Your Pelvic Floor

Some of your core muscles, in particular your pelvic floor and transverse abdominis (TA) are involved in labor. Having those muscles be as strong and flexible as possible during labor while greatly ease your baby’s entry into the world and you’ll be grateful for that.

But what about strengthening the pelvic floor during pregnancy and after? The pelvic floor is a group of muscles that act as a sling to the bottom of your core. As you can see in the image below, the pelvic floor muscles stabilize the joints around the pelvis.

Pregnancy, childbirth and decreasing estrogen weaken these muscles. BUT these muscle fibers can be trained! Like any muscle group, you have to specifically target these muscles. You wouldn’t swim to train for a marathon right? So let’s find the correct muscles to train.

The moves are less intense and obvious, for the pelvic floor you are going to stimulate muscles you won’t necessarily feel all the time. Sometimes it can take several tries to make your brain communicate with your pelvic floor.

A study published in the American Journal of Obstetrics and Gynecology found that moms who’d had a c-section were less likely to do pelvic floor exercises, probably because they didn’t push the baby out with the pelvic floor. But it’s pregnancy itself that affects the pelvic floor, so pelvic floor exercises are a must for every moms. It’s important to note core stability is a key component of pelvic and core health. You can find all of the core stability and pelvic floor exercises in the Prenatal and Postnatal Exercise Guide.

3 Key Exercises for the pelvic floor

Perform these seated, sitting on a Swiss ball or standing — really you can do these anywhere, but seated on a ball will help you identify the pelvic floor muscles.

  • Hold Ems
    • Squeeze and lift the pelvic floor muscles. Think about using the muscles that you use to stop the flow of urine or hold in gas.
    • Hold for 5-10 seconds (you should be able to talk while you do these so you don’t hold your breath). And relax for 10 seconds.
      • It is just as important to learn how to relax these muscles as it is to turn them on, so don’t skip that step!
    • Do 10 contractions. Try to get in about 4-5 sessions of these puppies a day.
  • Quick Squeezes
    • Now contract those same muscles quickly 5 times. Don’t hold. We’re training motor control here… fancy term for retraining that brain to turn them on/off quickly. Relax for 10 seconds after your 5th quick contract.
    • Repeat 10 times.
  • The Kegel
    • Kegel is-a simple exercise you can do while sitting, standing or getting ready for bed. And nobody will even notice you’re “exercising” the pelvic floor. Act as though you are stopping the flow of urine, hold for 10 seconds and release. Repeat as often as you like-reach for at least 10 times a day.
    • The pelvic floor is not meant to be “turned on” all day.The Kegel was discovered in 1948 when Dr. Kegel observed that women in South Africa had stronger vaginal muscles. The reason was midwives there would have the new mother contract the vaginal muscles on distended fingers for the weeks following birth.

Should I see a physical therapist? My answer is always yes. In just 1-2 sessions a women’s health physical therapist can look at your movement patterns to determine if your pelvic floor is turned on too much, or not turning on as much as it should. A physical therapist can also help with any pain associated with your pelvic floor.

Incorporating the pelvic floor into Core Exercise

Now that you know how to perform a kegel, it’s important to incorporate it into everyday exercise. To work all the layers and aspects of the pelvic floor, I am going to introduce you to the transverse abdominis, another inner layer of the core.

Using the transverse abdominis muscle is a big part of getting your belly healthy again. As you can see from the image above, the TA is a thick layer of muscle. The transverse abdominal muscle wraps around the torso from front to back and the muscle fibers of the TA run horizontally, similar to a corset or a weight belt. These muscles, one on each side, are your true core muscles and strengthening them will give you power and tone your entire body.

In order to fully engage your abdominals, and in particular your transverse abdoinimis transverse (TA), you have to pull your belly button in toward your spine. This engages the TA, and also works on the other muscles that run along your spine as well as your abdominals. You’ve probably engaged these muscles without even knowing it when you put on your skinny jeans.

