Pelvic floor muscle exercise in pregnancy and postpartum – should I do it?

It’s quite likely at some point before, during or soon after pregnancy, you’ve heard the advice, “Do your Kegels!” 

Kegels more properly referred to as pelvic floor muscle exercises (PFME) on their own and pelvic floor muscle training (PFMT) when part of an exercise plan, are often a topic of conversation among moms and moms-to-be. They also may have been discussed by your health care provider, or perhaps you may have heard mention in the media, the movies, or even your favorite tv show.  

And if you’ve received this advice, you’ve been doing them correctly, diligently, several time a day, right?! Chances are, probably not. Despite being such a common topic, there is still a lot of confusion about PFME in pregnancy and in general.  Maybe you tried to do them and couldn’t quite figure out how or if you’re doing them right. Or maybe you heard about stoplight Kegels (aka squeezing in as many exercises as you can while in sitting at traffic lights). This practice may be better than none at all, but it really isn’t the ideal “dosing” of exercise or ideal position for exercising these very important muscles. 

All that said, it is so important to exercise the pelvic floor during pregnancy and postpartum, so let’s answer some common questions on the subject! 

Urinary Incontinence (UI):

• I’ve heard about urinary incontinence (commonly referred to as leaking), but it isn’t happening to me:
• PFME is still for you! Practicing pelvic floor muscle exercises can prevent prenatal and postpartum urinary incontinence. Studies show reduction in the odds of developing incontinence during pregnancy and postpartum when women do PFMT.^1,2 
• I have been having some UI (leakage):
• If you’re already having incontinence symptoms during pregnancy or early postpartum pelvic floor muscles exercises and training can help to decrease the severity of symptoms.^2,3 
• Women with UI who begin pelvic floor exercises early in the postpartum period are 22% less likely to report UI at 12 months.²

Pelvic Organ Prolapse (POP):

• POP is a type of pelvic floor dysfunction characterized by a loss of support for one or more of the internal pelvic organs.  POP symptoms in the early postpartum period typically include a sense of heaviness or pressure in the pelvis or a bulge that may be seen or felt in the vagina. Studies show that women who practiced regular PFMT experienced lower risk of bothersome prolapse symptoms by the time they were 6-12 months postpartum.³ 

Sexual function:

• Female sexual function is a bit more complicated and requires more than a healthy pelvic floor. Even so, there is evidence in favor of pelvic floor muscle exercises for improved sexual function in the postpartum period.^3,4 One study found that women noted improvement in self-described symptoms of vaginal looseness or laxity, which may contribute to an improved sexual experience.⁵  

All of this sounds very encouraging, and it is! The answer for most women is “YES! You should do Pelvic floor muscle exercise in pregnancy and postpartum.”  

However, it is also very important to note that for some women, having help from a knowledgeable health professional is useful to assure exercises are performed correctly and at the right amount.  It is also very important to note that for some women this kind of PFMT is not beneficial, and if, for example, you have pre-existing pelvic symptoms (such as pain, urinary urgency and frequency, or constipation) classic PFMT focused on strengthening may be aggravating to your symptoms.  If this is the case, talking to your healthcare provider and working with a physical therapist or other specialist can help you find the type of pelvic floor training that is right for you. So, the answer for most women is “YES! You should do Pelvic floor muscle exercise in pregnancy and postpartum.” No matter what, your pelvic floor plays a big role in pregnancy and postpartum and there is a lot to learn! Ask questions, seek information, and if you need help, don’t hesitate to ask! 

---

Read more

• Kegel exercises during pregnancy: keep calm and kegel on
• Urinary incontinence when pregnant

References

1. Davenport MH, Nagpal TS, Mottola MF, et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1397-1404. doi:10.1136/bjsports-2018-099780
2. Nobili F, Mallozzi M, Scarani S, Marci R, Caserta D, Soave I. Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Arch Gynecol Obstet. 2019;299(3):609-623. doi:10.1007/s00404-018-5036-6
3. Wu YM, McInnes N, Leong Y. Pelvic Floor Muscle Training Versus Watchful Waiting and Pelvic Floor Disorders in Postpartum Women: A Systematic Review and Meta-analysis. Female Pelvic Med Reconstr Surg. 2018;24(2):142-149. doi:10.1097/SPV.0000000000000513
4. Sobhgol SS, Priddis H, Smith CA, Dahlen HG. The Effect of Pelvic Floor Muscle Exercise on Female Sexual Function During Pregnancy and Postpartum: A Systematic Review. Sex Med Rev. 2019;7(1):13-28. doi:10.1016/j.sxmr.2018.08.002
5. Kolberg Tennfjord M, Hilde G, Stær-Jensen J, Siafarikas F, Engh ME, Bø K. Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction – Secondary analysis of a randomised trial. BJOG An Int J Obstet Gynaecol. 2016;123(4):634-642. doi:10.1111/1471-0528.13823