Pelvic pain after birth: causes, treatments, exercises

Your body is strong and resilient, but it does undergo significant changes during pregnancy and delivery. While some soreness is expected as you recover from childbirth, dealing with pelvic pain that doesn't go away can feel unsettling. It also affects how you move, sit, sleep, and care for your newborn.

Pelvic pain can appear in your lower abdomen, pelvis, or perineum (the area between the vagina and rectum) as you’re healing and moving through your day. “Clinically-speaking, pelvic pain is very common after birth, but it’s not something you have to deal with for the rest of your life," says Karla Arevalo-Alas, PT, DPT, a physical therapist at Hinge Health. "A lot of people tend to think that because they’re caring for a newborn, they have to just deal with pain or other issues like leakage, but that’s not the case."

Whether you had a vaginal delivery or a C-section, your pelvic floor muscles need time and support to heal. Doing pelvic floor physical therapy and targeted exercises can help ease pain and strengthen your pelvic floor muscles.

Read on to learn more about what causes pelvic pain after birth, plus how to ease discomfort — especially with exercises recommended by Hinge Health pelvic health physical therapists.

Causes of pelvic pain after birth

Pelvic pain after birth can stem from a variety of factors, ranging from muscle tension and healing tissues to hormonal shifts. Some of the most common causes of pelvic pain postpartum include:

• Pelvic floor muscle tension. Just like you might clench your jaw when you are stressed, you can unknowingly clench your pelvic floor muscles. After birth, your body is working hard to heal. Sometimes, the muscles react to this process by "guarding" or tensing up to protect the area. "Birth is a major physical event, whether vaginal or C-section," says Dr. Arevalo-Alas. "This can cause the muscles to react by guarding or tensing up." Tight, overactive muscles (also known as a hypertonic pelvic floor) can lead to aching or sharp pain in the pelvis.

• Healing tissues. If you experienced perineal tears or had an episiotomy (surgical incision of the perineum) during a vaginal birth, the healing tissue can be sensitive. Similarly, C-section scars can contribute to pain in the pelvic area. "C-section scars can sometimes feel tight or sensitive as they heal," explains Dr. Arevalo-Alas. "This can affect how muscles in the area move and stretch."

• Hormonal changes. If you are breastfeeding or chestfeeding, low estrogen levels can affect your pelvic tissues. "Hormones and lactation are significant causes of discomfort, especially during intercourse," says Dr. Arevalo-Alas. "Shifts in hormones can decrease self-lubrication, leading to dryness and pain."

• Pelvic organ prolapse. This occurs when the pelvic organs (like the bladder or uterus) shift and push against the vaginal walls due to changes in support. "Prolapse can cause pressure and discomfort due to changes in support in the pelvic region," says Dr. Arevalo-Alas. It often feels like heaviness or a bulging sensation.

• Birth-related strain. The physical demands of delivery can sometimes strain the pelvic joints or cause bruising to the tailbone or pubic bone. "Pressure or strain from delivery, including the use of vacuums or forceps, can contribute to pain," notes Dr. Arevalo-Alas.

Symptoms of pelvic pain after birth

Symptoms of pelvic pain after birth can vary widely, including localized soreness, radiating aches, or specific pain during activities like sex or exercise. Common signs include:

• Perineal or deep pelvic pain. You may feel soreness in the perineum or a deep ache inside the pelvis. "This can manifest as discomfort in the perineum or even shooting pain toward the hips or abdomen due to tense pelvic floor muscles," says Dr. Arevalo-Alas.

• Radiating pain in hips or legs. The pelvic floor is connected to many other muscle groups. "Hip pain can be a symptom, often linked to hip muscles that connect to the pelvic floor," says Dr. Arevalo-Alas. Pain may also travel down the inner thighs or into the groin.

• Pain during intercourse. Many people experience pain when resuming sex. "Intercourse is often affected by tense muscles," says Dr. Arevalo-Alas. "Hormonal shifts can also cause dryness that contributes to pain.”

• Lower back pain. The pelvic floor works in tandem with your core and back. "There is a strong correlation between lower back pain and pelvic floor dysfunction because the pelvic floor is part of the core," notes Dr. Arevalo-Alas.

How movement can help ease pelvic pain 

You might feel hesitant to move or exercise when you have pelvic pain after birth, but gentle activity is often one of the best ways to find relief. Movement helps increase blood flow to healing tissues and encourages tight muscles to relax.

