Pelvic Floor in Pregnancy

You may have heard that you should be doing your pelvic floor exercises during pregnancy. And yes, you should. But your pelvic floor is about much more than squeezing a set of muscles as hard as you can. Your pelvic floor needs to be able to contract, relax, lengthen and respond to what your body is doing. That matters during pregnancy, birth and recovery afterwards.

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What is your pelvic floor?

 

Your pelvic floor is a group of muscles at the base of your pelvis. Think of it a little like a supportive hammock running from the pubic bone at the front towards the tailbone at the back. It helps to:

• Support your pelvic organs, including your bladder, bowel and uterus

• Control urine, wind and bowel movements

• Contribute to sexual function

• Support your pelvis and core during movement

 

Pregnancy places additional demands on these muscles, which is one reason pelvic floor exercises are recommended during pregnancy.

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Why does it matter during pregnancy?

 

As your baby grows, your pelvic floor is supporting increasing weight. Pregnancy and birth can also place the muscles and surrounding tissues under additional strain. A weakened pelvic floor can contribute to symptoms such as:

• Leaking urine when coughing, sneezing or exercising

• Difficulty controlling wind or bowel movements

• A feeling of heaviness or pressure in the vagina

• Symptoms of pelvic organ prolapse

 

These symptoms are common, but they aren't something you simply have to put up with. Pelvic floor exercises can help prevent and improve some pelvic floor problems, and are recommended for women during pregnancy.

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How do I find my pelvic floor?

 

Imagine you're trying to stop yourself passing wind and urine at the same time. You should feel a gentle squeeze and lift around the openings of your pelvis. Then completely relax. You may also notice a subtle feeling of lift inside your pelvis. Try not to squeeze your:

• Bottom

• Inner thighs

• Abdominals

And keep breathing normally.

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One important point

Don't practise your pelvic floor exercises by repeatedly stopping the flow of urine. That can interfere with normal bladder emptying and isn't recommended as a way to exercise the pelvic floor.

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Strength and relaxation both matter

 

This is the bit I really want you to remember. Your pelvic floor isn't supposed to be switched on all day. Just like any other muscle, it needs to be able to contract and relax. A useful pelvic floor practice includes both:

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Long squeezes

Gently lift and hold your pelvic floor for as long as you comfortably can, then fully relax. Over time, you can work towards holding for up to 10 seconds.

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Short squeezes

Gently squeeze and lift, then release straight away. These help your muscles respond quickly when you need them.

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The NHS recommends working towards regular sets of both long and short pelvic floor contractions during pregnancy. If you're new to pelvic floor exercises, start where you are rather than trying to hit a particular number immediately. Quality matters more than forcing lots of repetitions.

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What does the pelvic floor have to do with birth?

 

Quite a lot. During pregnancy, you want a pelvic floor that can support your body and respond to increases in pressure. During birth, your pelvic floor needs to be able to lengthen and relax as your baby moves through the pelvis. This is why birth preparation isn't simply about having the strongest possible pelvic floor.

 

Imagine trying to open a fist that you're clenching as tightly as possible. That's a little like asking a muscle to lengthen when it's constantly holding tension. So alongside strengthening, it's useful to practise noticing what it feels like to let the pelvic floor soften. Your breath can help. Try taking a slow breath in and, as you breathe out, deliberately relax your jaw, shoulders, belly and pelvic floor. You don't need to force anything downwards. Just notice the difference between holding and releasing.

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What if my pelvic floor feels too tight?

 

Not every pelvic floor problem is caused by weakness. Some people have a pelvic floor that is overactive or tense, which can contribute to pelvic pain, difficulty emptying the bladder or bowel, or pain during sex. If you experience pelvic pain or you're finding pelvic floor exercises difficult or uncomfortable, don't simply do more squeezes. A specialist women's health or pelvic health physiotherapist can assess what's happening and tailor your exercises accordingly. RCOG recommends seeking professional support for pelvic floor symptoms and highlights women's health physiotherapists as specialists in pelvic, bladder and bowel problems.

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Pelvic floor and everyday movement

 

Your pelvic floor works automatically as part of your wider movement system. You may notice it responding when you:

• Cough

• Sneeze

• Laugh

• Lift something

• Run or jump

• Change position

• Exercise

 

You can practise gently engaging your pelvic floor before activities that increase pressure, such as coughing or lifting. But remember to release it afterwards. Think responsive rather than permanently switched on.

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What about leaking during pregnancy?

If you leak a little urine when you cough, sneeze, laugh, exercise or lift something, you're not alone. But common doesn't mean you have to accept it as inevitable. Pelvic floor exercises can help with stress urinary incontinence, and getting support during pregnancy can be useful if symptoms are bothering you. If you're experiencing regular leakage, difficulty controlling your bladder or bowel, vaginal heaviness or other pelvic floor symptoms, speak to your midwife, GP or a pelvic health physiotherapist. You don't have to wait until after your baby is born to ask for help.

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A simple pelvic floor practice

 

You can practise your pelvic floor almost anywhere.

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1. Get comfortable

Sit, lie down or stand.

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2. Breathe normally

Don't hold your breath.

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3. Gently squeeze and lift

Imagine stopping wind and urine at the same time.

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4. Hold

Hold for as long as you comfortably can, gradually building towards 10 seconds.

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5. Fully release

Let the muscles soften completely before repeating.

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6. Add some quick squeezes

Squeeze and release quickly several times.

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The NHS suggests working towards 3 sets of 8 squeezes each day, including both slow and fast contractions. If that's too much to start with, begin with what you can comfortably manage and build gradually.

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And remember...

Your pelvic floor isn't a muscle you need to keep clenched all day. It's a responsive part of your body. It needs to be strong enough to support you, but relaxed enough to lengthen and respond when you need it to. So don't think: "I need to squeeze harder."

Think: "Can I contract, and can I completely let go?" That awareness is useful throughout pregnancy, during birth and in your recovery afterwards.

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