Pelvic floor exercises

There is a huge amount of information available on pregnancy, birth and post-natal recovery. Though you’ve probably found a lot of it is conflicting and at odds with each other. This means decision-making about healthcare is often not as easy as it could be. But when it comes to information about the importance of the pelvic floor muscles, experts generally agree that this is an area of vital significance. There is no doubt that having a healthy, toned and fit pelvic floor will make your life more comfortable. Not just during your pregnancy but for years to come.

What are my pelvic floor muscles?

An easy way to describe a woman’s pelvic floor muscles is as a type of hammock, which acts as a supportive, muscular sling. These muscles support the uterus (womb), bowel, and bladder as well as enveloping the urethra, rectum and vagina. Essentially, most of the organs, which lie below your waistline are supported by your pelvic floor.

Pregnancy exercises

Why do I need to think about them?

During pregnancy, the hormone progesterone has a softening and relaxing effect on the muscles and ligaments within the body. This helps with childbirth and the progression of the baby through the mother’s pelvis and vagina. But high progesterone levels can also mean these muscles become more lax and stretched. Regaining pre-pregnancy tone is difficult, especially if a woman has been carrying a very heavy baby and gained a lot of weight through her pregnancy.

Multiple pregnancies and having lots of babies is another factor. The length of a mother’s labour, particularly her second stage, can also affect the muscles in her pelvic floor. The second stage of labour refers to the time between full dilation of the cervix to 10 cm and the actual birth of the baby. A long second stage, with lots of pushing and straining, can further stretch the muscles of the pelvic floor.

Constipation, another common problem during pregnancy, is another factor that doesn’t do any favours to a woman’s pelvic floor. A permanent heavy mass sitting in the large bowel and rectum causes unnecessary swelling and discomfort. Over time, prolonged constipation also leads to a further loss of tone. To avoid becoming constipated drink lots of water, exercise, and remember to boost the fibre content of your diet.

Benefits of doing pelvic floor exercises

They will help you feel in touch and connected with what is going on within your body and that you are taking an active and important role in maintaining your pelvic floor tone.
Targeting your pelvic floor with an exercise programme will help to keep this area firm and tight.
Reduces the likelihood of having a uterine or bladder prolapse. This is because these organs will be better supported in their correct positions. It is not uncommon for women who have had more than one vaginal delivery to require a vaginal repair. This can also involve lifting the womb and bladder back where they need to be in within the pelvis.
An improved pregnancy and delivery, with a quicker recovery time postnatally.
Easing of post-partum discomfort from perineal swelling and haemorrhoids.
Reduces the likelihood of needing an episiotomy or perineal tearing.
Improved sex life as the muscles and tone of the vagina are maintained.
Helps to combat urinary incontinence/leakage during pregnancy and after delivery.
A toned pelvic floor leads to more complete emptying of the bladder and bowel.
Helps to avoid stress incontinence after delivery. This is when small amounts of urine leak out of the bladder when laughing, sneezing, coughing or lifting something heavy.

Kegel exercises

Yes it is a strange name but you’re unlikely to forget it. Like a lot of names, this one has its origins in its founder, Dr. Arnold Kegel, who just happened to be a gynaecologist. He generously donated his name to this important group of exercises and in the process, has saved a lot of pelvic floors from rapid descent.

Kegel exercises use the same muscles as the ones that stop your urine from flowing. So the sensation of holding on when you need to empty your bladder, or stopping when you are actually weeing, are the muscles you will be trying to target.

When will I do them?

Women of all ages benefit from doing pelvic floor exercises every day. They are not a unique exercise limited to pregnancy or the post-natal period. Try to get into the habit of associating certain activities with doing daily pelvic floor exercises. When waiting in a queue at the bank, in the car at a red light, waiting to be served at the shops or standing at the sink. It will not be obvious to anyone else what you are doing and it is unlikely you’ll break into a sweat.

But I feel so sore

Many women find Kegel exercises difficult to do in the first few weeks after they have had a vaginal delivery. This is especially true if there has been some trauma from an episiotomy, perineal tear or generalised swelling and bruising. But it is important to start doing them shortly after birth even if you have had a caesarian delivery.

Some women find it easier in the early post-natal period, to do a set of Kegel exercises when they are sitting or lying down, rather than standing. If you have become used to doing pelvic floor exercises during your pregnancy, it will be much easier for you to resume them after birth.

How to do pelvic floor exercises

Try to visualise the muscles that are supporting your vagina, anus and urethra and tighten them. If you are doing this effectively, you will be able to feel a pulling and lifting sensation throughout your pelvic floor. Your aim is to build up frequency and repetitions as you do sets of Kegel exercises and not aim to do too many at once.

Like any other exercise programme, success lies with gradually building on what you can do, establishing what your personal threshold is and then maintaining it.

It is important not to tense or squeeze the muscles in your tummy, bottom or your thighs when you are doing Kegel exercises.

At first, try squeezing your pelvic muscles and holding for the count of 5 seconds.
10 repetitions, taking 10 seconds for each, 3 times a day is the goal.
At first, the more slowly you do them the better.
As you get better, try squeezing and relaxing your muscles more quickly so that you are holding them for around one second each time. Repeat this 10 times.
If you feel your strength building, you could try isolating each set of muscles which support your urethra, vagina and anus. Working from front to back, gradually tense and then relax each of these muscles in turn. Now work back the other way.
Try stopping your urine flow mid-stream, hold for a second or two and then proceed to empty your bladder. It is important you do this, so that any residual urine does not stay in your bladder and potentially cause a urinary tract infection.

If you are going to antenatal classes, you’ll find some information on pelvic floor exercises is included. It is important to read what you can, so you are able to develop a good understanding of what is involved. Like any form of exercise the effectiveness of pelvic floor exercises relies on how frequently and how well they are done. Don’t expect miracles within a couple of days.

If you’ve never thought about your pelvic floor muscles before and are confused about where they are, ask your midwife or obstetrician to help you. Physiotherapists specialise in muscular and joint issues and you could benefit from seeing one with a special interest in antenatal and postnatal care.