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Your pelvic floor in pregnancy

Approved by the BabyCentre Medical Advisory Board Last reviewed: September 2013 Show references

Highlights

What is my pelvic floor? Why is my pelvic floor so important? How does pregnancy affect my pelvic floor? How will pelvic floor exercises help me? How do I find my pelvic floor muscles? How can I get better at exercising my pelvic floor? How often do I need to exercise my pelvic floor muscles? What else do I need to know about my pelvic floor?

VIDEO
Your pelvic floor
Understand how your pelvic floor works.

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, as it can stretch in response to weight, and bounce up again. Unlike a trampoline, however, if it bears weight for a long time, as it does during pregnancy, the muscles or tissues can become overstretched and weak.

Why is my pelvic floor so important?


Your pelvic floor supports your bladder, bowel and uterus (womb) and gives you control over when you empty your bladder and bowel. Having 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. You may accidentally leak a little wee when you cough, sneeze or exercise (stress incontinence). It also means that your bowel, bladder and womb arent well supported, causing you to feel a heavy dragging sensation. Your pelvic floor also affects your vaginal muscles. You may find sex less satisfying, and feel less sensitivity in your vagina, if you have weak pelvic floor. You'll need to keep your pelvic floor strong for the rest of your life, as hormonal changes after the menopause can make pelvic floor problems more likely. If your vaginal muscles are weak, it's possible for your uterus, bowel or bladder to sag down and push against the walls of your vagina (prolapse) . Doing just a few pelvic floor exercises every day will help to treat bladder weakness or prolapse symptoms, and will help to prevent problems later on.

How does pregnancy affect my pelvic floor?

Being pregnant can place a lot of stress on your pelvic floor muscles, which can lead to weakness before your baby is born. Your pelvic floor can become weak and stretched from as early as 12 weeks into your pregnancy. Constipation is common in pregnancy and can put even more strain on your pelvic floor.

How will pelvic floor exercises help me?


If you do your pelvic floor exercises correctly and often, it can help to protect you from leaking wee while youre pregnant and after your baby is born. It will also help to p revent a prolapse. If you havent been shown how to do pelvic floor exercises during your antenatal classes, ask your midwife about them at your next visit. Strong pelvic floor muscles may help to: Support the extra weight of pregnancy. Heal the area between your anus and vagina (perineum) after birth, by increasing the circulation of blood to it. Make for a more satisfying love life, by making orgasms during sex more likely.

How do I find my pelvic floor muscles?


Sit on the arm of a chair, or the edge of a table, and imagine that you're trying to stop yourself from passing wind at the same time as stopping your flow of wee, mid-stream. The feeling is one of squeezing and lifting, or pulling up and in, around your front and back passages, as if you are lifting your perineum off the chair or table. 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, but you shouldnt feel anything above your belly button. Try to hold this contraction for between six seconds and 10 seconds, and then relax. Try to feel the difference between when the muscles are relaxed, and when they are tight. You may feel more happening at the front, or you may feel it more around your bottom. As long as you can feel a tightening in at least one of these areas, you will be exercising your pelvic floor. You need to squeeze and lift without: Pulling in your upper tummy (above your belly button). Squeezing your legs together. Tightening your buttocks. Holding your breath. When you first try pelvic floor exercises, if you cant feel anything when you try them while sitting, try them while lying down. It may help you get a feel for where your muscles are. Once you know how to do the exercises in this position, doing them while sitting down will become easier.

How can I get better at exercising my pelvic floor?


When you first start exercising your pelvic floor muscles, you may find that you hold your breath as you squeeze. Youll need to learn to breathe normally as you do the exercises. 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 will relax when you cough or sneeze, and you may leak wee. To help you get the technique right, try the following exercise: Place one hand at the top of your bump, and the other on one of your shoulders. Breathe normally for four or five breaths. If your breathing is relaxed, your tummy should move up and down more than the hand on your shoulder. If this is not happening, try to stop your shoulders moving and let your tummy rise and fall naturally.

Gently pull your pelvic floor up and in, as you breathe out. Start with a gentle contraction until you have managed to coordinate your contraction with a breath out. Try then to hold a contraction for a few seconds, while you continue to breathe in and out as normal. It's fine to feel your lower tummy muscles tightening. But if you're tightening your upper tummy muscles (above your belly button), you're trying too hard. Go back to the breathing exercise, and start again. You should aim to be able to hold a pelvic floor contraction for six seconds to 10 seconds while breathing normally. If you lose your breathing control, stop and start again. There is a way to help you check if youre doing the exercise properly. Only do this check if you have not been told to avoid sex during pregnancy and don't have any bleeding or infections in your bladder or vagina. Gently insert one or two fingers in your vagina while having a bath. Start doing the exercises. You should feel a squeeze and lift inside your vagina if you are exercising your pelvic floor muscles correctly. Once you have got the basic exercise down to fine art, you can try fast pull-ups. Begin by making sure you are breathing in a relaxed way. As you breathe out, pull up your pelvic floor muscles, and let go quickly. Then try to pull up and let go quickly up to 10 times in a row, without holding your breath. This exercise helps your pelvic floor muscles to react quickly when you cough, sneeze or laugh. It only works if your pelvic floor muscles are already strong enough to support your pelvic floor, which is why it is important to master slow contractions first. It is much harder to learn how to do these exercises after your baby is born, so practise as much as you can while you're pregnant.

How often do I need to exercise my pelvic floor muscles?


