The Pelvic Floor:

Pregnancy, Postpartum and Beyond

If you are pregnant, you have likely heard of "Kegal" exercises. Whether from a friend, or magazine article, or in an exercise video or prenatal class, the message is all around us - strengthening the pelvic floor muscles during pregnancy is essential. However, most women don't really know what the pelvic floor is, or how to strengthen the muscles. Even among women who have received instruction, studies show that at least 50% do the exercises incorrectly.

"Kegals" are exercises designed to strengthen the pelvic floor muscles. The pelvic floor muscles are integral to core stability, organ support, and aid in the control of urine and stool. As pregnancy places a great deal of stress on these muscles, strengthening the pelvic floor during pregnancy is crucial.

A strong pelvic floor will ensure proper support for the baby during pregnancy, promote better muscle function during delivery, and will help to promote healing and prevent potential consequences of delivery after birth. Healthy pelvic floor muscles have the ability to effectively contract as well as fully relax. These functions are equally important during a vaginal delivery, and in order to strengthen the muscle effectively.

No matter how smooth your delivery, some damage has been done to the pelvic floor (damage to the soft tissues including strain, stretching, tearing of the pelvic floor muscles, connective tissues, ligaments and nerves). This can contribute to pelvic pain, weakness, and incontinence. Pelvic floor muscle weakness can go unnoticed for some time. Symptoms of incontinence or organ prolapse may appear later after a cold, with sudden heavy lifting, birth of another child, menopausal hormone changes, and increase in body weight.

Here is how to get started or progress the pelvic floor muscle exercises you are already doing:

The Pelvic Floor Muscles

The pelvic floor muscles line the bottom of the pelvis and are made up of a group of muscles that ideally work together in balance to provide the support needed.

They are attached on the pubic bone, inside the walls of the pelvis and on the tailbone. There are two components to the action of the muscles. There is a squeezing action (imagine drawing your tailbone towards your pubic bone) and a lifting action (imagining squeezing an inserted tampon and trying to lift it up deeper inside you).

It is important to isolate the pelvic floor muscles while training them.

Contractions should be intense, but should not involve bracing with the abdominal, leg or gluteal muscles. These muscles will try to compensate if there is a weakness, and may start to activate as the pelvic floor muscles fatigue. This is a good indication to stop to give your pelvic floor muscles a rest. Maintain a natural breathing pattern while performing the exercises. Do not hold your breath.

Pelvic Floor Muscles Exercises

The following are suggested exercises to train the different muscles fibres and functions of the muscles. The exercises may be started in a lying position and progressed to sitting and standing.

Do what you can handle without pushing the pelvic floor muscles beyond the point of fatiguing, no matter what your level of strength, endurance or intensity is. You will gradually increase the time and intensity you are able to hold for.

Do 2 to 3 sessions of each exercise per day.

Strength

Contract maximally

Hold for 5 sec

Relax 5-10 sec

Repeat 10 times 2-3 sets

Progress to 10-12 sec holds for 3 sets

Endurance

Contract at about 20-50% of maximal effort

Hold for 10 sec

Rest 5-10 sec

Progress to 30 sec to 1 min

Hold

Speed

Contract maximally and quickly,

and then release completely as quickly as possible

Try 5 in a row

Rest 5 sec

Repeat 3-5 times

Progress to 10 contractions in a row

Proprioceptive Elevator

Tighten the muscles gradually one floor at a time

Holding for 5 sec at each floor

Gradually relax one floor at a time

Rest 5-10 sec

Repeat 5 times

Progress to 4 floors and then hold for 10 sec at each floor

Wave

Tighten the muscles one section at a time, start by contracting around the anus (trying to prevent the leakage of gas).

Relax

Next, contract around the vagina (trying to hold a tampon in place and lift it up)

Relax

Finally contract the muscles around the urethra (trying to hold urine)

Relax

Hold each section for 3-5 sec

Repeat 5 times

Progress to 10 sec hold

It is important to have a good release and complete relaxation of the muscle. Ensure that you continue deep, relaxing breaths and that you allow for enough time to relax the muscle properly between contractions.

Try to contract the pelvic floor muscles prior to activities which increase the pressure on the abdomen suddenly or forcefully. Contract the pelvic floor muscles just before and during coughing, sneezing, laughing, and lifting.

Pelvic floor muscle exercises can be started as early as 24 to 48 hours post-delivery. Begin by gently contracting your pelvic floor muscles a small amount, even if you have stitches. This will encourage blood circulation and encourage healing in the area.

Try to resume your pre-delivery exercise program of pelvic floor exercises over the first few weeks post-partum.

Always practice within your tolerance, gradually increasing the intensity and length of hold and number of repetitions. Be patient if the muscle feels weak at first, the strength will resume over time. Eventually you will only need to do one session of the exercises, three times a week to maintain the strength that you have attained. It is recommended to maintain this practice as a lifelong routine to prevent incontinence, pelvic organ prolapse, and to maintain a strong and healthy core.

It is important that you seek help if you have any difficulty with the pelvic floor exercises, pelvic pain or a sense of vaginal heaviness, or if you have symptoms of incontinence that do not improve with the exercises. Registered Physiotherapists that have post-graduate training in this specific area will be able to give you personalized advice to treat your particular symptoms at any point during your prenatal or post-partum period. Remember that you are building a strong core foundation for the coming years and by incorporating these fitness exercises into your life you will save yourself much grief by avoiding some potential problems that result from pelvic floor dysfunction.