You Were Cleared at 6 Weeks.

Your 6-week postpartum checkup does not assess your pelvic floor. It checks that your incision or tear site looks healed, asks about your mood and bleeding, and clears you to resume exercise and intimacy. What it does not check is whether your pelvic floor muscles are actually functioning — their strength, coordination, ability to relax, scar tissue mobility, or risk for prolapse. That requires a completely different assessment.

Being "cleared" at 6 weeks means your body has healed enough to resume activity. It does not mean everything is working the way it should. And for a lot of women, this is where the confusion starts. You were told you are good to go, but your body does not feel good to go.

So what does a real pelvic floor assessment actually look at? Here is exactly what I check — and why your OB visit did not cover it.

Strength, Relaxation, and Coordination

This is the foundation. When I assess your pelvic floor, I am checking three things most women have never had evaluated:

• Can you squeeze when you want to squeeze? Voluntary control — can your brain tell your pelvic floor muscles to contract, and do they respond?
• How strong is that squeeze? Research shows muscle strength can decrease by as much as 30% after delivery, with nearly half of women experiencing this reduction months postpartum.
• Can you relax those muscles after you squeeze? This is just as important as strength. A pelvic floor that contracts but cannot fully relax causes its own problems — pelvic floor muscle spasm, urgency, and pain.

Then I check something most women have never considered: can you differentiate between squeezing the front of your pelvic floor versus the back?

Your pelvic floor is not one uniform muscle. The front supports your bladder and urethra. The back supports your rectum. Being able to engage them independently tells me a lot about your neuromuscular coordination. Most women cannot do this at first — and that is completely normal. But it is information your OB never checked and generic Kegel advice completely ignores.

Scar Tissue: More Than "It Looks Fine"

If you had any tearing during delivery or an episiotomy, your OB likely looked at the scar at your 6-week visit and said it looks healed. But looking is different from assessing function.

I check three things about your scar:

• Sensitivity — Is the tissue hypersensitive to touch? This is a common contributor to pain during intimacy that many women assume is just "how it is now."
• Mobility — Is the scar tissue moving freely, or has it adhered to deeper layers? Restricted scar tissue pulls on surrounding structures and can limit how your pelvic floor functions.
• Healing quality — Is the deeper tissue well-healed, or are there areas that need manual therapy?

A visual check at your 6-week appointment cannot assess any of these things. And for women dealing with C-section scar pain, the same principles apply — abdominal scar tissue needs functional assessment, not just a visual "looks good."

Prolapse Screening: What Your OB Probably Didn't Do

When I ask you to bear down, I am measuring how much downward movement is happening. This tells me whether we need to start protective exercises to prevent prolapse from developing.

If you have symptoms — heaviness, pressure, a bulging sensation — I do a full prolapse assessment in two positions: lying down and standing. Why both? Because gravity matters. Some women have minimal findings lying down but significant descent when standing, which is when they actually feel their symptoms. A standard OB exam is done lying down only.

Here is the important context: Stage 1 prolapse is now considered normal anatomical variation — not a diagnosis. And up to 78% of early postpartum prolapse improves on its own. The purpose of screening is not to scare you. It is to know where you stand so we can protect and support your recovery.

The Check Most Women Have Never Heard Of: Levator Ani Avulsion

This is something I always screen for postpartum, and something your OB almost certainly did not check.

A levator ani avulsion is a partial tear of the pelvic floor muscles where they attach to the front of your pubic bone. It happens during birth — the muscles stretch and sometimes partially tear to make space for the baby to come out.

The research on this is significant:

• It occurs in 10-36% of vaginal deliveries (Dietz & Simpson, 2022 review)
• Forceps-assisted delivery increases the risk 6-fold compared to spontaneous birth (2024 meta-analysis, European Journal of Obstetrics & Gynecology)
• Women with levator avulsion are approximately twice as likely to develop Stage II or higher prolapse

Why does this matter for your recovery? Two reasons:

First, prolapse prevention. If I know you have an avulsion, we start protective exercises and preventative strategies immediately — before symptoms ever develop. This is proactive care, not reactive.

Second, muscle compensation. When one side of the pelvic floor has a tear, the other side often works harder to compensate. This creates imbalance — one side overworking, the other underperforming. I need to know this so I can train both sides appropriately and maintain balanced support throughout your pelvic floor.

None of this is something to panic about. It is something to know about. And it is exactly the kind of detail that gets missed when someone tells you to "just do your Kegels and you will be fine."

Pain Assessment: Because Everything Is Connected

The most common places women have pain postpartum are the hips, the low back, and the mid-back. If you are having pain anywhere, I am going to check those areas too — because your pelvic floor does not exist in isolation.

I am looking for:

• Tenderness and trigger points in the muscles around your pelvis and spine
• Asymmetrical movement — one side tighter or weaker than the other
• Overall tightness that may be contributing to or caused by pelvic floor dysfunction

Your hip and back pain may be directly caused by your pelvic floor dysfunction, or your pelvic floor symptoms may be driven by what is happening in your hips. You cannot effectively treat one without understanding the other. This is what whole-person treatment means.

Why This Matters Now — Not Later

The most common pattern I see is this: a woman gets cleared at 6 weeks, tries to resume exercise, notices something does not feel right, assumes it will get better on its own, and comes to see me 6 months or 2 years later after the issue has become a long-term pattern.

The longer dysfunction goes unaddressed, the more your body adapts to it — making it harder to correct later. Your muscles learn compensatory patterns. Your brain builds new movement habits around the dysfunction. What starts as a minor coordination issue at 6 weeks can become a chronic pain pattern by 6 months.

Getting assessed early does not mean something is wrong with you. It means you are being proactive about your recovery instead of waiting for problems to develop.

In Utah, you do not need a referral to see a pelvic floor physical therapist. It is a Direct Access state. You can schedule directly the moment you are cleared at your 6-week visit.

Most clients invest between a few sessions to several months depending on their goals. And at least half of every session is education — because I want you to understand your body well enough that you do not need me forever.

Get Answers About What’s Actually Going On

By Dr. Danaya Kauwe, PT, DPT, PRPC, Cert-DN — Board-Certified Pelvic Rehabilitation Practitioner providing in-home pelvic floor physical therapy throughout Utah Valley.