Your pelvic floor in pregnancy

What is my pelvic floor?

Your pelvic floor is a broad sling of muscles, ligaments and sheet-like tissues that stretch from your pubic bone at the front of your body, to the base of your spine at the back.

The pelvic floor is sometimes compared to a trampoline, because it can stretch down under pressure from weight and bounce up again.

But if your pelvic floor muscles are weighed down for a long time, as they are during pregnancy, they can become weak so they don't bounce back as far (Handa 2020, Kahyaoglu Sut and Balkanli Kaplan 2016).

Weak pelvic floor muscles may make it harder for you to control your bladder, especially in your second and third trimesters (Handa 2020, Kahyaoglu Sut and Balkanli Kaplan 2016). That's because a weak pelvic floor makes it harder for you to squeeze the muscles and sphincters at the bottom of your bladder to prevent wee from escaping (Brubaker 2019).

You may accidentally leak a little wee when you cough, sneeze or exercise (stress incontinence) (Brubaker 2019, NHS 2019a, NICE 2019). It also means that your bowel, bladder and uterus (womb) aren't as well supported (Brubaker 2019, NHS 2019b).

Constipation, which is common in pregnancy, can put even more strain on your pelvic floor (NICE 2019, POGP 2018).

How will pelvic floor exercises help me?

Building strength in your pelvic floor muscles can help to:

• Support the extra weight of pregnancy.
• Protect you from leaking wee while you're pregnant and after your baby is born (Dumoulin et al 2018, Kahyaoglu Sut and Balkanli Kaplan 2016, Van Geelen et al 2018, Woodley et al 2020).
• Help shorten the pushing stage of your labour, and reduce more severe tearing between your anus and vagina (perineum) during birth (Sobhgol et al 2020).
• Heal your perineal area after birth (NHS 2020a).
• Help your pelvis recover from birth. This is especially helpful if you've had pelvic problems such as SPD (Sobhgol et al 2019).
• Make for a more satisfying sex life, by increasing sensation and making it more likely that you’ll have orgasms during sex (NHS 2019b, 2020b, POGP 2018, Sobhgol et al 2019).
• In the long term, it can also help prevent a prolapse, which happens when your uterus, bowel or bladder sag down and push against the walls of your vagina (NICE 2019).

How do I do pelvic floor exercises?

First, make sure you can feel your pelvic floor muscles. You can do this by squeezing and lifting around your urethra, vagina, and anus.

Imagine you’re trying to stop a wee midstream, at the same time as gripping a tampon with your vagina, and stopping yourself from passing wind (Brubaker 2019, NHS 2020c).

The muscles you can feel contracting on the inside of your pelvis are the muscles you're aiming to strengthen. You should squeeze hard enough to feel a little trembling in your vagina. If you pull hard enough, you may also feel your lower tummy muscles tightening just above your groin (POGP 2018). It's a subtle sensation but it will become clearer as you get used to doing the exercises. If you’re doing them correctly, you should be able to breathe normally while you’re squeezing.

Notice the difference between when your muscles are tight and when they are relaxed. At first, it's enough to hold the squeeze for a few seconds, then release, as you get used to the feel of your muscles contracting and relaxing (NHS 2020c, POGP 2018).

It's more important to exercise the right muscles for a little time, than to exercise the wrong muscles for longer. For example, your tummy shouldn’t contract above your belly button, and you shouldn’t squeeze your inner thighs and buttocks (POGP 2018).

When you first try pelvic floor exercises, if you can’t feel anything when you are sitting, try them whilst lying down (POGP 2018). It may help you get a feel for where your muscles are. Lie on your side if you're later on in pregnancy, because this is safer for your baby and more comfortable for you. Once you know how to do the exercises lying down, it will be easier to do them when you're sitting down or standing up (POGP 2018).

Once you've got used to tensing and releasing your pelvic floor muscles, start to build in some structure to each set of exercises, like this:

• Squeeze and hold for 10 seconds, then relax for a few seconds. Repeat 10 times. This long, 10-second squeeze helps to support your growing baby, and your bladder and bowel (POGP 2018, Tommy's 2018).
• Follow your set of 10 long squeezes with 10 short squeezes. The short squeezes will help you control your bladder when you cough, exercise or sneeze (Tommy's 2018).
• Do this set of 10 long and 10 short squeezes, three times a day. Keep in mind "10, 10, 3" to remind you of your daily target (Brubaker 2019, POGP 2018).

When you first try pelvic floor exercises, you may find that you hold your breath as you squeeze. You'll need to learn to breathe normally as you do the exercises (POGP 2018). This is because when you cough or sneeze, you breathe out forcefully. If you can only tighten your muscles when you hold your breath, they’ll relax when you cough or sneeze, and you may leak wee.

A physiotherapist who specialises in women’s health can help if you’re not sure whether you’re doing the exercises correctly or effectively. Your midwife or doctor may be able to recommend one in your area.

After a few months, you should start to notice your pelvic floor exercises making a difference (NHS 2020b). Try not to get disheartened if you can't feel much, though. Your baby is getting bigger all the time, which means your pelvic floor will have to work harder to support your uterus. Keep going, because your efforts will pay off.

