Pelvic Floor Training During Pregnancy

The pelvic floor muscles are often not the first muscles that come to mind when we refer to the core, but they are among the most important, especially during pregnancy.  Properly functioning pelvic floor muscles can be the key to avoiding pregnancy pains and injuries, improving pushing, and minimizing tearing and other trauma during delivery.  However, there is certainly a right and wrong way to “train” these muscles during pregnancy, and traditional guidance of encouraging women to simply “contract and squeeze” their pelvic floor muscles could lead to more harm than good.  Read on to learn more about these important deep core muscles, and how to train them most effectively during pregnancy.

Pelvic Floor Structure & Function

The pelvic floor (PF) muscles form a sling at the bottom of the core, basically creating the “floor of the core.” They consist of superficial and deep layers, and have both slow and fast twitch muscle fibers. The PF muscles attach from the pubic bone in the front to the tailbone in the back, and from the “sits” bones (ischial tuberosities) on both sides.

Together, these critical deep core muscles are responsible for:

  • Supporting the pelvic organs: bladder, bowels, and uterus
  • Providing core stability, working with TVA to stabilize and support spine
  • Controlling continence
  • Supporting proper sexual response and satisfaction
  • Assisting in guiding baby out during delivery

The Role of the Pelvic Floor Muscles During Pregnancy

During pregnancy, the PF muscles must be strong enough to support the added weight of the growing belly and uterus (which grows to about 500 times its original size during pregnancy).  The PF muscles must also be strong enough to help counteract the destabilizing effects of relaxin — a hormone that softens a woman’s joints and ligaments to provide added mobility for childbirth.  The combination of a growing belly (which throws off a woman’s alignment and center of gravity) and relaxin (which decreases her stability) can lead to a host of injuries.  However, strong and properly functioning PF muscles can help resist these issues.

The PF muscles also help guide the baby out during childbirth.  Therefore, they must be able to fully relax and open to allow the baby to pass through.  When a woman has the ability to fully contract and fully relax her pelvic floor muscles, she is much more likely to have the control necessary to prevent significant tearing during delivery.

How to Properly Train the Pelvic Floor Muscles

Given the above, the key to proper pelvic floor training is helping your clients develop good control through a full range of motion.  This means knowing how to contract the muscles, but also (perhaps even more importantly) how to fully relax them.  This can be a bit tricky to learn, so watch this video carefully to learn how to find all the pelvic floor attachment points, and activate them properly.

It’s a good idea to encourage your pregnant clients to do a few sets per day of the Pelvic Floor Activations described in this video (PFAs-Slow and PFAs-Fast), where 1 Set = 3-5 PFAs-Slow + 8 – 10 PFAs-Fast.  You don’t have to worry about making your clients do tons of these.  It’s more about getting to the point where they establish good control through a full range of motion.  You can also incorporate pelvic floor work into the beginning of your session, and program it into breaks.

Why don’t we use the term Kegel?

This is the first exercise that comes to mind for most people when they think of pelvic floor exercises.  However, we try to avoid this term for two reasons.  First, because Kegels are often described by guiding women to “stop the flow of urine,” but as we discussed above, this only targets the front of the PF muscles.  The other reason we prefer to avoid this term is that Kegels have become synonymous with only the concentric contraction phase of the movement.  Women are often guided to “squeeze and hold their PF muscles,” but not as much attention is placed on relaxing or lengthening, which is equally (if not more) important during pregnancy.  Like any other muscle in the body, a focus on chronically contracting — and not working through a full range of motion — can lead to altered length-tension relationships, and potential pains or complications.

One Word of Caution

If your client is exhibiting symptoms such as accidental urine leakage during sudden movements like coughing, laughing, sneezing, or exercise, this could be a sign of pelvic floor dysfunction.  If you have been through our Pre/Postnatal Performance Training Education, you can work with clients with moderate symptoms (though if you do not see any improvement after 4 weeks, you should refer your client out, as they may need internal work that is outside your scope).  If you have not been through our education, it is best to refer your client immediately to a pelvic floor physical therapist.

Learn More…

To learn more about proper pelvic floor training, as well as pelvic floor recovery after pregnancy, register for training to become a Pre/Postnatal Performance Training Specialist.