What is the Pelvic Floor?

The pelvic floor is a group of muscles, ligaments, and tissues that stretch like a hammock across the base of your pelvis. These muscles support your bladder, uterus, and bowel, controlling urinary and bowel function while playing a critical role in sexual health. During pregnancy, your pelvic floor muscles are under increased pressure as they support the growing weight of your baby, and they play a key role in labor and delivery.

Why Pelvic Floor Health is Crucial During Pregnancy

Pregnancy places unique demands on your pelvic floor, making it essential to strengthen and maintain these muscles throughout this period. Maintaining a strong and functional pelvic floor during pregnancy can:

1. Prevent Urinary Incontinence
   Pregnancy is a major risk factor for urinary incontinence due to increased pressure on the bladder and weakened pelvic floor muscles. Studies have shown that pelvic floor muscle training (PFMT) during pregnancy significantly reduces the risk of urinary incontinence, both during pregnancy and postpartum (Level 1 evidence). Women who perform PFMT are less likely to experience stress incontinence (leakage of urine during coughing, sneezing, or exercise) during and after pregnancy.

2. Support the Growing Baby
   As your baby grows, your pelvic floor muscles bear the increased load. Weak pelvic floor muscles can lead to a feeling of heaviness or discomfort, particularly in the third trimester. By maintaining pelvic floor strength, you provide crucial support for your baby and reduce the risk of pelvic organ prolapse, a condition where the pelvic organs descend due to muscle weakness.

3. Ease Labor and Delivery
   Strong pelvic floor muscles can make labor easier by promoting efficient pushing during the second stage of labor. Studies indicate that pregnant women who practice pelvic floor exercises have better muscle control during childbirth, leading to shorter labor times and a reduced need for medical interventions like forceps or vacuum-assisted delivery (Level 1 evidence). Additionally, having a healthy pelvic floor can aid in recovery after birth.

4. Prevent Pelvic Organ Prolapse
   Pelvic organ prolapse occurs when the pelvic organs (such as the bladder, uterus, or rectum) drop from their normal position due to weakened pelvic floor muscles. Pregnancy and childbirth are major risk factors for this condition. Regular PFMT has been shown to reduce the risk of developing pelvic organ prolapse, both during pregnancy and postpartum (Level 1 evidence).

How to Maintain Pelvic Floor Health During Pregnancy

Maintaining pelvic floor health is simple and can be integrated into your daily routine with exercises that strengthen and protect the muscles. Here are some strategies:

1. Pelvic Floor Muscle Training (PFMT)

Also known as Kegel exercises, PFMT involves contracting and relaxing the pelvic floor muscles to strengthen them. The key is to perform these exercises correctly and consistently.

Here’s how to do them:

1. Identify your pelvic floor muscles: Imagine you’re trying to stop the flow of urine midstream. The muscles you engage are your pelvic floor muscles.

2. Perform the exercise: Contract these muscles for 5-10 seconds, then relax for the same amount of time. Repeat 10-15 times in a session, aiming to do three sessions daily.

3. Progress over time: Gradually increase the duration of each contraction as your muscles strengthen.

A Cochrane review confirmed that pregnant women who perform regular pelvic floor exercises are significantly less likely to experience urinary incontinence and pelvic organ prolapse postpartum (Level 1 evidence).

2. Proper Posture and Body Mechanics

Good posture during pregnancy is essential to reduce strain on your pelvic floor. When standing, maintain a neutral pelvis by avoiding excessive arching of your lower back. When sitting, use a support cushion and avoid slouching.

3. Avoid Excessive Straining

Straining, whether during bowel movements or while lifting heavy objects, can weaken your pelvic floor muscles. To prevent constipation, which can lead to straining, consume a high-fiber diet, stay hydrated, and engage in regular physical activity.

4. Stay Active

Engaging in low-impact exercises such as walking, swimming, and prenatal yoga can help maintain pelvic floor health without placing too much strain on these muscles. A systematic review of exercise during pregnancy found that physical activity, combined with PFMT, improves pelvic floor function and reduces the risk of incontinence (Level 1 evidence).

5. Breathing and Relaxation Techniques

Learning how to coordinate your breathing with pelvic floor muscle engagement can help you maintain strength and prevent over-tightening of these muscles. During pregnancy, it’s important not just to strengthen the pelvic floor but also to learn how to relax these muscles—especially for labor.

When to Seek Professional Help

While many women can manage their pelvic floor health with regular exercises, some may need extra support. If you’re experiencing pelvic pain, incontinence, or a feeling of heaviness or pressure in your pelvic area, it’s essential to seek advice from a pelvic floor physiotherapist. Early intervention can help prevent more serious issues, such as pelvic organ prolapse or severe incontinence.

A pelvic floor physiotherapist can:

• Assess your pelvic floor muscles

• Teach you proper exercise techniques

• Provide personalized advice and modifications based on your pregnancy

Conclusion

Pelvic floor health during pregnancy is essential for preventing incontinence, supporting your baby, and ensuring an easier labor and recovery. By incorporating pelvic floor muscle training into your routine and staying mindful of your posture, body mechanics, and overall activity levels, you can maintain a strong and healthy pelvic floor. If you’re unsure about how to perform these exercises or if you’re experiencing discomfort, don’t hesitate to seek guidance from a physiotherapist specializing in women’s health.