Postpartum Pelvic Pain: How Physical Therapy Helps

Written by Dr. Courtney Buhrow, PT, DPT, pelvic floor specialist at Revive PT & Wellness.

If you're reading this at 2am with a baby on your chest, or scrolling between diaper changes trying to figure out if what you're feeling is normal — we see you, and we want you to know: postpartum pelvic pain is common, but it is not something you're stuck with forever. There is a real difference between "your body is still healing" and "this is just permanent now." What you're feeling has a reason behind it, and there are people trained to actually find that reason. Let's talk about what's actually going on.

You Were Told This Was "Just Normal." It's Not the Whole Story.

Maybe you went to your six-week appointment hopeful for real answers, and instead you heard, "You're cleared for all activity and exercise." Maybe your pain, your heaviness, your tailbone ache, or that catch in your hip got labeled as just normal for having a baby, something to manage with rest or medication, not something worth investigating further.

Here's the thing: when that phrase gets repeated enough, by a provider, by your mom, by a friend who "went through the same thing", it starts to feel like fact. It's not. It's just a phrase that gets said because pelvic pain isn't always fully understood or fully assessed.

So you leave that appointment "cleared," but your body doesn't feel cleared. Maybe you've started avoiding certain movements. Maybe you're scared to run, lift your toddler, or even sneeze too hard, because you don't want to make the pain worse. Maybe you've quietly wondered if a C-section would have spared you from this. It's not the delivery method that determines whether you end up with lasting pelvic pain, it's whether the underlying cause ever actually gets addressed.

It's common to have pain while your body heals and readjusts after pregnancy and birth. It is not something you have to just live with.

What's Actually Happening in Your Pelvic Floor After Birth

Although this is often misunderstood by providers, pain doesn't always mean weakness. In a lot of postpartum bodies, it means the opposite.

After birth, your pelvic floor muscles frequently go into a kind of protective mode. Your body has just been through something intense, so those muscles clench and guard, the same way your shoulders might tense up after a stressful week. That guarding is your body trying to protect itself. When those muscles stay overactive and tight for too long, it can actually create the pain itself.

This tightness can show up as:

• Pelvic pain or a deep, achy pressure

• Lower back pain that doesn't seem to fully resolve

• Tailbone pain, especially with sitting

• Hip pain, or a feeling of instability when walking or standing

  
  

This is a genuinely under-recognized piece of postpartum recovery. Pelvic girdle and low back pain affects roughly a quarter of postpartum women, according to research published on PubMed, and a good portion of that pain traces back to muscles that are tight and overworked, not weak or damaged.

Understanding this matters, because the fix for a tight, guarding muscle is very different from the fix for a weak one. This is exactly why a real assessment, not a quick check, matters so much.

Symptoms That Often Get Brushed Off As "Normal"

If any of these sound familiar, you deserve more than "give it time":

• Pelvic pain or pressure, whether constant or with certain movements

• Pain with sitting, especially around the tailbone

• Lower back pain that hasn't let up since delivery

• Hip pain or a feeling like your pelvis is "off"

• Pain during sex that hasn't improved

• Fear or hesitation around exercise because you're worried about making pain worse

• A general feeling that your body "isn't back" even though you were told you're cleared

  
  

None of these mean something is permanently wrong. They mean your body is asking for a closer look than a standard checkup usually provides.

You Don't Have to Wait Until Your 6-Week Appointment

Here's something a lot of moms don't know: in Iowa is a direct access for physical therapy. That means you don't need to wait for your six-week OB clearance, and you don't need a referral, to call and get on the schedule. If you're struggling in week two, week three, or week five, you can start getting real answers right now, not weeks from now.

You should reach out sooner rather than later if:

• You're avoiding movement or exercise out of fear of pain

• Your pain hasn't improved, or has gotten worse, since delivery

• You were told you're "cleared" but don't feel like it

• You're not sure whether what you're feeling is normal healing or something more

  
  

Waiting doesn't make guarded, overactive muscles resolve on their own. A proper evaluation does.

What Pelvic Floor Therapy Actually Looks Like

A real evaluation goes far beyond a quick internal check. At Revive, we look at the whole picture, because your pelvic floor doesn't work in isolation — it works with your hips, back, core, and breathing pattern as one connected system. That includes:

• A full pelvic floor muscle assessment — checking for tightness and guarding, not just strength

• Hip, pelvis, and back evaluation — since pain in one area often starts somewhere else

• Pressure management assessment — looking at how your breath, core, and pelvic floor coordinate under load

• Movement and behavior modifications — practical changes to reduce pain during daily tasks like lifting your baby, sitting, or walking

• A gradual, guided return to exercise — so you're not stuck choosing between "do nothing" and "push through the pain"

• Manual therapy to help release overactive, guarded muscles instead of just strengthening around them

  
  

This is also exactly what we wish every six-week checkup asked about: how your back, hips, and pelvis actually feel, what movements you're avoiding, what your goals are for returning to exercise/movement, and whether you've already connected with a pelvic floor therapist. If nobody asked you that, we're asking now.

Frequently Asked Questions

Do I need a referral from my OBGYN before starting pelvic floor therapy?

No, Iowa is a direct access state, which means you can call and schedule with a pelvic floor therapist without a physician referral. You don't have to wait for your six-week appointment to get started.

I was told my pain is just normal. Should I still get checked out? Yes. "Normal" and "common" aren't the same thing. A full assessment can tell you what's actually driving your pain, whether that's tightness, weakness, or something else entirely.

Could a C-section have prevented this? Not necessarily. Pelvic pain after birth isn't only about vaginal delivery, pregnancy itself places significant demands on the pelvic floor and surrounding muscles regardless of how you delivered. The real question isn't which delivery you had, it's whether the cause of your pain has been properly evaluated.

I'm scared to exercise because I don't want to make my pain worse. Is that normal? It's an extremely common fear, and an understandable one. The goal of therapy is to help you understand what's actually safe for your body right now, so you can move forward with confidence instead of guessing — or avoiding movement altogether.

Is there a pelvic floor therapist near Des Moines who treats postpartum pain? Yes, our team at Revive works with postpartum moms throughout the Des Moines metro and central Iowa area on exactly this: pelvic, back, hip, and tailbone pain after birth. You can reach out and get on the schedule directly.

This Doesn't Have to Be Your "Forever"

If you've been told this is just what happens after having a baby, we want you to hear something different: it's common, but it's not your forever. Your pain has a reason, and that reason can be found and treated. You don't have to keep bracing yourself for the next sneeze, the next time you pick up your baby, or the next time someone tells you "just wait it out."

When you're ready, our pelvic floor therapy team is here to give you the full assessment your body actually deserves. You can also read more about our postpartum recovery services, learn about pelvic floor tightness and pain, or get to know our approach to care. And if it's the middle of the night and you're just trying to figure out if this is normal, it's okay to reach out in the morning. We'll be here.

Dr. Courtney Buhrow is a Physical Therapist and pelvic floor specialist with Revive PT & Wellness, based in Johnston, a suburb of Des Moines, working with postpartum moms on pelvic pain, back and hip pain, and the return to movement and exercise after birth.

Source cited: Postpartum pelvic girdle pain and low back pain prevalence statistic (approximately 25% of postpartum women) referenced from a study indexed on PubMed (National Library of Medicine).