Pelvic floor muscles 

These are a group of muscles stretching from your pubic bone in front to your tail bone. Along with the ligaments, connective tissue, and nerves in the pelvis, the pelvic floor muscles help to: 

• support of your pelvic organs 
• control of the bladder and bowel 
• sexual sensation 
• core stability 

During pregnancy and labour the pelvic floor muscles, tissue and nerves get stretched and sometimes injured, significantly increasing your risk of developing pelvic floor dysfunction. 

Signs of pelvic floor dysfunction include: 

• Stress incontinence - Leaking urine when you laugh, cough and sneeze 
• Feeling the sudden urge to urinate and not reaching the toilet in time 
• Prolapse (feeling a heaviness, bulge or a “stuck tampon” feeling in your vagina) 
• Constipation 
• Leaking stool 
• Pelvic pain- Lower back, sacroiliac and abdominal pain 
• Pain with sexual intercourse 

There is a strong genetic link with leaking urine and pelvic organ prolapse – if your mother, older sister, or grandmother has had incontinence or prolapse, you will be at an increased risk of developing these issues. 

Pelvic floor muscle exercises 

It’s important to keep your pelvic floor muscles strong during pregnancy but learning to relax the muscles is just as important. When the body experiences pain (like during labour) muscles will squeeze and tense up. The pelvic floor muscles will tense in response to pain as the baby is trying to birth through the vaginal opening. Learning (and practicing well before your due date!) to use your breathing to relax the pelvic floor, plus effective pushing techniques could help to decrease the risk of perineal trauma and tearing. Pregnancy yoga is a great place to learn these techniques! 

To engage your pelvic floor, try some of the cues below: 

• Stop the flow of urine 
• Try to stop passing wind 
• Once you have the squeeze and lift, try contracting your pelvic floor as your exhale. Avoid holding your breath or bearing down (like you are trying to pass a bowel movement) as you contract your pelvic floor muscles 

To practice relaxation, as you inhale imagine bringing the air all the way down into your ribs, belly and pelvis. Feel the perineum relax down. As you exhale, imagine the muscles of the pelvic floor melting (like chocolate or ice cream). Start with lying down and once you have the hang of this, practicing contracting and relaxing your pelvic floor in lots of different positions. 

Start with holding for about 5 seconds, and work up to 10 seconds or breaths at a time. You can even try some quick contractions/let go faster contractions. Remember it is never normal to leak so if you are leaking or if you can’t quite get the hang of this, have a chat with your pelvic floor physiotherapist. 

Squeeze your back passage. Think about bringing your pubic bone and tailbone together and up into your pelvis. 

General exercise is an important part of healthy living 

It improves your body and your mind, but women who are pregnant or have ever had a baby, are at greater risk of pelvic floor problems. These include leakage of urine, constantly having to go to the toilet, accidents with your bowel, and a heaviness or dragging sensation in the pelvic region.

Exercise in Pregnancy 

Exercise in pregnancy is recommended for every woman. Some women will be restricted in the exercise they can do for different reasons so it is really important to check with your Lead Maternity Carer if you are safe to exercise during pregnancy. Current guidelines suggest aiming for 150 minutes of moderate intensity exercise per week, with at least two strength/resistance training sessions per week. There is very limited research on higher intensity exercise and increased risk of pelvic floor dysfunction but this is something to chat with your pelvic floor physiotherapist about. They will be able to assess your individual risk factors and give you individualised advice. Even if you have never exercised, starting out in pregnancy is safe as long as you check with your LMC. It is important to train with a health and fitness professional who is specially trained in exercise during pregnancy. Always check what qualifications and training your health and fitness professional have completed to ensure they are safe to train you during pregnancy. 

Do I need to see a pelvic floor physiotherapist? 

It’s a great idea to see or even speak to a pelvic floor physiotherapist at some stage in your pregnancy. Earlier in your pregnancy, they can assess your pelvic floor and breathing, teaching you how to contract and relax your pelvic floor. You can also discuss any issues such as pelvic girdle or low back pain, wrist pain, constipation (good toileting technique is a must) and what is safe exercise in pregnancy for you. 

Closer to your due date, some pelvic floor physiotherapists will be able to assess your risk factors for developing pelvic floor dysfunction prior to birth. You can also get advice on pushing techniques and labour positions, plus what to expect in the early days post birth. Once baby has arrived a Post Natal WOF is always a great idea! It all seems a bit doom and gloom for the pelvic region…but don’t panic! If you develop any symptoms during or after pregnancy, or have an injury after birth, don’t worry. Get in touch with your local pelvic floor physio and chat about what the next step is in your pregnancy and postpartum journey. You have only got one pelvic floor, look after it!