Try doing them between eight and twelve times, three times a day, or more often if you sometimes leak wee. Try to do as many as you can as you go about your daily routine, so they become part of your life. To strengthen your muscles, do this many exercises for at least eight weeks. If you stop doing them after this time, your muscles can lose their strength. If you are over 35, and it is your first baby, it may take your pelvic floor muscles longer to recover after the birth. So its even more important to strengthen them while you're pregnant.

What else do I need to know about my pelvic floor?


It is just as important to learn how to relax your pelvic floor as it is to tighten it. When your babys head crowns during the second stage of labour, your muscles need to relax. Some midwives believe that a relaxed pelvic floor at this stage can help prevent tearing or an episiotomy. Also, if your muscles cant relax properly, they will tire more quickly. After you have tightened your pelvic floor muscles, relax them fully, before tightening them again. For some women, a gentle push out at the end of each pelvic floor contraction will help. Getting your breathing right will make this easier. You can also protect your pelvic floor by drinking fluids as you would usually, and only having a wee when your bladder feels full. It's quite normal to go to the toilet more often during pregnancy, though, so don't try to hold on for too long. 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 womens health physiotherapist or continence nurse. For more information on incontinence problems, contact The Continence Foundation.

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http://www.babycentre.co.uk/a536339/your-pelvic-floor-in-pregnancy#ixzz2gxkWtVVZ

Pelvic floor exercises


Reviewed by Mr Chris Dawson, consultant urological surgeon
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Pelvic floor exercises are sometimes called Kegel exercises, after the obstetrician who developed them. Another name for the exercises is pelvic floor muscle training (PFMT).

What kind of incontinence can they help?


Pelvic floor exercises are one of the first-line treatments for stress urinary incontinence (SUI). There is no evidence they are effective for urge urinary incontinence.

How effective are they?


In 1998 Norwegian scientists carried out a six-month trial on different treatments for SUI: pelvic floor exercises electrical stimulation vaginal cones no treatment. The women who did pelvic floor exercises showed the most improvement.

How do they help SUI?


The exercises are designed to: make your pelvic floor stronger make you more able to tighten your pelvic floor muscles before pressure increases in your abdomen, eg when you sneeze, cough or laugh.

How do you do the exercises?


Pelvic floor checklist
1. Identify the muscles. 2. Contract the muscles correctly. 3. Use fast and slow contractions Pelvic floor exercises are best taught by a specialist, eg a continence adviser or physiotherapist. Visit your GP or phone the Bladder and Bowel Foundation helpline for details of advisers in your area.

1. Identify the muscles


First you need to find your pelvic floor muscles. Try to tighten your muscles around your vagina and back passage and lift up, as if youre stopping yourself passing water and wind at the same time.

A quick way of finding the right muscles is by trying to stop the flow of urine when youre in the toilet. Don't do this regularly because you may start retaining urine. Once you've found the muscles, make sure you relax and empty your bladder completely. If you're not sure you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise.

2. Contract the muscles correctly


The movement is an upward and inward contraction, not a bearing-down effort. When you first start the exercises, check that you are doing them correctly. Put your hands on your abdomen and buttocks to make sure you cant feel your belly, thighs, or buttocks moving. Don't hold your breath. You should be able to hold a conversation at the same time, or try counting aloud while you're doing the exercises. Don't tighten the tummy, thigh or buttock muscles - you'll be exercising the wrong muscle groups. Don't squeeze your legs together.

3. Fast and slow contractions


You need to train your pelvic floor muscles through repetition, in the same way as you would train a muscle group at the gym.

Slow contractions
Slow contractions help to increase the strength of your pelvic floor. They help your muscles to hold back the urine. Lift your pelvic floor muscles to a count of ten. Hold the muscles tight for 10 seconds. You may find at first that you can only hold the contraction for one or two seconds, so concentrate on lifting your muscles and holding the contraction for as long as you can. Gradually increase the time until you reach 10 seconds. Relax your muscles and rest for 10 seconds. Repeat the contractions up to 10 times.

Fast contractions
Fast contractions help your pelvic floor to cope with pressure, for example when you sneeze, cough or laugh. This works the muscles that quickly shut off the flow of urine. Lift your pelvic floor muscles quickly. Hold the contraction for one second. Relax the muscles and rest for one second. Repeat the contractions 10 times.

How often should I do the exercises?


Try to do one set of slow exercises and one set of fast contractions six times a day. The Chartered Society of Physiotherapists also recommends that you do a quick contraction just before you cough, sneeze or laugh. You may also find it useful to do a fast contraction just before you get out of a chair. This is because the movement of getting up puts pressure on your bladder and pelvic floor.

How do I know they are working?


You can test your muscle strength with the stop-start test. When you urinate, partially empty your bladder and then try to stop the flow of urine. If you cant stop it completely, slowing it is a good start. Try the test every two weeks or so to see if your muscles are getting stronger. Don't do the test more often than this.

The pros of pelvic floor exercises


They're simple. They're cheap. They're effective. You can do them when sitting, standing or lying down.

You don't need any special equipment, but until you get into the habit of doing them, you may find that a tick chart helps to remind you to do your exercises. You can do them with or without vaginal cones.

The downside of pelvic floor exercises


You have to keep doing them for the rest of your life. It can take up to 15 weeks before you see any difference. If you haven't noticed a difference after three months, see your continence adviser again to check whether you're doing them correctly or if there's another problem.

NetDoctor shop
Elise: A discreet and compact pelvic floor exerciser designed for home use.It has programmes for Stress, Urge, and Mixed Incontinence as well as sexual wellbeing.
References Bo et al: Bo K, et al. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999;318(7182):487-93. Based on a text by Dr Dan Rutherford, GP Last updated 14.06.2012

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