Pelvic floor exercises during and after pregnancy
This article covers the following topics:
During pregnancy, increasing pressure is put on the muscles of your pelvic floor. The effects of the hormone relaxin encourage these muscles to relax in preparation for labour. It's therefore important to exercise your pelvic floor muscles regularly. Continuing these excercises after pregnancy can help prevent long-term problems.
Your pelvic floor is a group of muscles and ligaments which go across the base of your pelvis in two joined halves with gaps for the urethra, vagina and anus to pass through.
The pelvic floor:
- supports your internal organs (bladder, intestines, uterus etc),
- maintains bladder and bowel control (including when you sneeze, cough or lift heavy objects etc),
- plays a vital role in supporting the spine and
- helps you enjoy sex more.
During pregnancy and birth, the pelvic floor:
- helps rotate the baby's head into the correct birth position,
- helps prevent constipation and piles, and
- supports the weight of the baby and fluid.
Being pregnant can put a lot of stress on the pelvic floor muscles.
There are a number of ways to become aware of and locate your pelvic floor muscles. Try 'squeezing' your partner during penetrative sex or insert one or two fingers into your vagina and try squeezing them.
You can also try using your pelvic floor muscles to stop your urine mid-flow or stop wind from your back passage - but don't do this as an exercise as it can lead to your bladder not emptying properly.
Your pelvic floor muscles are made up of two kinds of muscle fibre: slow twitch for stamina and fast twitch for quick contractions. For best effect, you need to exercise both kinds.
Slow exercise option 1
- Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, then pull up towards the front. Hold and count to four, remembering to breathe normally.
- Double check you aren't pulling in buttock muscles by placing your hand on your bottom as you do the exercises. It's OK if you're tensing your lower abdominal muscles slightly.
- When you find this exercise easy, try holding for a longer count, up to a maximum of ten.
- With these exercises, quality is better than quantity: it's much better to do a few good ones at a time.
Slow exercise option 2
- Imagine your pelvic floor is like a lift. Tighten the muscles around the anus and vagina, as if closing doors in a lift. Now tighten a little more as if you're going up to the first floor, then the second, then gently come back down to the ground again, making sure you keep breathing normally throughout.
- Try coughing or blowing into your fist. You will feel the muscles of your pelvic floor being pushed down. This will also happen when your baby's head starts to move down the birth canal during the second stage of labour. Knowing how to relax these muscles will help you give birth to your baby.
Try tightening and then relaxing your pelvic floor muscles as quickly as you can, 5-6 times in a row. These are the muscles which contract instantly when you cough or sneeze to resist the rise in abdominal pressure. Before you cough, sneeze, lift or laugh, try to take a moment to pull these muscles up.
Try and work up to doing about 50 exercises per day. Try and fit them into your daily routine like doing them while you are stuck in traffic, watching TV or on the loo. Some women have found it helpful to put little stickers round the house and do a few exercises each time you see one.
Massaging the area between the vagina and anus in the last weeks of pregnancy has been shown to reduce the likelihood of tearing during birth, and of needing stitches or an episiotomy.
- Either on your own with a mirror or with your partner, massage oil (preferably vegetable based) into the skin of the perineum using your fingers or thumbs.
- Then place your fingers around 5cm (2 inches) inside your vagina and press downwards towards the anus, then move to each side in a U-shaped stretching movement. This may give a tingling/burning sensation.
- Hold the stretch for 30-60 seconds then release.
The feeling is similar to what you will feel when your baby's head is crowning.
Resuming pelvic floor exercises as soon as possible after giving birth will help reduce swelling and speed up the healing process. If you have had stitches you may wish to start the exercises lying down and work your way up to doing them whilst sitting.
Continuing with your pelvic floor exercises until you feel they are completely back to normal is a good idea. Doing them for the rest of your life will help prevent problems in later life such as a prolapsed uterus or bladder.
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.