Many women assume a C-section spares the pelvic floor, since baby did not pass through the vagina. In reality, the pelvic floor muscles and ligaments carry the weight and pressure of nine months of pregnancy regardless of how delivery happens. A C-section avoids certain risks specific to vaginal delivery, but it does not mean the pelvic floor is back to its pre-pregnancy strength immediately.
The abdominal incision also affects the deep core muscles that work together with the pelvic floor. Returning to running or high-impact exercise before the core and pelvic floor are ready can bring on leaking with running or jumping, or a new sense of heaviness in the vagina that was not there before.
Signs that high-impact exercise may be too soon include leaking with coughing, sneezing or jumping, heaviness that increases after exercise, or pain at the incision site when bracing the abdomen.
An assessment of the pelvic floor and core before returning to demanding exercise helps sequence the comeback properly — building foundational muscle control first, then adding impact gradually — rather than returning straight to full running because the incision looks healed on the outside.