What we are talking about
The pelvic floor is a set of muscles closing the pelvis from below. It supports the organs, controls continence and works as a team with the diaphragm and the abdominal wall. When that team loses coordination, the symptoms can be very different from one another.
After a pregnancy, abdominal diastasis — the two rectus muscles left apart — and leaking urine under effort, when coughing or jumping, are common. Many women consider these the inevitable price of having given birth. They are not: they respond to specific work.
There is also a male version, talked about even less: after prostate surgery, or in some forms of chronic pelvic pain. The exercises differ, but the principle is the same.
When it makes sense to get seen
The most common reasons, often told with an embarrassment that is not needed here:
- Leaking urine when you cough, laugh, jump or run
- A belly that stays bloated and «open» down the middle after pregnancy
- A feeling of weight or heaviness low down
- Perineal pain that has not gone since the birth
- You do not know whether you can go back to running or doing sit-ups
- You have been told to do Kegel exercises and do not know whether you are doing them right
What can be done remotely, and what cannot
Being honest about the limits matters particularly here, because part of the assessment is by its nature physical — and because for many people the remote format is also the only one they can face.
What can be done remotely
- Taking the history and understanding when and how the symptoms appear
- Teaching you to recognise and correctly activate the pelvic floor
- Coordinating breathing, abdomen and pelvic floor, which is the heart of the work
- Setting up the diastasis programme and the gradual return to activity
- Telling you which exercises are, in this phase, working against you
What cannot
- Internal assessment, which is physical and has to be done in person
- Biofeedback and electrical stimulation
- Manual therapy on the perineum and on the scar
If the symptoms are significant, or there is pain with intercourse or a prolapse, in-person assessment with a specialist pelvic health physiotherapist remains the reference: we say so and do not pretend to replace it.
Frequently asked questions
Does diastasis close by itself?
Partly, and in the first months, yes: a proportion narrows spontaneously after birth. What matters, though, is not so much the gap in centimetres as how well the abdominal wall holds, and that is what exercise acts on.
Are classic sit-ups harmful?
In the early phase often yes, and they are the thing that most frequently makes the picture worse. They are not banned forever: you get to doing them, but after building coordination and control.
Does it concern men too?
Yes, far more than is said: after prostate surgery and in some forms of chronic pelvic pain. It is rarely discussed, but the pathway exists and it works.
Is leaking after birth normal?
It is common, which is a different thing. It responds well to specific pelvic floor work, and the earlier you act the better: resigning yourself is the worse of the two choices.