Pulling your belly button toward your spine is NOT the same thing as sucking in your gut. What do you when you suck in your gut? You hold your breath, you tuck your hips. You don’t want to do that. We cue these important exercises in all of our workout programs.


Pelvic Pain, Dysfunction and Prolapse

Pelvic Pain

Relaxin is great for helping the pelvis and rib cage to expand to fit your growing baby. But it will also cause loose joint stability, and can lead to pelvic pain both during and after pregnancy. Relaxin remains in the body while breastfeeding.

Your pelvic floor just carried all the weight of that baby for 10 months, and then you went through delivery. Vaginal deliveries involve the trauma of making room for the baby to come through, and cesarean deliveries involve disruption of the tissues in the front of your abdomen. Both have a significant impact on our pelvic mechanics and ability to perform all our normal activities and jobs in a pain free manner. As mentioned above, relaxin causes laxity in our ligaments. Our pelvis is made up of bones that are tethered together by the ligaments and muscle tendons surrounding the pelvis and sacrum. And there are a bunch them!

It is important to keep working the core with the pelvic tilts, kegels, and foundation moves. Download our Prenatal and Postnatal Exercise Guide for more info! Additionally, some women find it feels better to have compression through the pelvis and use a support belt.

It is best to avoid certain moves and exercises. You should avoid the following:

It is best to avoid certain moves and exercises. You should avoid the following:

•abductions (where the leg moves away from the body)

•uneven leg distribution, such as side squats

•moves where the feet are further than hip width apart

•or any move that causes pain or distributing the pelvis area unevenly, such as crossing the legs.

Pelvic pain can be tricky to address on your own as there are so many things that impact pelvic mechanics, pelvic floor health, and trauma that can occur during delivery. If you are having pelvic pain that is not going away with gentle exercise, stretching, or a postnatal exercise program, please follow up with a women’s health physical or physiotherapist. Their job is to assess the cause of your pain and help you get back to life faster and teach you how to take care yourself. You could be sitting or standing with a slight pelvic rotation and this can cause other issues like knee pain. Do not put up with pelvic pain, ladies! It can be so debilitating.

Pelvic Dysfunction

Pelvic dysfunction and subsequently, incontinence, can result from trauma to the nerves in the pelvis, causing the pelvic floor muscles to spasm. More than 30% of women of childbearing age are coping with this aftereffect of pregnancy. These conditions may heighten a woman’s pain and anxiety if she participates in wide-stance or prolonged sitting exercises and/or high-impact activity, try to be sensitive to her resistance to these movements, even if she is shy about telling you outright what her concerns are. In addition, episiotomies and natural tears can cause pain when scar tissue attaches to the tissue in the pelvis. A woman can actually reduce the thickness of the scar tissue by massaging it after her incision or tear has healed. [references below]

Recovery rates are high, but decrease with severity of pain.

Symphysis Pubis Dysfunction

This condition can be almost debilitating to a pregnant woman and can produce symptoms months after delivery. To ease the symptoms, you should work the pelvic floor muscles. It is best that you work one-on-one with a medical professional/physical therapist.

Pelvic Organ Prolapse

Some women also lack control of their bowel movements and the exercises above will help with that as well. A more serious difficulty can develop. In the most serious cases of disruption of or damage to the muscles of the pelvic floor, your muscles could prolapse. Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The uterus is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress. And you will want to see your doctor about this condition.

References from Prenatal and Postnatal Fitness Specialist:

15. Hyatt and Cram, p. 135.

16. Aston, B. Preventing pelvic floor dysfunction: childbearing women deserve better care. Abstract. J Fam Health Care. 2009;19(5):150-1. Retrieved from: PubMed. < pubmed/19911728>.

17. Vogel, p. 6.

18. Hyatt and Cram, p. 135.

19. Hyatt and Cram, p. 136.

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