I am a pelvic floor physical therapist in Atlanta. I run postpartum workshops for Black mothers, and the most common thing I hear at week one is some version of "nobody told me this was a thing." The evidence on pelvic floor muscle training has been settled for years. The gap is in what new mothers are told about it, who gets referred for it, and what their insurance will cover.
A Cochrane review of 1,817 women found PFMT cured stress incontinence eight times more often than no treatment
The anchor study is a 2018 Cochrane meta-analysis by Chantale Dumoulin and colleagues that pooled 31 randomized trials of 1,817 women across 14 countries. Women assigned to supervised pelvic floor muscle training (PFMT) reported cure of stress urinary incontinence at 56 percent versus 6 percent in control groups, a risk ratio of 8.38 (PMID 30288727). Cure-or-improvement ran 74 percent versus 11 percent. The reviewers concluded that PFMT can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence, and should sit in first-line care.
The word "supervised" is doing work in that sentence. PFMT is not a folded-up page of printed exercises handed over at discharge. It is a clinical course of care with a trained physical therapist who confirms that you are contracting the right muscles, teaches a graded program, and tracks results. Self-directed Kegels are what most women in the US actually get, and the effect size drops when the training is unsupervised.
Roughly a quarter to a third of women leak urine in the first year postpartum
Postpartum urinary incontinence is not an edge case. A 2023 systematic review and meta-analysis of 28,303 postpartum women reported an incidence of 26 percent (95 percent CI 21 to 30 percent), per Dai et al. in BMC Pregnancy and Childbirth. A separate 2021 meta-analysis of 35,064 women put the weighted prevalence between six weeks and one year postpartum at 31 percent, with stress-type incontinence accounting for 54 percent of cases, per Moossdorff-Steinhauser et al. in the International Urogynecology Journal. Leakage at one year was roughly equal to leakage in the third trimester. It does not quietly resolve on its own for most women.
What shows up in clinic alongside leakage: pelvic organ prolapse (a feeling of pressure or heaviness, sometimes a visible bulge), diastasis recti (the gap between the rectus abdominis muscles that widens in pregnancy and does not always close), and pain with intercourse. These conditions overlap, they respond to the same category of therapy, and they are treatable outside of surgery in most first-line cases.
US postpartum care is built around a single visit. France funds ten PT sessions.
Since 2018, the American College of Obstetricians and Gynecologists has recommended that postpartum care shift from a single six-week visit to an ongoing process, with initial contact in the first three weeks and a comprehensive visit no later than twelve weeks, per ACOG Committee Opinion 736. In practice, the single six-week visit still defines most US postpartum care, and pelvic floor screening is not a universal part of it. Insurance coverage for pelvic floor PT exists but usually requires a specific diagnostic code and a referral the patient has to ask for.
France treats the same problem differently. Under the French public insurance system (Assurance Maladie), a postpartum prescription for rééducation périnéale covers ten sessions of pelvic floor rehabilitation with a trained physiotherapist or midwife, at 100 percent of the base rate, if performed within six months of delivery. A patient does not have to know to ask. The referral is routine.
Black women are less likely to know postpartum leakage is treatable
A 2015 study of 416 community-dwelling women in New Haven County found that African American women were significantly less likely than white women to identify childbirth as a risk factor for urinary incontinence and pelvic organ prolapse, and less likely to know that exercises can reduce leakage, per Mandimika et al. in Female Pelvic Medicine and Reconstructive Surgery. The authors framed knowledge, not biology, as the modifiable barrier to seeking care.
A 2022 review in Urology looking across stress incontinence, overactive bladder, prolapse, and interstitial cystitis found inconsistent disparities in reported prevalence and severity, but flagged a clear research-representation gap: in the overactive bladder literature the review examined, African American patients made up 10 percent of study subjects and Hispanic patients 8 percent, below their share of the US population, per Gonzalez et al.. Treatment-outcome data specific to Black women on pelvic floor PT is limited, and I say that as a clinician who looks for it. What we have is evidence that PFMT works in the populations studied, and evidence that Black women are referred to it less often and informed about it less often.
How to find a board-certified pelvic floor PT and what to ask your OB for
Look for a physical therapist with the PWCS credential (Pelvic and Women's Health Clinical Specialist, renamed from WCS in September 2025). The American Board of Physical Therapy Specialties grants it after an exam and a documented caseload in pelvic and women's health. There are two public directories. The APTA's specialist directory lets you search certified specialists by name and state (specialization.apta.org/find-a-specialist). The APTA Academy of Pelvic Health maintains a separate PT Locator for clinicians who focus on pelvic care, including PTs who are not board-certified but practice in this area (aptapelvichealth.org/ptlocator).
The request to your OB or midwife is specific. Ask: "I would like a referral to pelvic floor physical therapy for postpartum evaluation." If you have leaking, pressure, pain, or an abdominal gap that has not closed by about eight weeks, say so by name. A referral with a diagnostic code (the common ones are stress urinary incontinence, mixed urinary incontinence, pelvic organ prolapse, or diastasis recti) is what most US insurance plans need to authorize the visits. If your provider brushes off the symptom as normal after birth, a second-opinion visit with a women's health nurse practitioner or a urogynecologist is reasonable. Postpartum leakage at six months out is not something you are expected to live with.
The Cochrane evidence is almost a decade old. The prevalence numbers are not new. What is new is a generation of Black mothers who are asking for the referral by name at the six-week visit and showing up with the APTA directory URL open on their phones. Do that.
