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Overview of Pelvic Floor Exercises During Pregnancy

Besides reducing the risk of incontinence during pregnancy, strengthening the pelvic floor muscles (a group of muscles used to stop urinating) is one of the best ways to have a safe childbirth and postpartum recovery. If your pelvic floor is not flexible and strong, it can affect your pregnancy and cause continuing problems after childbirth. 

For example, a weak pelvic floor can cause incontinence (stool or urine leakage). You can also develop anal or uterine prolapse (pelvic organs sagging into the vagina). 

Pelvic floor training, also known as Kegel exercises, can make your pelvic floor muscles strong. Kegel exercises consist of contracting and relaxing the muscles you use to urinate repeatedly. These exercises are not only for pregnant women. They can help women (and even men) at all stages of life by preventing pelvic floor dysfunction and improving sexual function. But Kegels are especially useful in preventing postpartum incontinence (urinary stress incontinence) and pelvic organ prolapse.

Why Should Pregnant Women Practice Pelvic Floor Exercises?

Common pelvic floor issues during and after pregnancy include urine leaks, stool leaks, and prolapse (slipping out of place) of the pelvic organs.

Pelvic floor exercises can strengthen the muscles in the pelvic region and help you maintain control over bladder and bowel movements. A strong pelvic floor also supports sexual function throughout life.

Role of the Pelvic Floor in Pregnancy

The pelvic floor plays a key role in supporting the uterus during pregnancy. A strong pelvic floor can support the growing baby right until the third trimester. Additionally, pregnant women who practice pelvic floor exercises tend to have better control of these muscles, which helps with pushing during vaginal delivery; it also helps reduce the need for an episiotomy (a cut through the area between the vaginal opening and the anus to widen the vaginal opening during childbirth). For this reason, performing Kegels exercises is especially useful for women who are pregnant or planning a pregnancy. 

Impact on Postpartum Recovery

Women are advised to perform pelvic floor training during pregnancy to increase the chances of a smoother delivery and postpartum recovery.

Pelvic floor training during and after pregnancy helps the pelvic floor to return to its pre-pregnancy strength after childbirth, thereby promoting postpartum recovery. This type of training can lower the risk of continuing problems post-pregnancy, such as stress incontinence (where you leak urine) and anal or uterine prolapse (where pelvic organs drop from their normal location). It can also help to make your spine and joints stronger and improve circulation. 

Kegels for Menopausal Women

It’s common for menopausal women to leak urine when they cough, sneeze, bend over, laugh, or lift something heavy. This is called stress incontinence. Urine leaks can also occur when you don’t make it to the bathroom on time. This is called urge incontinence. 

A systematic review of studies shows that Kegels can benefit women with urinary incontinence (urine leak issues) related to menopause. 

Clinical trials have shown that using a disposable tampon as visual biofeedback during pelvic floor muscle training can improve symptoms, quality of life, and sexual function in women with and without urinary incontinence. 

Understanding the Pelvic Floor

The pelvic floor consists of a group of muscles that support the uterus, urinary bladder, and bowel. These muscles are attached to the pubic bone in the front and the tailbone at the back, creating a sling-like structure, which holds and protects the pelvic organs, namely, the uterus, urinary bladder, and anus.

Changes and Strain During Pregnancy

The pelvic floor muscles stretch significantly during pregnancy as a result of hormonal changes. In addition, as the pregnancy progresses, the weight of the growing baby exerts strain and pressure on the pelvic floor, so that the muscles work hard. These changes can increase the risk of developing bowel and bladder dysfunction during pregnancy or after delivery.

How to Identify Your Pelvic Floor Muscles

Kegel exercise is one of the most effective ways of pelvic floor training. The first step for practicing the Kegel exercise is to locate your pelvic floor muscles and learn to contract and relax them.

To locate your pelvic floor muscles, lie down or sit with your thighs and buttock muscles relaxed. Next, try to squeeze the muscles in your perineal area (around your anal, vaginal, and urethral openings), as if you are trying to stop passing wind or urine, respectively. You can also practice this exercise on the toilet when you are emptying your bladder. This will help you locate the pelvic floor muscles and learn to contract and relax them.

Some women have difficulty voluntarily squeezing their pelvic floor muscles. You can seek advice from your continence nurse or physiotherapist if you are struggling with locating or squeezing your pelvic floor muscles and muscles of the bladder properly.