When it comes to introducing movement with pelvic pain, more intensity isn't always better. "If there’s pelvic pain and your muscles are already tight, you don't want to add more tension," says Dr. Arevalo-Alas. "You want to first focus on relaxation and getting back your full range of motion. Then, you can add strengthening if needed." The key is to ease into movement and find your movement sweet spot. This is the level of activity — whether it’s a short walk, gentle stretching, or deep breathing — that challenges you enough to support your recovery without causing more pain.

Practicing these exercises regularly can play a key role in relaxing tight muscles, improving circulation, and reconnecting with your core and pelvic floor after birth. Dynamic stretches like cat cow help gently mobilize the spine and pelvis, while happy baby pose encourages relaxation in the hips and pelvic floor. Diaphragmatic breathing and reverse Kegels are essential for calming your nervous system, allowing your muscles to rest and recover rather than constantly guarding.

Together, these exercises build a foundation of mobility and relaxation, helping you feel more comfortable and capable in your daily life. "Just getting in tune with your pelvic floor muscles is a great way to start," says Dr. Arevalo-Alas. "Even if it just means checking in with your body, doing those breaths, and seeing how you feel in that area."

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for pelvic pain after birth

Managing pelvic pain often involves a combination of strategies to relax tight muscles, improve mobility, and support healing tissues. Consider these treatments recommended by Hinge Health physical therapists for pelvic pain after birth:

• Try physical therapy and targeted exercises. Targeted exercises can help ease tension in your pelvic floor and lower abdomen. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Targeted pelvic floor exercises are designed to help with recovery, but any type of movement — like walking, stretching, or even household chores — can improve blood flow and reduce stiffness. "It’s so important to listen to your body," says Dr. Arevalo-Alas. "Tuning in and finding what types of movements and what level of activity feels good is a huge part of recovery."

• Relaxation techniques. If your pelvic pain is from tension, relaxation is key. "If muscles are already tense, you don't want to just strengthen them immediately," says Dr. Arevalo-Alas. "You want to first work on relaxing those muscles and restoring full range of motion." Strategies like a body scan — where you mentally check in with your body from head to toe to notice and release areas of tightness — can help you identify and release tension.

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) are generally considered safe to use for postpartum pain relief — including while breastfeeding — but always check with your provider.

• Apply ice or heat. "Ice can help ease swelling immediately postpartum and may even help numb pain," says Dr. Arevalo-Alas. Heat therapy is ideal if you have muscle tension in your glutes (butt muscles) or hip area as it boosts blood flow to the area. Try either option or stick to the method that brings you the most relief. 

• Consider complementary treatments. Talk to your provider if you're interested in trying alternative treatments for pelvic pain relief, such as massage or acupuncture. "Soft tissue mobility, like a massage or using a foam roller on the glutes, can be helpful for releasing tension in surrounding areas," adds Dr. Arevalo-Alas.

• Ask your doctor about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain in the areas surrounding your pelvis. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

Physical therapy for pelvic pain after birth

Physical therapy is a key treatment for pelvic pain after birth, focusing on movement, exercise therapy, and stretches to improve strength and flexibility. The goal is to restore function and reduce pain so you can get back to your daily activities. Targeted exercises and stretches can help relax tight muscles and coordinate your core and pelvic floor.

A physical therapist (PT) can assess your symptoms and movement to design a customized program to meet your specific recovery needs. They can also provide tips to modify everyday activities to make them more comfortable and recommend strategies to manage pressure and load during childcare tasks. Recommendations may include scar mobilization techniques, breathing exercises, or posture adjustments. You can see a physical therapist in person or through Hinge Health to access a PT via telehealth/video visit. 

When to see a doctor

Pelvic pain often improves on its own with simple treatments. But if your pelvic pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It's also a good idea to get care if you have:

• Foul-smelling vaginal discharge

• Heavy bleeding or passing large clots

• Fever or chills (signs of infection)

• Severe pain that does not improve with rest or medication

• Difficulty urinating or passing bowel movements

• Loss of bladder or bowel control

PT tip: it’s never too late to go to physical therapy

If you are experiencing pain months or even years after giving birth, know that you haven't missed your window for recovery. "It is never too late to seek treatment," says Dr. Arevalo-Alas. "Some people think, 'I had kids 20 years ago, so this is just how it is,' but you can still get pelvic PT and see improvement. Pain is not a required part of parenthood."

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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