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. This is due to pregnancy hormones, and the increasing weight of your baby. Research shows that exercising your pelvic floor muscles during pregnancy makes it less likely that you will leak urine (be incontinent) after birth. It's therefore important to exercise your pelvic floor muscles regularly.
Continuing these exercises after pregnancy can help to prevent long-term problems, such as prolapse (when the pelvic organs have lost some support, and can bulge into the vagina).
Your pelvic floor muscles form the base of your pelvis. The muscles attach to your tailbone (coccyx), and up to your pubic bone at the front - they are also attached at the sides of your pelvis, to the bones that you sit on. The back passage (anus), vagina and urethra (tube from the bladder) pass through these muscles (please see image below - copyright Pelvic, Obstetric and Gynaecological Physiotherapy, used with permission).
The pelvic floor muscles:
- support your internal organs (bladder, intestines, uterus, etc.),
- maintain bladder and bowel control (including when you sneeze, cough or lift heavy objects, etc.)
- play a vital role in supporting the spine and
- help you to enjoy sex.
During pregnancy and birth, the pelvic floor muscles help rotate the baby's head into the correct birth position and support the weight of your growing uterus.
There are a number of ways to find 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 occasionally 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 fibres: fast fibres for strength, and slow fibres for stamina. For best effect, you need to exercise both kinds of fibres within your pelvic floor muscles.
- Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, as if you are stopping yourself from passing wind. Now add a squeeze towards the front around your vagina and bladder, as if stopping the flow of urine. Let go straight away. This is a short squeeze of no more than one or two seconds.
- Rest for one to two seconds, then repeat. See how many good quality squeezes you can do before the muscles get tired.
- Make sure that you aren't squeezing your buttocks, or holding your breath to squeeze.
- If they are working correctly, these muscles should contract automatically when you cough or sneeze, to resist the rise in abdominal pressure. This reflex can be lost after having a baby. You can help the muscles to work correctly by pulling them up before you cough, sneeze, lift or laugh. This will help to keep you in control of your bladder.
- Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, as if you are stopping yourself from passing wind. Now add a squeeze towards the front around your vagina and bladder, as if stopping the flow of urine. Hold the squeeze while you count to four seconds, remembering to breathe normally.
- Double check you aren't pulling in your 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.
- Rest for a few seconds, then repeat your long squeeze. See how many good quality squeezes you can do before the muscles get tired. Stop when your muscles get tired.
- You may find that holding for four seconds is too easy, or for some women it may be too hard. If this is the case, try holding for more or less time, concentrating on getting a good quality squeeze. Once you know how long you can hold a good squeeze, you can work to build this up over time (see below).
- When you find this exercise becomes too easy, try holding for a longer count, up to or beyond 10 seconds. You should also gradually increase the number of repetitions you do in each session.
With these exercises, quality is better than quantity: it's much better to do a few good squeezes at a time than lots of squeezes incorrectly.
Try to do your exercises three times each day. Try and fit them into your daily routine by practising when you are watching TV, or after you've finished on the loo. Some women find it helpful to put stickers round the house to remind them do their exercises. There are also some useful phone apps to record your exercises.
You could also try perineal massage.
After a straightforward delivery
Resuming pelvic floor muscle exercises as soon as possible after giving birth will help to reduce any 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.
Start with gentle, short, pelvic floor muscle squeezes, within 24 hours of having your baby. Although you might be worried that it will hurt, most women find that it's not as sore as they expect.
As you feel more confident and more comfortable, you can squeeze a little harder and add in your long squeezes again. Gradually build up how many squeezes you do, and how long you hold. Try to do this four to five times per day. Once your baby is feeding well you may find that this is a good time to practice your exercises.
After a delivery with ventouse or forceps, or by caesarean
Start your pelvic floor muscle exercises once any urinary catheter has been removed, and you are passing urine normally.
Don't assume that you don't have to do these exercises if you've had a caesarean. Just being pregnant can weaken your pelvic floor muscles. You are still at risk of bladder and bowel problems.
In the future
Continuing with your pelvic floor muscle exercises at least three times each day, until you feel they are back to normal is a good idea. Doing them daily for the rest of your life will help prevent problems in later life, such as a prolapsed uterus, bladder or bowel.
Incontinence (leaking from your bladder or bowel) and prolapse can be distressing at any time. Unfortunately leaking is common during and after pregnancy. Pelvic floor muscle exercises are the main treatment. Sometimes it can be difficult to feel your muscles after giving birth, or to know if you're squeezing correctly.
You should speak to your GP, midwife or health visitor if:
- You are having problems with your bladder or bowel.
- You think you might have a prolapse.
- Sex is painful.
- You are having difficulty with your pelvic floor muscle exercises.
You may be referred to a specialist physiotherapist, nurse advisor or a medical team.
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.
You can find leaflets about exercise, preparing for pregnancy and parenthood, as well as physiotherapy for common pregnancy conditions here.
NHS Choices offers information on pelvic floor exercises.