Your pelvic floor is a group of muscles that you might not think about very often, but if they aren’t strong and flexible, they can sorely impact your quality of life.
Incontinence, leakage, constipation and pelvic pain can all be signs something isn’t right with your pelvic floor. These dysfunctions could be caused by weakened or tightened muscles that can make it so you can’t control your bladder or bowels, or may cause you pelvic pain.
So, how does pregnancy impact your pelvic floor and are there exercises to strengthen the pelvic floor? Hannah Ferrigan, a physical therapist who specializes in aquatic therapy and pelvic floor therapy at OSF HealthCare, has the facts.
How pregnancy impacts the pelvic floor
Incontinence or urine leakage during or after pregnancy is often mistaken as a symptom of a pelvic floor weakened during pregnancy, but Hannah said that’s not true.
“Pelvic floor muscles typically don’t weaken during pregnancy,” Hannah said. “Due to the growth of baby, it does change their orientation a bit. They do get a little bit stretched.”
But if your pelvic floor muscles were already weak when pregnancy began, or if they were already tight, pregnancy can make those issues noticeable. That’s because those muscles aren’t in shape enough to keep up with your baby’s increasing weight and the changes in your body as pregnancy progresses.
“As your body shifts and changes to prepare for delivery, it can emphasize if there were imbalances, if your hips were weak before, if your core was weak before,” Hannah said. “As you progress through your pregnancy, if there is an imbalance in your pelvic floor, core or hip strength, that can result in having your pelvic floor seem impacted.”
Pelvic floor exercises in pregnancy
According to Hannah, the best time to start doing exercises to strengthen your pelvic floor during pregnancy is actually long before you get pregnant, but it’s never too late to start. Basically, it’s best to include your pelvic floor muscles as part of a regular exercise routine whether you’re pregnant or not.
When it comes to pelvic floor therapy exercises, you can simply add in the pelvic floor strengthening to your existing routine. For a general strengthening routine, Hannah recommends:
- Spending about 20-30 minutes, at least three to four days a week, to start building up some muscle strength throughout your body. That includes the pelvic floor exercises.
- Aiming for two to three sets of each pelvic floor exercise with about 10-15 repetitions.
- Not pushing too hard as you perform the exercises. You don’t want to feel pain or have difficulty doing them, but you want to make sure by the final repetitions your muscles feel like they have worked.
If you are already pregnant, or plan to be soon, your best first step is to speak to your health care provider and, if necessary, a pelvic floor physical therapist to figure out where your pelvic floor health stands and which pelvic floor dysfunction exercises will work best for you.
How to do Kegels properly
Let’s say your physician has identified that you have a strength issue with your pelvic floor – the first exercise you typically start with is Kegel exercises, commonly referred to as Kegels.
Kegels are one of the most common pelvic floor muscle exercises and are the foundation of pelvic floor muscle strengthening. They are generally good for anyone to do, and if you’re pregnant, they should be doable with a baby growing inside you.
When doing Kegels, make sure you’re engaging not just your pelvic floor muscles, but also your core abdominal muscles.
Your first task is to “find” and feel those pelvic floor muscles. You can lay down, sit or stand – whichever is easiest for you – and try to envision those muscles between your legs running from your hip bones on both sides to your tail bone in back and pelvic bone in front.
“What you want to do is try to squeeze those muscles together,” Hannah said. “Try to lift them up toward your head, as if you’re trying to cut off a stream of urine or trying to hold in some gas. That’s kind of how you want to squeeze and feel the lift.”
If you can’t quite feel the lift, it may be because the muscles are tight or they may be really weak. For some it takes practice to feel the squeeze and lift.
As you squeeze and lift your pelvic floor muscles, you also want to engage your lower abdominal muscles. You do this by trying to squeeze your belly inward toward your spine, like you’re holding in your gut to put on some tight pants.
Making sure the lower abdominals muscles work during Kegels is something Hannah said she often sees get left out of online videos and tips.
“You can squeeze your pelvic floor until the cows come home, but if you’re not getting your core working, and you’re not making sure your hips are strong, you might not notice any improvement,” Hannah said.
