle relaxation

• graded return to intimacy

Recovery should never feel rushed or forced. You should feel connected with your partner and ready for intimacy if that is what you are wanting. Low libido, difficulty reaching climax, and pain are all reasons to seek help. 

5. Core Weakness and Instability

Hormones like relaxin remain elevated postpartum, influencing joint stability and connective tissue behavior. This can make the core and pelvic floor feel less supported.

Generic “bounce back” workouts may overload healing tissues. You may feel disconnected from your core and your pelvic floor. It can be helpful to have a pelvic floor therapist check for muscle activation and cue proper pelvic floor and core coordination. 

Individualized therapy focuses on restoring safe load transfer, breathing coordination, and progressive strength tailored to your body’s stage of healing.

Things like abdominal separation, SI joint pain, and low back pain are common postpartum due to connective tissue instability. This can be treated with graded exercise and intentional movement. 

Common Myths About Postpartum Recovery

Myth: “You just need to do more Kegels.”

Not all postpartum pelvic floors are weak — many are tight, guarded, or poorly coordinated. Strength without relaxation can worsen symptoms. Even if kegels are what you need you may not be properly engaging your pelvic floor muscles. 

Myth: “If you’re leaking, it’s permanent.”

Research supports pelvic floor rehabilitation as a first-line treatment for postpartum urinary symptoms.

Myth: “Pain with sex is normal after babies.”

Common does not mean untreatable. Pain deserves evaluation and support.

Myth: “Online workouts are enough.”

Recovery is individual. What works for one body may overload another. Customized care leads to safer outcomes than generic internet advice.

How Pelvic Floor Therapy Supports Hormonal Recovery

Pelvic floor therapy does not change hormones — but it treats how your body adapts to them.

Treatment may include:

• manual therapy for tissue mobility

• Nutrition support

• scar care

• breathing and pressure retraining

• nervous system regulation

• progressive strength work

• bladder and bowel retraining

• education about postpartum physiology
  

Both in-person care and telehealth pelvic floor therapy programs can guide recovery at a pace that respects healing tissues.

FAQ

How long do postpartum hormones affect recovery?

Hormonal shifts occur immediately after birth and can influence tissues for up to 2 years, especially during breastfeeding.

Is leaking urine normal after birth?

Common, yes. Permanent, no. Therapy is strongly supported by research as an effective treatment.

Can therapy help years after childbirth?

Yes. Hormonal and muscular adaptations can persist, but improvement is possible at any stage.

When should I start pelvic floor therapy postpartum?

Many women benefit from evaluation within the first few months, but care is helpful at any time.

You Don’t Have to Navigate Postpartum Recovery Alone

If postpartum symptoms are affecting your confidence, comfort, or daily life, support exists. Pelvic floor therapy focuses on restoring function with evidence-based, personalized care.

A discovery call is a low-pressure way to ask questions and learn your options.

Book a free discovery call to learn whether pelvic floor therapy is right for you.

Healing isn’t about bouncing back, it’s about rebuilding with support.