As every prenatal guide will tell you: “You must strengthen the pelvic floor during pregnancy!” This is true. Ish. It’s very important to keep your core muscles strong & active. They are crucial in supporting your pelvic organs (uterus, bladder, bowel) during & post-pregnancy, regardless of whether you have a vaginal or cesarean birth.
However, there are a LOT of guides telling you to constantly “squeeze” your pelvic floor muscles, repeat them a million times per day & constantly remember to be lifting them up & in. “Do your Kegels.” This is misleading & leaves out the crucial role that your core muscles play – support AND release. That baby will have a hard time coming out if your pelvic floor is being pulled upwards.
The pelvic floor isn’t just one muscle. It’s a group of muscles that sit like a sling at the base of your pelvis. They connect from your public bone at the front, to your coccyx (tailbone) at the back, and the 2 sit bones on either side. They act as a base for your pelvic organs & also support the stability of your pelvis & spine. They include your vaginal muscles, as well as the sphincters that surround your bladder & anus. Therefore, they’re crucial in the role of peeing, pooping & supporting sexual function too. They do a lot!
Signs that your pelvic floor is not functioning correctly, either before or after birth, can include : urine leakage (like when you laugh or sneeze), difficulty going to the toilet, vaginal heaviness, pain during intercourse, and pelvic pain & lower back pain. In severe cases, women can experience pelvic organ prolapse, which is where the pelvic organs bulge into the walls of the vagina.
Strengthening the pelvic floor & getting your core muscles to function optimally will reduce your likelihood of these problems. It will also make your recovery from birth (no matter how you deliver) easier too.
Unfortunately, we’re often not taught how to engage these muscles correctly. Below is a list of common mistakes I see & hear about, as well as a guide to getting your pelvic floor functioning properly.
1. You’re doing a million Kegels
These are not really the best pelvic floor exercises. They’re only a small part of the equation, however, they are probably the most well-known pelvic floor exercises. They basically involve the feeling of “pulling up” or stopping yourself from urinating. This isn’t wrong as such, but there is so much more to it. The pelvic floor muscles wrap around from front to back. So it’s not just the feeling of stopping urine, we need to feel like we’re stopping ourselves from passing wind too.
The other part of the equation that Kegels fail to address is that our pelvic floor works in conjunction with the rest of your core muscles. These include your deep transverse abdominous, internal obliques around the sides of the core, the multifidus at the back, and your diaphragm on the top. These muscles work together in order to provide support & stability for your pelvis & spine. Imagine your core is like a cylinder – a good, strong support wrapping in from all sides as well as the top & bottom. If you remove one of the sides, the contents will spill out. This is why we not only need good pelvic floor activation, we must use all the core muscles collectively for the most functional results.
2. You’re tightening & lifting the pelvic floor without learning how to release the muscles too
Tight muscles are not strong muscles. Imagine holding a heavy object in your hand and then lifting it up towards your shoulder. Consider how your biceps would feel pulling that heavy object up 1,000 times a day. The biceps would be tight & overworked & eventually, it would be difficult to straighten your arm. Your pelvic floor acts in much the same way – repetitive tightening & lifting leaves them feeling tense. And most importantly – not functional. If we look at the location of the pelvic floor, we can easily see that these muscles are needed for going to the bathroom. They need to release. And the same goes for delivering a baby. So while we should practice lifting & engaging the pelvic floor, it is crucial we learn to release them fully & with control. Your pelvic floor muscles also need to be mobilized. Several of these muscles connect to your hips & lower back so creating movement that safely moves these joints in conjunction with pelvic floor support is important.
3. You’re doing your pelvic floor exercises anywhere at any time
I find a lot of prenatal guides will tell you to practice your Kegels when you’re stopped at a red light, or if you’re waiting in line at the supermarket, etc. While it’s good to have a reminder of when to do exercises, these positions miss a fundamental component of good pelvic floor connection – your pelvic floor relies on a neutral spine to function properly. Seated in your car, are you slumped back into the seat, shoulders rounded as you hold the steering wheel? Standing in line at the supermarket, are you leaning onto one hip, carrying a basket in one hand? Neither of these positions put your spine in a good position. If you’re in neutral, there won’t be any tension on one side of your core & the muscles can contract in good alignment. The muscles will be evenly balanced from front to back. If your spine is rounded or you’re leaning on one leg, you’re pulling the pelvis & spine out of neutral & your core muscles are already overworked on one side just to hold this position.
So how do we find a good pelvic floor connection without overly tightening the muscles?
So here are some of the best pelvic floor exercises you can do during pregnancy & postpartum. First of all, get yourself into a good neutral spine position. You can do this seated or lay on your back with your knees bent (if you’re in your 2nd or 3rd trimester of pregnancy, avoid laying on your back for any more than 5 minutes).
Lengthen through the spine & ensure there is a small, natural curve of your lower back. If you’re sitting, you should feel even weight through both sit bones. Feel the ribcage draw up & away from your hips, but avoid popping the ribs forward or slouching into the upper back. The ribcage should sit over the top of the pelvis.
Deep, diaphragmatic breathing is your best friend in training the pelvic floor. Staying in a neutral position, take a long deep breath in through your nose, and slowly exhale out completely. You should feel your belly & chest expand on the inhale & soften on the exhale. Seeing as your diaphragm is one of your core muscles, learning to breathe fully & deeply will ensure the better function of your core as a whole (rather than holding the breath during exercise or taking short, shallow breaths instead).
2. Think of picking up a pea with your vagina & anus
This should be a subtle feeling of both the front & back of the pelvic floor connecting & lifting. Subtle as in 10-20% of the maximum you may be able to pull up. I find that any more of a “pull up” on the pelvic floor & other, stronger, nearby muscles will start taking over. You can also use the feeling of stopping yourself from peeing or passing wind, but make sure it is an internal lift, NOT the feeling of bearing down or pushing down. Once you have this feeling of lifting the peas up, add the connection to your breath. Inhale to prepare, then use your exhale to lift & connect, inhale to release. As you lift the pelvic floor, you can also engage your other core muscles at the same time. Imagine you’re lifting & then wrapping a tight corset around your waist. Remember, we want a slow, controlled release as you relax (not a “drop” or a sudden letting go).
3. Practice relaxing your pelvic floor completely
I like to teach this one in a really comfortable position where you don’t need to hold yourself up. Restorative yoga poses such as savasana, supta badha konansana or child’s pose are great options. Make sure you’re completely relaxed through your core & pelvic floor. Focus again on deep breaths. A long, slow inhale & a complete exhale. If you’re in your later stages of pregnancy, you may want to picture your cervix slowly opening like a flower as you do this, getting ready to prepare for labour. Let the muscles surrounding be soft & free. Exercises like cat/cow & kneeling hip circles are also a fantastic way to mobilise the muscles around the pelvis & release tension/tightness in the pelvic floor.
In our online programs, we cover prenatal courses & postpartum pelvic floor exercises & connections in more detail. We also take you through exercises to ensure you’re performing them correctly. Head here for more info.