Don’t worry if you started to exercise them later in pregnancy than you'd have liked. Start as soon as you can. Continue doing the exercises after birth. It's just as important to help your pelvic area recover. In fact, your pelvic floor exercises need to be a habit for life (NICE 2019)!

Read more about your pelvic floor after birth.

How can I tell I'm doing my pelvic floor exercises properly?

You can ask your midwife or doctor for advice at your next antenatal appointment. You can also check yourself by using a hand-held mirror to look at the area between your vagina and anus (your perineum). As you do your pelvic floor squeeze, you should see your perineum move up and in (POGP 2018).

If your perineum bulges out instead, ask your midwife or doctor to refer to you a women's health physiotherapist. A bulging perineum can be a sign of prolapse (POGP 2018, Rogers and Fashokun 2020).

If you're having a straightforward pregnancy you can:

• Squeeze your muscles during sex and ask your partner if they can feel the squeeze.
• Gently insert one or two fingers in your vagina while having a warm bath. Start doing the exercises. You should notice a squeeze and a suck-in feeling inside your vagina if you’re exercising your pelvic floor muscles correctly. Many people find this very hard to do, so don’t worry if you can’t.
  (POGP 2018)

 

Why is my pelvic floor important for labour and birth?

Pelvic floor exercises allow you to control your pelvic floor muscles better, and this may help during a vaginal birth. When your baby's head crowns during the second stage of labour, your pelvic floor muscles need to relax. If you're well-practised at relaxing your pelvic floor, it may help you shorten this stage of labour, which is often the most intense (Du et al 2015, Schreiner et al 2018, Sobhgol et al 2020).

Research also shows that regular pelvic floor exercises can help reduce more severe tearing between your anus and vagina (perineum) during birth (Sobhgol et al 2020).

Some researchers suggest that combining pelvic floor exercises with perineal massage may help further with birthing your baby (Leon-Larios et al 2017).

Can my pelvic floor be too tight?

Yes, some people have what's called an overactive or hypertonic pelvic floor. This means that the muscles are unusually toned or tense, and can't relax properly (Pelvic Partnership 2017, Shaheed 2019). This may affect the whole of your pelvic floor or part of your pelvic floor (Pelvic Partnership 2017, Shaheed 2019).

Having tight or strong pelvic floor muscles is unlikely to affect your ability to have a vaginal birth (Bø et al 2013), but it may lead to pelvic girdle pain (PGP) (Pelvic Partnership 2017).

Your pelvic floor muscles may be compensating for joints and muscles that aren't working properly in your pelvis. It can also be related to birth trauma (Shaheed 2019), such as damage to one side of the pelvic floor following forceps birth or a long pushing stage (Handa 2020). These problems can result in one side of your pelvic floor being in spasm.

Symptoms of an overactive pelvic floor can be similar to those of a weak pelvic floor. That's because your tight, clenched muscles may weaken through overuse (Pelvic Partnership 2017). You may notice:

• pelvic girdle pain that persists or comes back, despite treatment
• pressure in the vagina or rectum
• lower back pain
• pain or discomfort during sex
• urinary tract infections (UTIs)
• bladder problems, such as urgency, frequency or not being able to empty your bladder fully during a wee
• incontinence
  (Pelvic Partnership 2017)

Overactive pelvic floor muscles can be treated with a tailored program of pelvic floor exercises that help train your muscles to relax (Pelvic Partnership 2017, Shaheed 2019). Ask your doctor or midwife to refer you to a women's health physiotherapist, who can give a special type of treatment called trigger point release (Pelvic Partnership 2017).

See these top 10 reminders for when to do your pelvic floor exercises during pregnancy and beyond.

Is vaginal birth more damaging to my pelvic floor than a caesarean?

In the long term, it makes no difference whether you give birth vaginally or by c-section, as long as your pelvic floor was normal before pregnancy and birth (Crane et al 2013, Van Geelen et al 2018).

Your pelvic floor is likely to get back to normal within a year of giving birth, no matter how you had your baby (Crane et al 2013, Van Geelen et al 2018).

It's pregnancy rather than birth method that weakens your pelvic floor (Van Geelen et al 2018), although, in the short term, your pelvic floor, like other areas of your body, will need to recover after a vaginal birth, especially if you had an assisted birth with forceps.

Doctors don’t recommend caesareans to prevent perineal and pelvic floor problems (Gachon 2018, Nelson et al 2019). But if you’ve experienced a serious third-degree or fourth-degree tear in a previous birth, your doctor or midwife will discuss with you the option of a planned caesarean to protect your pelvic floor (Gachon 2018).

If you find that pelvic floor exercises don’t help you control your bladder, ask your GP, obstetrician or midwife to refer you to a women's health physiotherapist or continence nurse (NHS 2019a, POGP 2018). For more information on incontinence problems, check out the Continence Foundation of AustraliaOpens a new window, the Department of Health’s bladder and bowelOpens a new window website, or call the Continence Helpline on 1800 33 00 66.

Find out more about your pelvic floor.