Pelvic floor exercises

One set of exercises that all women - pregnant or not - should learn to do is pelvic floor exercises. The pelvic floor is the sling of muscles that forms the base to your pelvis. Exercising these muscles during pregnancy, and afterwards, will help tone them up, as well as make you more aware of them so you can relax them during the birth. Exercising the pelvic floor after the birth may also help ease perineal pain.

Strong pelvic floor muscles also help prevent stress incontinence (the slight leaking of urine that some women experience when they cough or laugh) and prolapse, where the uterus slips down into the vagina, which sometimes happens in older women. Pelvic floor exercises are for life!

It can be hard to identify the pelvic floor muscles at first

• Begin by sitting on a firm chair like a wooden kitchen chair, with your feet flat on the ground
• Now tighten up the muscles around the vagina and then relax them. Try not to tighten the muscles of your buttocks. You will know if you are, because you will notice that your body lifts up a little
• Again tighten the muscles around your vagina and try to imagine them pulling up inside you. Hold this for a count of four and then relax them. Try not to hold your breath, or let your shoulders lift up while you do it
• Repeat the tightening, but this time make a point of breathing out slowly as you begin. Hold for a count of four and then relax

If you find it hard to identify which muscles are working, you can check by trying to stop the stream of urine when passing water. Start to empty your bladder, then squeeze the muscles so the flow stops, hold it for a count of four, and then continue, making sure you completely empty the bladder. Leaning forward on the loo seat can help to squeeze the last few drops of urine out. This stop/start technique is useful if you are asked for a midstream sample of urine.

Once you can begin to identify the correct muscles try this exercise

• Sit on a firm chair with your feet flat on the ground as before, and imagine your pelvic floor muscles are the lift in a department store
• Squeeze your muscles so the ‘lift’ rises to the first floor and rests, then goes onto the second floor and rests, and then rises to the third floor and stops
• Hold it there for a count of four, then let the lift go back down to the second floor, rest and then down to the first floor, rest and then down to the ground floor

Many women find it easier to take the ‘lift’ up the floors than down. Don’t worry if you find you cannot stop the lift on the way down. It takes practice, and as your pelvic floor gets stronger, you will find that your control increases as well.

Relaxing the pelvic floor is useful during the birth of your baby as it makes it easier for your body to stretch and give as the baby is born. To learn how to relax the pelvic floor, repeat the lift exercise, and when you get back to the ground floor imagine the lift going down to the basement. Try relaxing your jaw and letting your mouth sag open at the same time. Tighten your muscles slightly so the ‘lift’ comes back to the ground floor at the end of this exercise.

The pelvic floor needs regular frequent exercises to increase strength and control. Try to make sure that you do the lift exercise several times a day in batches of four or six. Since all the muscles you are exercising are internal you can do it while doing other tasks, and no one need know. Try to give yourself regular reminders by planning to do them every time you do certain things such as:

• Putting the kettle on
• Washing your hands
• Meeting a red traffic light when driving
• Waiting for a bus or train
• Sitting down at work
• Thinking about your baby

Once you can do the lift exercise, try changing the speed you do the pull ups for greater flexibility and control. Do four tightenings, followed by four quick pull ups, and then four more tightenings.

After your baby is born, pelvic floor exercises will help get the blood flowing through bruised or damaged soft tissues and help with healing. Start moving your pelvic floor as soon as you can; the muscles will have stretched and they may feel much less responsive. By squeezing and relaxing the muscles as often as you can you will improve the strength and control.

Find yourself some new reminders to do the exercises: every time you change your baby, or whenever he cries! If your pelvic floor is very weak after the birth talk to your midwife or ask your doctor to refer you to an obstetric physiotherapist. She can teach you more pelvic floor exercises and can offer other treatments to help tone up the pelvic floor. Read more about other types of exercising during pregnancy:

• New to exercise?
• More experienced?
• Your baby and exercise
• Unsafe exercise

Reviewed by babyworld midwife Hannah Hulme Hunter