Ask a group of mothers about leaking when they sneeze and most will nod. Ask about a scar that feels numb, or a dragging heaviness by the end of the day, and you’ll get the same recognition.
From there it’s a very short step to a conclusion that costs women years: everyone has this, so it must be normal, so there’s nothing to be done.
Common and normal are not the same thing. Plenty of postnatal symptoms are widely shared and highly treatable, and the reason they persist is usually that nobody sorted them into the right category.
So here’s the sort. Three groups: what’s expected and settles, what’s common but treatable, and what needs medical attention now.
Group One: Expected, and Settles
These are part of ordinary recovery. They warrant patience rather than intervention.
Afterpains — cramping as the uterus contracts back down, often stronger during feeding and with subsequent babies. Typically settles within days.
Bleeding that gradually reduces over several weeks, changing from red to pink to brown and tapering off.
Perineal soreness after a vaginal birth, easing steadily over the first weeks.
Tenderness around a caesarean wound, improving week by week.
Fatigue that tracks your sleep. Real, significant, and largely explained by broken nights rather than by anything wrong.
Feeling wobbly and unfamiliar in your body. Ligaments, posture, weight distribution and abdominal tone have all changed. Adjustment takes time.
A softer, less responsive abdomen. After a caesarean in particular, the abdominal wall needs considerably longer than people expect — research indicates it has regained roughly half its tensile strength at six weeks, and somewhere between three-quarters and most of it only by around six to seven months.
That figure alone should reframe the six-week check. At six weeks, an abdominal wall cut through during surgery is around halfway back.
Group Two: Common, But Not Something to Accept
This is the important group, and the one most often waved through.
Leaking urine when you cough, sneeze, laugh, lift or run. Extremely common. Not normal, and not something you have to plan your life around. Pelvic floor muscle training is well supported as a treatment, and it works considerably better when it’s assessed and tailored rather than guessed at.
There’s an important nuance here. Not every pelvic floor needs strengthening. Some are overactive and need to learn to release — and for those women, more squeezing makes things worse. A “just do your Kegels” approach misses this entirely, which is one reason so many women report that pelvic floor exercises didn’t help.
A dragging, heavy or bulging sensation, particularly worse by the end of the day or after lifting. This can indicate pelvic organ prolapse. It’s common, particularly after vaginal birth, and it’s treatable — with pelvic floor rehabilitation, load management, and sometimes a pessary. It is not something to endure quietly.
Bowel urgency, difficulty controlling wind, or difficulty emptying. Rarely raised because it’s embarrassing. Very much treatable.
Pain with sex. Common in the months after birth and frequently persistent if unaddressed. Scar tissue, pelvic floor overactivity, and hormonal changes affecting tissue quality all contribute, and all can be worked with.
A scar that is numb, tight, tethered or hypersensitive. After a caesarean, altered sensation around the scar is very common and often permanent to some degree, because small nerves are unavoidably affected. What isn’t inevitable is a scar that’s stuck.
Scar tissue can adhere to the layers beneath it, restricting how tissues glide against one another. That can show up as pulling when you stretch or reach, a shelf or overhang above the scar line, low back or hip discomfort, difficulty engaging the abdominal muscles, or a sense that the area doesn’t quite belong to you. Scar mobilisation, once healing is complete and you’ve been cleared, is straightforward and frequently underused.
Doming or coning along the midline of your abdomen when you sit up, lift, or strain. This relates to how the abdominal wall manages pressure. Current thinking has moved away from measuring the width of the gap as the thing that matters, and towards how well the tissue generates tension and manages load. Either way, it’s a signal to change what you’re doing rather than push through.
Persistent back, pelvic or hip pain beyond the early weeks.
Low mood, anxiety, intrusive thoughts, or not feeling like yourself. Common and treatable. Please tell your GP or health visitor. This belongs in this group, not in the “expected” one.
The unifying point: everything above is frequent, and everything above responds to appropriate treatment. Frequency is not a reason to accept it.
Group Three: Get Medical Help Now
Call 999 or go to A&E for chest pain, breathlessness, coughing blood, a seizure, or sudden severe symptoms.
Contact your GP, midwife or maternity unit urgently for:
Heavy bleeding — soaking a pad in an hour or less, or passing large clots. Foul-smelling discharge. Fever, shivering, or feeling generally unwell.
A severe headache, visual disturbance, sudden swelling of the face or hands, or pain under the ribs — pre-eclampsia can present after birth as well as before.
Calf pain, swelling, warmth or redness in one leg.
A caesarean wound that is increasingly painful, red, hot, leaking fluid, or opening.
Severe pain that isn’t controlled by simple pain relief.
Inability to pass urine, or a complete loss of bladder or bowel control.
And, importantly: thoughts of harming yourself or your baby, or feeling unable to cope. These need same-day support, and there is help available. Contact your GP, midwife, health visitor, or NHS 111. This is not a failure and it is not rare.
Why the Six-Week Check Isn’t the Full Picture
The standard postnatal check is a valuable appointment covering a lot of ground in a short time. What it typically isn’t is a musculoskeletal assessment.
It rarely includes an examination of pelvic floor function, an assessment of the abdominal wall under load, or an evaluation of your scar’s mobility. Not because those don’t matter, but because the appointment isn’t designed for them and there isn’t time.
Which means being told “everything looks fine at six weeks” is entirely compatible with having a treatable pelvic floor or scar issue nobody has looked for. The two statements aren’t in conflict.
Guidance in this area increasingly holds that every mother should have the option of a pelvic health assessment. Access varies considerably in practice — but knowing you can ask for one, or seek one, is the first step.
It Is Not Too Late
One more thing worth saying clearly, because it stops a lot of women from seeking help.
There’s no window that closes. Pelvic floor function, scar mobility and abdominal strength respond to appropriate treatment whether you gave birth six months ago or fifteen years ago. Women regularly arrive having lived with leaking or heaviness for a decade, assuming the moment had passed.
It hasn’t. It’s simply that nobody told them there was anything to be done.
Get Things Properly Assessed
If something on the second list sounds familiar, it’s worth having someone actually look at it rather than continuing to work around it.
Chadwick’s Physiotherapy offers a free discovery visit at no cost and no obligation. You’ll have time to talk through what’s actually going on, an assessment of how your pelvic floor, abdominal wall and scar are functioning, and a clear plan — however long it’s been since you gave birth.
If anything you describe needs medical review, we’ll tell you plainly and help you get there.