When and How to Practice Pelvic Floor Exercises

When Should You Start Doing Pelvic Floor Exercises In Pregnancy?

It is generally recommended that you start practicing pelvic floor muscle exercises during the first trimester of pregnancy, or even earlier when you are planning a pregnancy, to maintain pelvic health.

If you have not practiced these exercises during pregnancy, you can start gentle pelvic floor exercises about 24 hours after birth, even if you have stitches from an episiotomy. Pelvic floor exercises can improve blood circulation in the pelvic region and help your episiotomy heal faster.

When Should I Start Pelvic Opening Exercises During Pregnancy?

Some experts recommend starting pelvic opening exercises, such as a wide leg squat or supported deep squat, as soon as you find out you are pregnant or even before you become pregnant. However, others recommend waiting until you are in your second trimester. Talk to your primary health care provider or OB/GYN for individualized advice.

When Is The Best Time To Perform Pelvic Floor Exercises?

Pregnant women can practice pelvic exercises at any time of the day, in any place, and in any position that is comfortable for them. The only precaution is to make sure the exercises do not exert too much pressure on the belly. 

Frequency and Duration

• Frequency: Experts recommend doing Kegels daily or at least twice a week for maximum benefits.

• Sets and repetitions: You can try to do 2 to 3 sets of each exercise with 5 to 15 repetitions based on your comfort level.

Note: If you are doing Kegel exercises for incontinence issues, it may take several months for you to notice a difference in your symptoms. You will need to continue doing Kegels lifelong to keep getting the benefits. Stopping Kegels may cause your incontinence symptoms to come back.

Precautions

• Learn the correct technique for Kegel exercises to prevent injuries. Go to a physical therapist who specializes in pelvic floor exercise, if needed.

• Don't strain or hold your breath while doing pelvic floor training exercises.

• Make sure your stomach muscles, glutes (buttocks), and thighs are relaxed while performing the exercise. 

• Stop if you experience pain or dizziness.

• When you’re learning to identify the muscles for Kegels, you can try briefly stopping the flow of urine when you’re on the toilet. However, once you know how to do Kegels, do not do these exercises while urinating. This can weaken the pelvic floor muscles and damage your bladder and kidneys.

• Do not do Kegel exercises with too much force. This can cause tightening of the vaginal muscles and pain during sexual intercourse.

Kegel Exercises: How Can I Tighten My Pelvic Floor During Pregnancy?

Once you have identified your pelvic floor muscles, you can perform Kegels by following these steps:

1. Practice tightening (contraction or squeezing) your pelvic floor muscles; imagine as if you are stopping urination midstream. When you do this, you should feel your vaginal and anal muscles lifting up.  

2. Inhale deeply through your nose, expanding your belly, and then exhale, holding the pelvic area muscles as tightly as you can. Hold the contraction while continuing to breathe normally for a few seconds as you count slowly to 10 or 15. (Avoid holding your breath)

3. Then, on your next inhale relax the muscles completely and rest for around 5 seconds.

4. Repeat these steps 8 to 12 times.

Aim to do at least 3 sets of 8 to 12 squeezes daily. You can practice Kegel exercises in different positions, such as standing, sitting, or lying down, during your daily routine. 

Techniques to Incorporate Exercises into Daily Routine

You don’t need to set aside a special time to do Kegel exercises. You can include them in your daily routine. For example, you could do Kegels while waiting in line at the grocery store, while answering emails at your desk, or while lying in bed at the end of the day.

Safe Pregnancy-Specific Exercises

As your body changes during pregnancy it is important to notice how your body feels as you engage with certain exercises. If anything is uncomfortable, stop immediately and consult a professional to modify certain exercises. Remember to stay hydrated, breathe, and do not overexert yourself on any particular exercise. Below are a few safe exercises you can practice to help strengthen your pelvic floor muscles:

Standing Pelvic Tilt Exercise

A standing pelvic tilt exercise can help to correct the alignment of your lower back (lumbar spine) and ease backache, which is common during pregnancy.

1. To perform pelvic tilt exercises, stand with a good posture, with your feet shoulder-width apart and your hands on your hips.

2. Imagine your pelvis is a bucket of water. Relax gently forward like you are about to pour the water from the bucket. 

3. You’ll feel your abdominals lifted and your back arching as you do this. 

4. Release, repeat as desired.

Stretching Exercises for Pelvic Floor Strengthening

In addition to Kegel exercises, you can also practice gentle stretching exercises such as the pelvic tilt exercises described above. Stretching exercises during pregnancy help to reduce muscle tension, relieve abdominal and pelvic discomfort, and relax the pelvic floor.

