The Pelvic Floor Exercise You Need to Regain Strength After Baby

Content medically reviewed by Alexis Herzog, OTR/L

During and after pregnancy, your body goes through many changes. One area that can be greatly affected is your pelvic floor, which is made up of muscles and ligaments that support your bladder, bowel, and uterus. Pregnancy and childbirth can stretch, strain, and weaken these muscles and cause a range of issues for about 1 in 4 women. The good news is that pelvic floor exercises can gradually build up your strength and help you return to normal.

How Giving Birth Affects Your Pelvic Floor

“When you give birth, the stress on your pelvic floor muscles causes them to lose strength and can lead to pelvic floor dysfunction,” said Alexis Herzog, OTR/L, occupational therapist at Essentia Health. “This is especially true if your baby was large or if you needed to push for a long period of time during labor. This is also true for precipitous births [a rapid delivery that occurs less than three hours after contractions begin] and if there is perineal or vulvar tissue tearing.”

When pelvic floor muscles weaken, you may experience pelvic floor dysfunction, which can lead to issues such as urinary incontinence, fecal incontinence, and pain with intimacy.

Symptoms of pelvic floor dysfunction include:

• Urine leakage when sneezing, coughing, laughing, or running (stress incontinence)
• Overactive bladder, or sudden urges to urinate
• Constipation and difficulty having bowel movements
• Fecal incontinence, or accidentally passing stool or mucus, sometimes without knowing it
• Pain with intercourse
• Passing gas when lifting or bending over
• Reduced vaginal sensations

Pregnancy and childbirth can also put you at risk for pelvic organ prolapse, when one or more of the pelvic organs drop down and bulge into the vagina. This happens when the pelvic muscles and connective tissues become too weak to hold the organs in place properly.Symptoms of pelvic organ prolapse include –

• Feeling a bulge or that something is coming out of your vagina or rectum
• A sense of heaviness around your abdomen or vagina
• Uncomfortable intercourse
• Urinary problems such as urinary frequency, leaking urine, or incomplete bladder emptying

Take Time to Recover

Whether you’ve had an uncomplicated vaginal delivery or cesarean section, you need to prioritize rest, bonding with baby, and healing the pelvis in the first two weeks post-partum before starting pelvic floor exercises. During these first few weeks, prioritize diaphragmatic breathing, short walks without overexertion, monitoring bleeding, and trying to implement proper postures while feeding, carrying, and holding baby.

Each delivery and pregnancy are different, so please talk to your obstetrics provider regarding a safe timeline to return to exercise. Once you have their approval, it’s time to get started with pelvic floor exercises.

Identifying the Pelvic Floor Muscles

The first step to performing pelvic floor exercises is to make sure that you know how to find your pelvic floor muscles and learn how to contract them. Your pelvic floor muscles are positioned between your tailbone and pubic bone, providing support for the bladder, rectum, and uterus.

To locate the muscles, try the following –

• Anal: Pretend you are stopping yourself from passing gas and squeeze the muscles around the anus.
• Urethra: Pretend you are stopping urine flow.
• Vaginal: Think about closing your vagina.

“Weak muscles may be difficult to find or contract at first, but be patient,” Herzog said. “Pregnancy and childbirth place a lot of strain on your pelvic floor. After having a baby, it’s especially important to start slow and work your way up.”

A Pelvic Floor Exercise: The Pelvic Brace

Once your provider clears you to resume exercise, you can try the following exercise which a pelvic floor therapist may recommend to postpartum mothers.  The pelvic brace is an integrated exercise that combines pelvic floor (“Kegel”) exercises with transverse abdominus (lower abdominal muscle) exercises. Both muscle groups play a crucial role in supporting the pelvic organs, spine, and pelvis, often becoming weakened during pregnancy and childbirth. These muscles also work together with your diaphragm, so doing this exercise with diaphragmatic can effectively retrain these muscles to function together.

1. Lie on your back with your knees bent and feet planted about hip width apart. Avoid arching your low back. Place your fingertips just inside your hip bones.
2. Inhale through your nose. Think about your rib cage expanding outward, keeping your chest and shoulders relaxed.
3. As you exhale, gently squeeze your pelvic floor and tighten your lower abdominals by bringing your belly button up and back toward your spine. Imagine if you were pulling up a zipper from your anus, through your vagina and urethra, and finally your lower abdominals as if putting on a pair of tight pants. Hold for 5 seconds. You should feel the transverse abdominus muscle contracting under your fingertips.
4. Relax your pelvic floor and abdominal muscles for at least 10 seconds before doing your next repetition. Think about letting your pelvic floor muscles release and dropping back down prior to your next repetition.Complete 5 to 10 repetitions of this exercise up to three times per day. Avoid bulging of the abdomen, straining, or pushing down while completing this exercise. If you feel pain or the exercise is difficult to complete without proper form, stop the exercise.

The pelvic brace is also a great technique that can be completed with functional movements throughout the day to help support your back, abdominals, and pelvis. Try pelvic bracing with standing, lifting, carrying, coughing, or sneezing.

When to Seek Pelvic Rehabilitation

If you don’t begin to benefit from the pelvic brace exercise or are unsure if you are doing it correctly, a pelvic rehabilitation therapist can help with completing an appropriate evaluation of your postpartum body and take into consideration your delivery method with your recovery. It’s important to assess postural changes, abdominal strength and separation, and pelvic floor muscle strength and tissue integrity. This helps the therapist determine which home programming is the best fit for you.

The initial goal is to find the cause of any symptoms you are experiencing. Once they know the cause of your symptoms, your therapist will work with your provider on an individual treatment plan.“Your therapist will design a program for you based on your symptoms and the exact cause of those symptoms,” Herzog said. “They will work with you in a private setting to make sure you understand how to do pelvic floor exercises correctly and get the most benefit from them. This type of therapy can be very helpful for many women after childbirth.”