At your six week check, you were probably told you were cleared for exercise.
That appointment typically lasts a few minutes, rarely includes any assessment of your pelvic floor, and almost never involves anybody explaining what cleared for exercise actually means for running.
So a great many women take it as a green light, go out for a run at seven or eight weeks, and discover something.
There is actual guidance on this, published specifically for postnatal return to running, and most women have never heard of it.
What the Guideline Says
In March 2019, a group of physiotherapists published the first guideline offering evidence based recommendations specifically for postnatal women returning to running. It has since been adopted internationally and reinforced in the British Journal of Sports Medicine.
The headline recommendation: wait until at least 12 weeks postpartum before returning to running.
Not six.
The reasoning is that running is a high impact activity, that pelvic floor and abdominal tissue need time to recover from pregnancy and birth, and that returning before adequate healing and rehabilitation increases the likelihood of pelvic floor dysfunction.
And a survey of 881 postpartum women found the average time to return to running was 12 weeks, which aligns with the guidance, though the range in practice varies considerably.
Importantly, 12 weeks is a minimum rather than a target. It is the earliest point at which high impact becomes reasonable to consider, assuming the rest of the rehabilitation has happened. Twelve weeks of doing nothing does not make you ready at twelve weeks.
The Symptoms That Mean Stop and Get Assessed
The guideline sets out symptoms that should prompt contact with a pelvic health physical therapist, either before attempting a return or if they appear afterward.
Leaking urine, or an inability to control bowel movements.
A sensation of vaginal heaviness, dragging or bulging.
Pain, including pelvic pain or pain with intercourse.
Ongoing or increased blood loss beyond eight weeks postnatal that is not related to your cycle.
If any of those are present, that is information rather than something to push through. Specifically, it may indicate that your pelvic floor is not currently tolerating the load being placed on it.
The Finding That Needs Careful Handling
Here is a result from that survey of 881 women worth sitting with.
Leaking urine while running occurred in one third of the cohort, and it did not stop them running.
Two things follow from that, and they pull in different directions.
First, if you are leaking while running, you are in very common company. That is a third of a large sample. It is not a sign that something is uniquely wrong with you.
Second, it being common is not the same as it being fine. The researchers’ own conclusion was that clinicians should screen for these symptoms, and that their presence may indicate the pelvic floor is not tolerating the high impact load.
So the honest reading: a lot of women run with this, and a lot of women could be running without it if it were addressed. Carrying on is understandable. Carrying on without ever having it assessed is a missed opportunity.
The Other Finding
The same research identified something that will resonate with anybody who has felt nervous about running again.
A low fear of movement increased the odds of returning to running, and the researchers noted this mirrors what is seen in return to sport after ACL reconstruction.
Which tells you that confidence is a genuine factor, not a soft one, and that it responds to the same thing confidence always responds to, which is demonstrated capability rather than reassurance.
What the Build Looks Like
The guideline and the pathways built from it set out a graded progression rather than a date.
Weeks zero to two. Pelvic floor exercises, gentle core work, and walking.
Weeks two to four. Progress the pelvic floor and core work, extend the walking.
Weeks four to six. Introduce low impact exercise such as a stationary bike.
Weeks six to twelve. Continue progressing strength and gradually introduce more demanding low impact work, building toward tolerating impact.
Week twelve and beyond. Begin a graded return to running, assuming the criteria below are met.
The point of the structure is that the twelve weeks are spent building, not waiting.
The Tests Worth Passing First
Pathways built on this guideline typically include criteria to meet before starting to run. These vary slightly between versions, and the principle is consistent.
Pelvic floor endurance, such as holding a contraction for eight to twelve seconds, repeated.
Pelvic floor speed, such as ten fast contractions.
And load and impact tolerance, which typically includes things like walking for 30 minutes, single leg balance, single leg squats, jogging on the spot, hopping, bounding and single leg hops.
The rule throughout: these should be achievable without leaking, without a sensation of heaviness or bulging, and without pain.
If any of those symptoms appear during the tests, that is the signal to get assessed rather than to proceed.
And a proper pelvic floor assessment is ideally performed in standing, since that gives a more accurate indication of how the pelvic floor and pelvic organ support behave under the conditions running actually involves.
The Phrase Worth Keeping
There is a line used in this area that captures something important.
Once a woman is postpartum, she is always postpartum.
Which does not mean permanently limited. It means that the changes of pregnancy and birth do not have an expiry date after which they stop being relevant, and that pelvic health is worth attending to at any point afterward.
Practically: if you had a baby four years ago, never did any of this, and you leak when you run, the same approach applies. You have not missed the window.
If You Are Already Past Twelve Weeks and Struggling
Which describes a large number of women reading this.
The guideline still applies in principle, you have simply skipped the build. The answer is not to stop running permanently or to push through indefinitely.
It is to go back and do the part that was missed, which means proper assessment, pelvic floor training delivered correctly, and a graded reintroduction of impact.
And note that the training has to be correct. A meaningful proportion of women cannot produce an effective pelvic floor contraction from written instructions, and some contract in the wrong direction while believing they are doing it right. That is genuinely difficult to self correct, which is why assessment matters more here than in most areas.
One important caveat: not every pelvic floor needs strengthening. Some are overactive and held in tension, which produces its own symptoms and gets worse with more squeezing. That cannot be determined from symptoms alone.
Seek Medical Attention For
Heavy or increasing vaginal bleeding beyond eight weeks postnatal.
Fever, or feeling generally unwell.
Pain that is severe or worsening.
Inability to control your bowels.
Inability to empty your bladder.
Any wound that is not healing.
And please mention your mood to your physician if things have been difficult. Postnatal mood changes are common and treatable, and they are worth raising rather than carrying alone.
Get Assessed Before You Build
Whether you are at eight weeks and planning, or four years out and frustrated, an assessment tells you where you actually are rather than where a calendar says you should be.
Hays County Physical Therapy and Wellness offers a free discovery visit at no cost and no obligation. You will get unhurried time to talk through what is happening, a proper assessment, and a staged plan to get you running without symptoms rather than around them.
Nothing you describe will be the first time we have heard it.