Here is a step-by-step method to practice another stretching exercise for the pelvic floor:

1. Start by getting onto your hands and knees with your fingers facing forward. In this starting position, keep your knees about hip-width apart. 

2. Place your hands on the floor, such that they are beneath your shoulders, giving you a solid square box position. 

3. Make sure your body weight is evenly distributed and balanced between your hands and knees.

4. Then, try to move your hips backward while rounding your lower back. You might feel your pelvic floor and lower abdominal muscles tightening a little as you lift your pelvic floor.

5. Next, reverse that motion by tilting your pelvis forward, such that your belly button arches toward the floor.

6. Slowly return to the original position, and repeat 5 times.

Pelvic floor stretching or opening exercises are especially useful for women who experience back pain, pelvic pain, or sciatic pain during pregnancy. The positioning achieved in these pelvic tilt exercises helps to get the baby off your hips and back and can therefore ease backache. 

Stomach Muscle Exercises During Pregnancy

A strong core can help you carry your baby without developing health issues. To strengthen your stomach muscles, doctors recommend this pregnancy-safe exercise:

1. Stand with your feet shoulder-width apart. Keep your knees soft.

2. Pull in your abdominals (like you’re moving your tummy button towards your back passage), while raising your back upwards. 

3. Gently relax your head forward as you curl your trunk. 

4. Do not lock your elbows. Keep your knees soft.

5. Hold the pose for a few seconds.

6. Return to the starting box position. 

Maintaining Pelvic Floor Health Postpartum

Pelvic Strengthening After Delivery: Postpartum Pelvic Floor Exercises

The muscles in the pelvic floor and lower abdomen are stretched significantly during labor and delivery. These stretched muscle fibers can become weak, preventing them from working properly to prevent stool or urine (poop or pee) leaks. This can result in urinary stress incontinence or fecal incontinence (stool leakage), especially in the first few weeks after childbirth until the muscles regain their normal strength.

Postpartum pelvic exercises and stomach strengthening exercises are safe and suitable activities after childbirth to strengthen these weak pelvic floor muscles and help them regain normal strength faster.

Postpartum Pelvic Floor Exercises

Here is a good example of postpartum pelvic exercises:

1. Lie down on your back, keeping your knees bent up such that your feet are on the floor and your hips are shoulder-width apart.

2. Let one leg fall out slowly to the side without allowing your pelvis to rotate.

3. Gently bring it back to the middle.

4. Repeat with the other leg.

Practice this exercise 5 to 8 times once every day to strengthen your pelvic floor after giving birth.

Long-Term Benefits and Maintenance

As noted, weak pelvic muscles can cause you to leak pee or poop or pass gas accidentally. Doing Kegel exercises long-term can prevent the weakening of your pelvic muscles and give you better bladder and bowel control throughout life, including during and after pregnancy and childbirth, after surgical procedures, and as you grow older. 

Pelvic Floor Exercises During Pregnancy: Frequently Asked Questions

What Are The Benefits of Pelvic Floor Muscle Training for Pregnant Women?

Pelvic floor training can improve pelvic floor health and help women avoid problems with bowel and bladder control and anal or uterine prolapse after delivery.

How Soon Will My Pelvic Floor Muscles Become Stronger After My Baby Is Born?

Your pelvic floor will become stronger in about 6 months after your baby is born. Your pelvic organs need time to recover after giving birth. This includes your pelvic floor muscles as well as the other muscles in the pelvic region that are stretched during labor and delivery. 

Women who give birth to large babies, have to push longer, or need an assisted birth, may take longer to recover.

Most women regain optimum pelvic floor health in 6 months after childbirth. However, regular pelvic floor muscle training can speed up the recovery process. 

Can You Do Kegels After a C-Section?

Most women can start doing Kegels as soon as the catheter is out after a C-section (cesarean section). But you should check with your physiotherapist and/or health care provider before doing any exercise, including Kegels. A C-section is a major surgery, and it takes 6-8 weeks to recover fully from it.

What Happens If You Don't Do Pelvic Floor Exercises During Pregnancy?

If you don’t do pelvic floor exercises during pregnancy, you may be at an increased risk of incontinence (urine leak or stool leak) and pelvic organ prolapse (pelvic organs slipping out of place).