There shouldn’t be any pain or discomfort as you engage your pelvic floor and core muscles. If there is pain, or you are not noticing any difference, that may be a sign you need to stretch more first, you may not be doing the squeeze correctly or that other muscles, such as your glutes and hips, also need to be addressed.
Pay attention to posture
Your posture can impact how well your pelvic floor is functioning. Poor posture can result in increased leakage, retention or even increased pain.
“One thing we’ll look at is how your sitting posture is, so when you sit in a chair, you want to be sitting tall,” Hannah said. “You don’t want to be slouching too much where you have a curve in your spine.
This is where, again, the Kegel comes in. If you feel that you need some support to hold good posture while sitting, you can squeeze in the pelvic floor muscles and squeeze in your abdominal muscles to get a nice gentle engagement through your middle.
“Even if you are in your third trimester and baby’s way out in the front, it’s still important to keep an upright posture,” Hannah said. “You want to still make sure you’re using those core muscles to help keep things supported.”
Stretching and strengthening
It’s important to do gentle stretching during pregnancy. It helps reduce muscle tension and alleviate discomfort. Changing positions – getting on your hands and knees – can also help.
- This stretching exercise helps relax the pelvic floor. It requires you to get onto your hands and knees on the floor, or another safe surface.
- Try to get your knees hip width apart, and place your hands so they’re beneath your shoulders to give yourself a solid square base. Try to keep your weight evenly distributed between your hands and knees.
- Gently try to tilt your hips backward, rounding your lower back. You may feel your pelvic floor and your lower abdominal muscles tighten a little.
- Reverse that motion and let your pelvis tilt forward, so your belly arches toward the floor.
“It’s a good exercise to do if you’re having a lot of back pain or a lot of pelvic pain or sciatic pain because this positioning helps to kind of get baby off of the hips and out of that area that could be painful for you,” Hannah said. “Or, if you’re having a lot of pressing on your bladder, sometimes being ‘on all fours’ can also reduce a little bit of that pressure, too.”
You can also strengthen your pelvic floor and core muscles in this hands and knees position.
- While on your hands and knees, engage your pelvic floor and core, so you have no arching or swaying, and your weight is evenly distributed.
- While holding that pose, try to keep your balance centered while reaching forward with one hand, extending your arm. Then switch hands.
- Next, try extending one leg at a time straight backward.
- And if you can handle both of these, try combining them, so you extend your right arm and your left leg at the same time and so on.
“If you notice leakage with any of these exercises, chances are you’re holding your breath or you’re straining too much,” Hannah said.
You may need to modify the exercise or find something easier to start with.
Postpartum pelvic floor exercises
Initially, after having a baby, your pelvic floor and abdominal muscles are stretched out. So it’s common to have some incontinence or leakage in the first few weeks as you heal and your muscles resume their normal length.
Any postpartum incontinence or leakage should go away after you’ve healed. If you experience pelvic floor dysfunction after that healing period, speak with your physician and get a referral for physical therapy, so an expert can assess your needs and help you learn the exercises or stretches that will serve your specific needs.
However, you can work on your pelvic floor health on your own, too, once your physician gives you the OK. Kegels can help strengthen your pelvic floor, for instance. So if you think you have a weak bladder, chances are it’s actually your pelvic floor that needs strengthening, not your bladder.
And once baby is out and you’ve healed from delivery, it may be more comfortable to do exercises that involve lying on your back.
Here is a good example:
- Lie down on your back with your knees bent up so your feet are on the floor – or whatever you’re lying on – and hip width apart.
- Gently tighten your pelvic floor muscles and your stomach muscles.
- While you hold that, lift with your bottom. You should keep your shoulders on the floor as you push through your hips and push your bottom up toward the ceiling, keeping those muscles engaged.
- Then relax your bottom so you come back to rest. If you feel some cramping in the back of the thighs, that can be normal, initially.
Here’s another exercise you can do from this same starting position while keeping your core and your pelvic floor engaged:
- Gently let one leg fall out to the side while keeping your pelvis from rotating.
- Then, bring it back to the middle.
- Repeat the same movement with your other leg. Keep your pelvis nice and level while you’re keeping your “core and floor” engaged. This will help strengthen your core stabilizers.
Keep in mind
If exercise doesn’t improve the leakage, or you experience pain while exercising, speak with your physician.
Last Updated: June 14, 2023