Pelvic Floor Considerations in Pregnancy

Pelvic floor care during pregnancy is a bit more complex than just “do your kegels”. It is important to understand the changes that are happening in our bodies throughout pregnancy, and how to best care for ourselves so as to minimize the stress on an already stressed system.

Some of the changes that occur during pregnancy that may affect our pelvic floor muscles include: a growing belly, relaxing & stretching of ligaments/joints, weight gain, gastro-intestinal issues (such as constipation), form & posture changes, and stress/tension.

While certain things are out of our control (genetics, hormones, baby size & position) there are a few things that we can do to minimize the stress on the pelvic floor.

  1. Breath work – learning how to coordinate breath with pelvic floor contraction. This can be done anywhere, anytime, and in any position. Begin by taking a slow breath in, and at the same time relax your belly & pelvic floor. As you start to exhale (also slowly), GENTLY engage your abdominal muscles & “lift” your pelvic floor (think kegel, but not forcefully). Continue to coordinate the timing of your breath with your contraction & relaxation of the abdominals & pelvic floor.
  2. Breath + movement – using the breath technique above & incorporating it into exercise and daily activities. As a basic rule of thumb, you want to exhale as you complete the more challenging part of a movement (the lift of a heavy object, standing up from a squat/seated position, pushing something, etc.) Each person may have different tendencies, however (such as “bearing down” when breathing aka creating extra pressure down through the pelvic floor and/or out through the belly), and it’s important to check your form and breathing tendencies with a women’s health physical therapist and/or a pregnancy & postpartum coach.
  3. Exercise modifications – knowing when to make adjustments to training mode, intensity, form, etc. Your body is going through major changes throughout pregnancy, and the load on your pelvic floor increases as pregnancy progresses. Some indications that it’s time to adjust your training include pain anywhere in the body, pressure in the vagina, leaking of any kind, and the inability to maintain proper form throughout an exercise. The first thing you can try is to slow down the movement and check in with your breath, to see if you can still do the exercise with more control. Next, try decreasing the load/weight and range of motion. If you are still experiencing any symptoms, it might be time to choose a different exercise altogether. Remember that pregnancy is temporary, and consider the long term risk vs. reward of doing an exercise that may or may not be serving you at this time.

Final thoughts: I always recommend pregnant and postpartum athletes (and I believe that if you move your body, you’re an athlete!) should meet with a Women’s Health Physical Therapist both during pregnancy and postpartum. Pregnancy and Postpartum Athleticism coaches are also amazing resources if you need guidance with movement and exercise. Please don’t hesitate to reach out to me if you need guidance and/or a referral!

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