Antenatal pelvic floor exercises

The pelvic floor muscles are a group of muscles which run from the pubic bone to the base of the spine; they are stretched like a hammock.

These muscles:

• Provide support for the pelvic organs, the intestines, bladder, uterus and baby
• They help to control the bladder and bowel, they close the urethra (bladder outlet) and back passage (anus)
• They are important in sexual function
• They assist in childbirth
• Help to stabilize the spine

The pelvic floor muscles are kept firm and slightly tense to prevent leakage of urine, wind and faeces from the bowel.

The muscles relax when you pass urine or have a bowel movement, tightening afterwards so retaining control. Weak muscles means less control.

The pelvic floor muscles are also important to help increase sexual awareness for both partners during sexual intercourse.

During pregnancy, a hormone relaxin is released throughout the body. It softens the tissues, allowing the body to expand as the baby grows. It also allows the pelvic floor to stretch wide as you give birth.

The softening effect of the relaxin and the pressure from the increasing weight of the baby make it difficult for the pelvic floor muscles to keep the pelvic organs in their correct position. The pelvic floor muscles and ligaments are stretched at birth.

The muscles can be damaged:

• during pregnancy
• after childbirth
• due to raised BMI

• Exercising strengthens the muscles to improve support
• Improve bladder and bowel control to prevent leakage
• Being more aware of them helps you to relax them during childbirth, so helps during delivery
• Reduces constipation
• Exercising after birth will help to regain the strength and may help to ease perineal pain
• May also help to preventing prolapse in later life
• Pelvic floor exercises are for life

In order to identify the pelvic floor muscles you need to imagine you are trying to stop yourself from passing urine and wind.

The feeling is of’ lift and squeeze’, closing and drawing up of the front and back passages at the same time should be exercising the pelvic floor muscles. To start with, you will need to concentrate.

• Insert your fingers into the vagina, tighten the pelvic floor muscles, you should feel the muscles move around your fingers
• During sex, try to exercise the pelvic floor, ask your partner if they can feel the muscles tightening
• Check with a mirror, the skin between the anus and vagina (perineum) should move away from the mirror
• You can stop yourself passing urine mid flow with the pelvic floor muscles but you must only try this once and make sure you empty the bladder completely
• It is important that you use the correct muscles, specialist continence nurses and specialist physiotherapists can help

Try not to:

• Squeeze your buttocks
• Hold your breath
• Bring your knee’s together
• Lift your shoulders, eyebrows or toes

• Like any exercise it takes time to strengthen the muscles. Persevere and do the exercises regularly
• It is recommended that pelvic floor exercises are done daily for at least three months, then a few times a week for maintenance
• Use a trigger to remind you to do your exercises, washing up, a phone ringing, cooking
• You may find downloading the NHS Squeezy app onto your phone a good way of remembering to do your exercises.
• Don’t forget to use the pelvic floor when you most need it, squeeze every time you cough or sneeze.

• Aim to do a mixture of fast and slow ‘lifts’
• Repeat 5 to 6 times gradually increasing to 10
• Sitting with your feet flat on the floor, or lying down to start with. As you get stronger you may want to progress to standing.
• Gradually increase holding time to 10 seconds
• Repeat 3 to 4 times a day

Slow exercises

• Close and draw up the muscles around your back passage, as if you are stopping yourself from passing wind (don’t tighten your buttocks)
• Close and draw up the muscles around your vagina and urethra, as though trying to stop the flow of urine
• Hold to a count of 5 (if this is difficult, hold for2 then 3, gradually increasing to 5) breathe normally throughout. When you can feel the hold and relax you can hold for 5 seconds
• Slowly relax and let go

Fast exercises

• As before draw up the pelvic floor muscles
• Slowly relax and let go
• Ensure to fully relax between each contraction

Remember

Pelvic floor muscle exercises are for life. They should become something you just do!

Physiotherapy Department

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Urology Department

01709 426322