Pelvic floor muscle training during pregnancy

First, let’s look at some words you might not use very often:

• Pelvis: the bony bits below your waist, that protect your womb and bladder.
• The pelvic floor: a layer of muscles and connective tissues that covers the underneath opening of the bony pelvis and is attached to the pelvis by ligaments, a bit like a hammock.
• Urethra: the top opening in your pelvic floor, where urine (wee, pee, number one) that has been stored in the bladder comes out.
• Vagina: the middle opening in your pelvic floor, where the baby comes out (as well as blood from your period every month).
• Anus: the lowest opening in your pelvic floor, where faeces (poo, number two, bowel movement) that has been stored in the bowel comes out.
• Continent: being able to stop urine or faeces from escaping by mistake.
• Diaphragm: a thin muscle that lies in between the bottom of your chest and the top of your abdomen (tummy). When you take a breath in, it tightens and becomes flat. This helps you to suck air into your lungs. When you breathe out, the diaphragm relaxes and the air is pushed out of your lungs.
• Intra-abdominal pressure: pressure from inside your tummy, perhaps from taking a deep breath and holding it, or coughing, sneezing or lifting a heavyweight.

What do pelvic floor muscles do?

The job of your deep pelvic floor muscles is to keep you continent (stop any urine or faeces escaping out) by squeezing and lifting upwards and forwards to close the urethra and anal sphincters (the openings from the bladder and bowel). They support and keep the pelvic organs up against gravity, or against any increase in abdominal pressure.

The superficial (outside) layer of muscles closest to the skin plays a role in sexual arousal and function. The pelvic floor muscle activity is coordinated with the diaphragm and breathing. The inner abdominal and lower back muscles also work with the pelvic floor to provide core stability (keep you upright and balanced).

How do my pelvic floor muscles keep me continent?

When you feel an urge to empty the bladder or bowel, you can tighten the muscles on purpose, to stop your bladder or bowel emptying and allow you time to reach the toilet.

Then the pelvic floor muscles must be able to relax and allow your bladder or bowels to empty without straining (having to push hard).

When you cough, sneeze, lift a heavyweight or do some exercise the pelvic floor muscles know that there will be an increase in intra-abdominal pressure, so prepare by tightening beforehand.

Controlling your bladder during pregnancy

However, sometimes the load on the pelvic floor can be too great for this to work, and some women may find they are incontinent of urine (leak some drops of urine) when they do sport or exercise, or cough (due to the increased intra-abdominal pressure). This is called ‘stress incontinence.’

Some women find they have less control of their bladder just before their period and during pregnancy as a hormone called ‘relaxin’ softens the ligaments and supporting tissues in the pelvic floor.

As pregnancy continues, the increasing weight of the baby, the fluid around the baby, and the mother’s increased amount of blood and body weight all further increase the load on the pelvic floor. If you get constipation and are ‘straining at stool’ (having to push hard to get faeces out), this also can have a negative impact on the pelvic floor.

How many women have incontinence?

The MAMMI study (Maternal health And Maternal Morbidity in Ireland) found that 1 in 3 women leak urine before pregnancy. Women who leak urine occasionally before pregnancy are more likely to leak urine in pregnancy compared to women who are continent.

It is important to get help if you leak urine at any stage in your life.

Out of 10 women who develop stress urinary incontinence in their first pregnancy and whose symptoms have not gone away at 3 months following birth, 9 of them are likely to be incontinent 5 years later.

What can I do to help myself?

Pelvic floor muscle training during pregnancy has been shown to prevent urinary incontinence up to six months postpartum for first-time mothers. Women who are taught how to do their pelvic floor exercises correctly are more likely to improve their symptoms.

It is important that you know how to find your pelvic floor, exercise it in a way that has a training effect, and strengthen and coordinate the exercises with activity.

Tightening the pelvic floor before a cough or sneeze is called the ‘knack’. Women are busy and often forget to do their exercises, so reminders such as the ‘Squeezy’ app can be an excellent resource.

More of the science behind pelvic floor muscles

Another resource for women and healthcare professionals (available for free for a limited time only) is the ‘Women’s Health after Motherhood’ Massive Open Online Course which is available on the MAMMI study website.

This resource explores more of the science behind the pelvic floor’s role in incontinence and bladder control with a series of videos and provides a coached pelvic floor exercise task.

It also has downloadable trackers that you can use to help you to progress the pelvic floor exercises and integration into core training. This course is also available in Spanish.

You can also watch the four self-help videos on the Rotunda Hospital’s website which we have linked below.