Direct answer
Gentle pelvic-floor awareness may be possible after an episiotomy or first- or second-degree perineal tear when your maternity team permits it and a small contraction does not increase wound pain, pulling, swelling, bleeding, or pressure. There is no universal start day or dose. The injury depth, repair, infection risk, sensation, bladder and bowel function, and individual healing determine progression.
Third- and fourth-degree tears involve the anal sphincter and require a specific obstetric anal sphincter injury plan. Worsening pain, malodorous discharge, fever, increasing swelling, wound opening, bowel or gas leakage, or difficulty emptying needs prompt clinical review—not more Kegels.
Understand the injury category
An episiotomy is a surgical cut in the perineum. Perineal tears are classified by which tissues are involved. First- and second-degree tears involve skin and perineal muscles to different depths. Third- and fourth-degree tears extend into the anal sphincter complex and, at the deepest level, the rectal lining.
The label alone does not predict pain, sensation, scar response, or recovery time. An apparently smaller tear can still be painful or infected; a repaired injury may heal well but need graduated rehabilitation. Use the discharge information and follow-up plan from the team that knows the repair.
Healing comes before loading
In the early days, priorities include pain control, hygiene, bowel comfort, bladder function, rest, and monitoring the wound. NICE postnatal guidance says worsening perineal pain, malodorous discharge, swelling, wound breakdown, or healing concerns need assessment.
Gentle movement is different from loading a healing wound. RCOG patient guidance and UCLH guidance describe early pelvic-floor exercise as possible in many recoveries, including with stitches, when comfortable. These general statements do not override a restriction or complication.
A first movement check
When allowed, choose a supported position. Breathe normally and make a very gentle closure around the pelvic openings with a small inward lift. Release fully. The movement may be faint because swelling, pain, or altered sensation changes feedback.
Stop if there is sharpness, pulling at the repair, increased throbbing, downward pressure, heavier bleeding, or difficulty releasing. Do not force a stronger contraction to “improve circulation” or prove that the muscles work. One pain-free observation may be enough initially.
Do not practise by stopping urine flow. It does not assess wound healing or muscle coordination and may interfere with emptying.
Pain and guarding change the goal
A painful area may trigger protective pelvic-floor activity. Someone can feel tight, weak, numb, or all three at different times. Adding repetitions when the muscles do not release may increase discomfort. Pain during a contraction is not expected training soreness.
Comfortable breathing and release awareness may be more suitable before strengthening, but relaxation is not forceful bearing down. Persistent pain can also involve infection, wound separation, scar sensitivity, tissue or nerve injury, and other causes that require examination.
Bladder and bowel considerations
Swelling, pain, catheter use, medicines, and fear can alter urination. Report inability to urinate, weak flow, severe discomfort, burning, fever, or incomplete emptying. Sudden retention is urgent.
Keeping stool soft and avoiding repeated straining can protect comfort, but bowel advice should come from the maternity team. New wind or stool leakage, severe urgency, or difficulty controlling the bowel requires prompt review, particularly if the tear depth is uncertain or involved the sphincter.
Progression after early healing
Progress only when wound symptoms are stable, bleeding is not increasing, bladder and bowel function are manageable, and contraction and release remain comfortable. Change one variable at a time. A pelvic-health physiotherapist can assess direction, scar response, strength, endurance, and relaxation and coordinate with obstetric care.
The routine postnatal appointment is one review point, not a deadline. Seek earlier care for symptoms, and do not assume that being several weeks postpartum guarantees readiness for heavy lifting, running, or impact.
Prevention and treatment remain separate. General exercises do not guarantee prevention of leakage or prolapse. Existing urinary, bowel, pain, or support symptoms need their own assessment and outcome review.
How tear depth changes follow-up
First- and second-degree injuries may be managed within routine maternity care when healing is reassuring, while third- and fourth-degree tears need specific OASI follow-up. The grade does not eliminate the need to listen to symptoms. A smaller recorded tear with worsening pain or discharge still needs review, and an apparently well-healed deeper repair still needs bowel-function questions.
Ask what tissues were involved, what restrictions apply, how bowel care should be managed, and which service to contact if symptoms appear. Do not infer the answer from the number of stitches.
