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Pregnancy

      Pelvic floor exercises in pregnancy

      Read time: 5 minutes

      Your pelvic floor has an important role to play during pregnancy, birth and post-birth.

      A strong pelvic floor can:

      Support your baby and your bladder in pregnancy.

      Help rotate your baby’s head during labour.

      Help prevent prolapse and stress incontinence once your baby is born.

      If you’re starting to get active for two by exercising in pregnancy, it’s well worth including pelvic floor exercises in your routine.

      We’re now seeing evidence that exercising in pregnancy may be one of the best things you can do for your baby’s future health. Pregnancy exercise can have a huge impact on your personal experience of pregnancy, too. Provided you follow the expert guidelines, it’s safe for most women to continue and even start exercising in pregnancy. Just make sure you check with your midwife or doctor first, in case there are any specific medical reasons why you should avoid being physically active in pregnancy.

      @DrDawnHarper

      What is my pelvic floor?

      The pelvic floor is a set of muscles attached to the base of your spine at the back, and your pubic bone at the front. These muscles act like a hammock, supporting your bowel, uterus and bladder, which all pass through this hammock. When you use the toilet, sneeze or lift a heavy object, your pelvic floor muscles contract to keep everything in place.

      They also form the base of your core – the group of muscles which run from your pelvis to your diaphragm and are responsible for stability when exercising.

       

      How to locate your pelvic floor

      An easy way to locate your pelvic floor is by trying to stop mid-flow when you’re having a wee. The internal muscles you lift and clench to do this form your pelvic floor. It’s not advisable to do this regularly, though, as it can harm your bladder1.

      How to do pelvic floor exercises

      The most effective way to improve both the strength and stamina of your pelvic floor muscles is to combine both short and long squeezes.

      First, lift up and squeeze your buttocks as if you’re trying to hold in a bowel movement.

      Then lift up and hold the muscles of your vagina and bladder, as you would if you were holding in urine.

      For short squeezes, hold for a second or two, then release. Rest for one or two seconds before squeezing back and front again.

      For long squeezes, hold for at least four seconds, then release. Rest for a few seconds, then repeat. Over time, try to work up to holding the squeeze for 10 seconds.

      Do as many pelvic squeezes as you can, long and short, before your muscles get tired. Aim to repeat your exercises three times a day.

      You can perform pelvic floor exercises (also known as ‘Kegel’ exercises) sitting, standing or lying down, although if you’re sitting you may find it less tempting to squeeze your buttocks.

      Go for quality rather than quantity (doing it correctly is more important than doing it repeatedly) and check you’re not simply squeezing your buttocks or holding your breath. The squeeze should be internal, and your breathing should remain normal.

      How often should I do pelvic floor exercises?;

      The best thing to do is make it part of your daily routine. Think of activities you perform regularly and repeatedly throughout your day and practise your pelvic floor exercises at the same time. It might be cleaning your teeth, having a shower, waiting for the kettle to boil, or after every toilet break. If you can get yourself into a routine of regularly strengthening your pelvic floor muscles now, you may well avoid problems after birth.

      Your pelvic floor in pregnancy, birth and post-birth

      Your pelvic floor plays a particularly important role during pregnancy and labour2.

      Primarily, it supports the weight of your growing baby; the heavier your baby gets, the more these muscles feel the strain. Along with the challenge of supporting such a heavy load, your pelvic floor is also affected by increased levels of relaxin – a pregnancy hormone that softens the muscles and ligaments of your pelvis in preparation for childbirth. As the hormone makes them less effective at holding your bladder, it’s no wonder that some expectant mums experience the odd leak when they cough, sneeze or exercise.

      Later on, when labour begins, your pelvic floor helps to rotate your baby’s head into the ideal position, ready for birth. As your womb contracts to push your baby down, the gentle resistance from your stretchy pelvic floor below encourages your baby’s chin to tuck and their head to turn. Once they are in this position, it is easier for their head to pass under the pubic bone, ready for crowning3.

      Once your baby’s born, your pelvic floor muscle exercises will help you strengthen the muscles around your bladder, vagina and back passage to reduce the likelihood of incontinence prolapse and help you enjoy a satisfying sex life1.

      With regular, simple exercises, you can strengthen your pelvic floor muscles and reduce the likelihood of certain problems later on4.

      How does pregnancy affect my pelvic floor muscles?

      After nine months of supporting your baby, and the necessary stretching required to let your baby through the birth canal during labour, your pelvic floor may be understandably weaker after birth. Around 40% of mums experience ‘stress incontinence’ – leaking urine when they sneeze or cough5, regardless of how their baby was delivered. It’s thought to be mostly a consequence of being pregnant in general6.

      Pregnant women undertaking pelvic floor muscle training have been found to have a lower incidence of urinary incontinence4 after birth.

      When should you start pelvic exercises?

      The short answer is, the sooner the better. You can start doing pelvic floor exercises as soon as you find out you’re pregnant, but even if you don’t start until the later stages of pregnancy, it’s really beneficial.

      Pelvic floor exercises after birth

      You can start building up strength in your pelvic floor as soon as you feel ready to after having had your baby. Remember, you automatically engage your pelvic floor muscles when you sneeze or cough, so it's perfectly safe to start exercising it as soon as you can.

      Pelvic floor exercises – our top tips

      Practise locating your pelvic floor muscles

      Place reminders around your home in places you’re likely to have time to do the exercises

      Next steps

      1. NHS Choices. What are pelvic floor exercises (Kegel exercises)? [Online]. Available at: http://www.nhs.uk/chq/pages/1063.aspx?categoryid=52 [Accessed: December 2016]. Page last reviewed: 30 April 2017. Next review due: 30 April 2020.

      2. Ashton-Miller J, Delancey J. Functional anatomy of the female pelvic floor. Ann NY Acad Sci 2007;1101(1):266-96.

      3. Herbert J. Pregnancy and childbirth: the effects on pelvic floor muscles. Nursing Times 2009;105(7):38-41.

      4. Boyle R et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2012;10:CD007471.

      5. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 2013;24(6):901-12.

      6. McKinnie V et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol 2005;193(2):512-7.

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