Pelvic floor in pregnancy and after

What is the pelvic floor and why does it matter in pregnancy?

The pelvic floor is a set of layers of muscle and connective tissue along the base of your pelvis⁶. It forms a bowl that supports and controls your bladder and bowel⁷, and it supports your womb¹. It helps you hold in wee, wind and poo⁶.

These muscles work gently most of the time and harder when pressure in your abdomen rises, for example when you cough, sneeze or lift⁷. During pregnancy they are stretched and may become weak⁶. Pregnancy and childbirth are established risk factors for leaking wee, which is common in women and can lead some to stop exercising⁴.

That is why your pelvic floor is worth a little time. Pelvic floor exercises are rarely reported to cause harm⁹. Healthcare providers are advised to shape any plan around your health, what you're able to do, and safety for you and your baby⁸. If you're pregnant, ask your midwife or doctor which plan suits you.

How do you do pelvic floor exercises?

Tighten the muscles around your back passage as if you're trying to stop yourself going to the toilet. At the same time, draw up around your vagina and urethra as if you're stopping the flow of wee³.

• Start with quick squeezes: tighten, then let go straight away³.
• Then try slower holds: hold for as long as you can before you relax, building up towards a count of 10³. Holds of no longer than 10 seconds are also suggested¹⁰.
• Breathe normally and don't pull in your stomach¹⁰.
• How often: suggested amounts include three sets of eight squeezes every day³, or building up to 10 repeats of each type of squeeze at least 3 times a day¹⁰.

These exercises work best with guidance: they are effective when done with a trained professional⁴. So ask a midwife, doctor or physio to check your technique.

Keeping going is often the hard part. Lack of time, convenience and boredom get in the way, while encouragement from others and digital tools help¹¹. Linking a set of squeezes to something you already do, such as meals, gives you an easy cue³.

If the exercises cause pain, ease off. If the pain persists, see a midwife, doctor or physio.

What if you leak when you exercise, cough or laugh?

Leaking when you cough, laugh or exert yourself is the most common type around pregnancy and birth¹², and it is common: about 1 in 3 women leak wee after having a baby¹³. A lot can be done to reduce or prevent it, so you don't need to suffer in silence or feel embarrassed.

Pelvic floor training is the best-supported first step. In women with this kind of leaking, many more who did the training reported cure or improvement than those who had no treatment or an inactive one¹⁴, and it is recommended as the first treatment⁵.

In pregnancy, one point is different. Training helps prevent leaking in women who aren't leaking yet². Whether it treats leaking that has already started in pregnancy isn't clear yet⁹. If you're already leaking, raise it with your midwife, doctor or physio.

You don't need to give up being active. No one is advised to stop exercising because of leaking, and mild-to-moderate activity such as walking tends to lower the risk, while more leaking is linked with higher-impact activities⁵. Keep up gentle activity such as walking, and start your pelvic floor exercises. If leaking is getting worse, or high-impact activity makes it worse, ease off to gentler activity and get advice.

If leaking carries on despite the exercises, ask a midwife, doctor or physio for help. In some places you can refer yourself to a physio.

When to check with a health professional

If you're starting exercise after a long break, it's always a good idea to see your doctor first. For an injury or a health condition, see a health professional, such as your doctor or a physio.

Some pregnancy conditions mean exercise should be avoided or only done with your care team's agreement, so check with your midwife or obstetric care provider if you have a known condition^15,16.

A bulge, or a heavy dragging feeling inside the vagina, is worth raising with a doctor, midwife or physio. After birth, you can ask a doctor, midwife or health visitor about any physical problem at any time. For anything else that is sore or uncomfortable, ease off, and get advice if it persists.

Call your local emergency number for chest pain or pressure (or pain spreading to the arm, neck, jaw or back, especially with sweating or feeling sick), severe breathlessness, fainting or collapse, signs of a stroke, a serious injury, or someone who isn't safe.

In pregnancy and after birth, some signs need the midwife, doctor or maternity unit straight away, even when they seem mild: bleeding from the vagina, fluid leaking, regular painful contractions, the baby moving less than usual, pain or swelling in a calf, a bad headache or changes in vision¹⁵. If you have regular painful contractions, stop exercising and seek advice. Call your local emergency number for heavy bleeding, chest pain, severe breathlessness or collapse.