Scar sensitivity is not a strength deficit
As a wound heals, a scar may feel numb, tender, pulling, or unfamiliar. That sensation can change contraction and release and may lead to guarding. A pelvic-health physiotherapist can assess scar mobility and sensitivity after appropriate healing, but a scar should not be stretched through pain.
Treatment may involve education, graded touch or movement when chosen, tissue care, and coordination. More forceful contractions are not a scar-remodelling shortcut. Persistent focal pain, bleeding, or tissue change should be medically assessed.
Daily pressure and bowel care
Coughing, constipation, getting up, and carrying can load the perineum. Use comfortable movement strategies and the bowel plan from the maternity team. Repeated straining can increase pain and pressure, while fear of opening the bowels can lead to withholding and harder stool.
Report severe constipation, inability to pass stool or gas, significant rectal pain, or bowel leakage. Pelvic-floor rehabilitation may be relevant, but only after the injury and stool factors are understood.
Reviewing progress
Useful outcomes include less wound pain, easier bladder and bowel function, a clearer contraction and release, and better tolerance of ordinary tasks. Counted repetitions are secondary. If symptoms remain unchanged or worsen, review the wound, scar, muscle pattern, and plan rather than adding load.
Return to running or impact requires a separate readiness decision. A healed skin surface and a pain-free contraction do not establish capacity for repeated impact.
Sexual activity and internal assessment
There is no obligation to resume penetration by a particular date. Readiness depends on healing, comfort, desire, consent, tissue condition, and clinical advice. Pain should not be pushed through as scar stretching.
An internal vaginal examination may sometimes help assess muscle function or scar sensitivity, but it is not automatic. It requires informed consent, and you may ask for an explanation, modifications, a pause, or no examination.
When to seek care
Contact maternity services promptly for worsening perineal pain, malodorous discharge, fever, increasing swelling, wound opening, heavy or increasing bleeding, urinary retention, or feeling acutely unwell. Seek specific follow-up for bowel or gas leakage, severe bowel urgency, persistent wound pain, sexual pain, a new bulge, or symptoms worsening with exercise.
PelvicEx cannot assess a perineal repair. It cannot identify tear depth, infection, wound separation, scar or nerve injury, anal-sphincter function, or readiness for loading. Follow the maternity and specialist plan, and stop any exercise that worsens symptoms.
Preparing for the postnatal review
Bring the tear or episiotomy information if available and describe pain, wound change, bladder and bowel function, bleeding, sensation, sexual concerns, and activity response. Ask whether healing is reassuring, whether the tear involved the anal sphincter, and whether pelvic-health or specialist follow-up is indicated.
If an exercise plan is recommended, ask which movement was observed, how the starting dose was chosen, and what symptoms should stop it. Clarify when scar work, internal examination, heavier lifting, and impact may be considered. These decisions may have different dates.
When access or language is a barrier
Ask for an interpreter or translated discharge information where available. A person should not have to consent to an examination or rehabilitation plan they do not understand. If specialist access is delayed, continue wound and bowel instructions from maternity care, avoid aggravating load, and seek prompt review for red flags rather than improvising internal techniques.
Psychological safety matters
A tear or episiotomy can be associated with fear, grief, or a traumatic birth experience. Explain examinations and exercises before they occur, ask permission, and preserve the person’s control. Psychological support may be valuable when wanted, but it does not replace examination of persistent wound, bowel, bladder, or pain symptoms.
Healing advice should be accessible and specific enough to follow at home. Ask for written information about wound care, bowel care, pain relief, activity, warning signs, and contacts. A pelvic-floor exercise handout should not be the only discharge information after a repaired injury.
Sources
- National Institute for Health and Care Excellence. Postnatal care. NG194, updated 2026. Recommendations.
- Royal College of Obstetricians and Gynaecologists. “Your pelvic floor.” Patient guidance.
- University College London Hospitals NHS Foundation Trust. “Advice and exercise following childbirth.” Patient guidance.
- Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-Based Physical Therapy for the Pelvic Floor. 3rd edition. Elsevier; 2023. Chapter 7. Official publisher record.
- Santoro GA, Wieczorek AP, Sultan AH, editors. Pelvic Floor Disorders: A Multidisciplinary Textbook. 2nd edition. Springer; 2021. Official publisher record.