Understanding the importance of pelvic floor exercises during pregnancy

What are the pelvic floor muscles?

The pelvic floor muscles are a layer of muscles within the pelvis that stretch between the pubic bone at the front of the body to the tailbone at the back. To find it, touch your pubic bone and then touch your tail bone - your pelvic floor is between them.

Their main function is to hold in wee, wind and poo. They also play an important role in supporting the pelvic organs, such as the bladder, bowel and uterus (in women), or prostate (in men). Lastly, they help support and stabilise the spine and pelvis along with the other core muscles.

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction can occur when the pelvic floor is weak or hypertonic (lacks adequate relaxation). Pelvic floor dysfunction can result in urine or bowel incontinence, pelvic organ prolapse, pelvic pain (pain at rest, during sex etc.), increased urine frequency, and in men, it can cause erectile dysfunction.

What can you do about it?

The first thing to do is get assessed by a pelvic health physiotherapist to establish the cause of your symptoms. They will then prescribe a bespoke pelvic floor exercise program for you.

In the case of hypertonic pelvic floor muscles, your pelvic health physiotherapist may give you pelvic floor relaxation and breathing exercises. In the case of pelvic floor weakness, your pelvic health physiotherapist may give you pelvic floor strengthening exercises (Kegels).

The pelvic floor muscles have two types of muscle fibres. Slow twitch fibres help keep in a wee when you feel the need to wee but there isn’t a loo readily available. Fast twitch fibres keep in a wee when you cough, sneeze, laugh, run or jump. It’s important to work on both types of muscle fibres.

Example of Pelvic Floor Strengthening Exercises/Kegels:

Slow twitch fibres: Take a deep breath in. As you exhale, tighten the pelvic floor muscles as if you are holding in a wee or wind. You should feel the pelvic floor muscles lift both inwards and upwards towards your belly button. Avoid clenching your buttocks or thigh muscles.

Try to hold for 10 seconds while breathing normally.

Then relax the pelvic floor muscles completely.

Repeat this 10 times.

Fast twitch fibres: Take a deep breath in. As you exhale, tighten the pelvic floor muscles as if you are holding in a wee or wind, feeling them lift them both inwards and upwards towards your belly button. Once you’ve lifted them all the way up, immediately relax the pelvic floor. Avoid clenching your buttocks or thigh muscles.

Repeat this 10 times.

This program can be done in lying, sitting or standing and can be progressed to doing it in a functional position e.g. while squatting/walking. Ideally these exercises should be done 3 times a day to be effective.

Pelvic Floor Exercises during Pregnancy:

According to NICE guidelines, pelvic floor exercises should be started as soon as you find out you are pregnant, and you should continue it till 35 weeks into the pregnancy. At 35 weeks if you are asymptomatic (no urine leakage or prolapse symptoms), stop the kegels and focus on deep breathing to relax the pelvic floor muscles, as well as perineal massage. This will help your pelvic floor muscles prepare for your upcoming delivery. Perineal massage has also been proven to prevent stage 3-4 tears.

At 35 weeks, if you have any symptoms of pelvic floor dysfunction e.g., leaking urine, continue the kegel exercises as above, but in addition, you should also do deep breathing to help the pelvic floor muscles to relax and you should start perineal massage.

We recommend you book a Prenatal MOT at 35 weeks so we can teach you perineal massage and pelvic floor relaxation. We can also do certain measurements around the perineum and genital hiatus, which can tell us if you are at a higher risk of developing an anal sphincter tear or prolapse with a vaginal delivery. This information can be very useful to give to your midwife and obstetrician to make an informed choice about the type of delivery you would like to have.

The Squeezy App is a helpful NHS app which helps with pelvic floor exercises.

For more information, book an assessment with one our Pelvic Health Physiotherapists.