The best pelvic floor exercises for pregnancy: Reduce pain, prepare for birth, and set yourself up for a smooth postpartum recovery
Hey Mama! Congratulations on your pregnancy! As a holistic pelvic floor physical therapist specializing in pregnancy and postpartum and mom of (almost) 2, I know how confusing it can be to navigate all the “do’s” and “don’ts” of pregnancy, and your pelvic floor health is no exception.
With the rise of pelvic floor and pregnancy content on Instagram and Tik Tok, it can be difficult (and stressful!) to know if there’s something you “should” be doing to have a better pregnancy, support your pelvic floor, and have a smoother birth and postpartum.
As a pelvic floor PT, I see a LOT of misinformation from popular pregnancy websites like Babylist and What To Expect (don’t get me started on the advice to do kegels for hemorrhoid relief!!!), so today I’m going to cover exactly what you need to know about pelvic floor exercises for pregnancy.
We’ll discuss:
Common pelvic floor problems during pregnancy and how pelvic floor exercises can help
Common misconceptions and mistakes about pelvic floor exercises for pregnancy
Pelvic floor exercises for pregnancy to strengthen the pelvic floor (and when to use them)
The best ways to strengthen the pelvic floor during pregnancy (and why it’s about so much more than doing kegels)
Pelvic floor exercises to RELAX the pelvic floor (and when/why to do them)
My favorite exercises for relaxation of the pelvic floor
How pelvic floor exercises for pregnancy can help you prepare for a smooth birth
How to know when you need additional support with pelvic floor physical therapy
Here we go!
Common pelvic floor problems during pregnancy and how pelvic floor exercises can help
For many, the pelvic floor isn’t a term in your normal vocabulary until becoming pregnant, or possibly not until postpartum, and dealing with some of the following common (but treatable) issues:
Leaking urine during pregnancy
Back pain during pregnancy
Pelvic pressure and prolapse (that feeling of heaviness, or like something is falling out of your vagina)
SPD (symphysis pubis dysfunction) - Pain right over the pubic bone, that can also feel like hip pain, inner thigh pain, or like you’re walking funny and can’t bear weight on one side (Read more about SPD here)
Sacroiliac Joint Pain (pain at the lowest part of the back and into your buttocks)
Round ligament pain
Hemorrhoids (UGH!)
Tailbone pain
Diastasis Recti (separation of the abs that occurs during pregnancy)
Rib pain (yep, pain in your upper back and ribs can both cause and be a result of pelvic floor dysfunction)
All of these issues are related to pelvic floor dysfunction and can be helped greatly with pelvic floor exercises, along with solid nutrition, lifestyle support, and regulating your nervous system (because pregnancy isn’t stressful at all, right?)
In my experience, pregnancy itself doesn’t directly CAUSE these problems, but it certainly unveils underlying issues like muscular imbalances, pelvic floor tightness, breathing dysfunction, or muscle weakness that weren’t a problem before - but now that you’re growing a baby inside of you, the hormonal and musculoskeletal changes that are happening can tip these problems just over the edge and bam - you’re peeing yourself when you sneeze at the grocery store.
While pelvic floor exercises can definitely help these issues (and more!), there’s a lot of misinformation out there about what encompasses pelvic floor exercise - it’s not just as simple as doing kegels. Let’s discuss that further.
Common misconceptions and myths about pelvic floor exercises for pregnancy
As I mentioned above, many popular pregnancy guides - you know, those cute ones that tell you what fruit size your baby is week by week - are offering some pretty UNHELPFUL advice when it comes to pelvic floor problems during pregnancy.
Let’s bust some of the biggest MYTHS circulating around the internet (and OBGYN offices everywhere) when it comes to pelvic floor exercises for pregnancy:
All pelvic floor issues will be solved with kegels
Kegels are the only pelvic floor exercise to do during pregnancy
You need to strengthen your pelvic floor for birth
If you’ve heard any of these somewhere, let’s set the record straight.
Myth 1: All pelvic floor issues during pregnancy will be solved by doing kegels. For example, What to Expect, when discussing hemorrhoids, tells readers that “doing pelvic floor exercises (kegels) can help.” This advice is harmful because
Hemorrhoid pain is usually made worse by overactivating the pelvic floor. Hear me when I say, DOING 100s of KEGELS will NOT HELP YOUR HEMORHOIDS. It WILL probably make them worse. Of note, one of the things I find is most needed by my pelvic floor physical therapy clients is learning pelvic floor exercises that relax the pelvic floor vs. strengthening it (but keep reading, and we’ll discuss that more)
Myth 2: Kegels are the only pelvic floor exercise to do in pregnancy. “Pelvic floor exercise” does NOT equal JUST doing kegels. Pelvic floor exercises can include kegels, but they include so much more.
Additionally, people who just do kegels because of bad advice like this on the internet, are probably not even doing them effectively or correctly. Are kegels always bad? Nope! But in isolation, they won’t solve your pelvic floor problems in pregnancy (and could make them worse).
Myth 3: You need to strengthen your pelvic floor to prepare for birth.
It’s actually MUCH more important for your pelvic floor to be able to let go and RELAX (aka, get the hell out of the way) so that your baby can come through easily.
But does that mean doing pelvic floor exercises to STRENGTHEN your pelvic floor isn’t important during pregnancy? Not so!
To put a complex concept simply, pelvic floor exercises for pregnancy generally fall into two categories:
Pelvic floor exercises that RELAX the pelvic floor
Pelvic floor exercises that STRENGTHEN the pelvic floor
Both of these are helpful and necessary for a healthy pelvic floor during pregnancy and beyond. The key is knowing when to focus on what, and what types of exercises fall into each category.
I’m going to provide you with lots of helpful resources in the next sections, but know that sometimes it is best to seek out the help of a trained pelvic floor physical therapist to develop an individualized plan for you.
But if you learn nothing else from this section, just please, oh please, don’t go doing hella kegels to prepare yourself for birth. You’re wasting your time, boo! Keep reading for a better way.
Pelvic floor exercises for pregnancy that strengthen the pelvic floor (and when to use them)
If you DON’T need a strong pelvic floor for birth, why would you want to incorporate pelvic floor strengthening into your exercise routine during pregnancy?
Pelvic floor strengthening during pregnancy is extremely helpful for:
Mitigating aches and pains during pregnancy
Feeling strong, energized (as is possible) confident, and comfortable during pregnancy
Preventing and managing problems like SPD, back pain, prolapse, and incontinence during pregnancy
Setting yourself (and your pelvic floor) up for a smooth postpartum recovery and return to exercise
Preparing your body to carry ALL the heavy baby shit!
(another side note here - the recommendation to not lift more than 20 lbs during pregnancy is NOT evidence based and is SO outdated. As a pregnant mommy of a 30-lb, 19 month old velcro baby, I can tell you that staying strong during pregnancy - not only with pelvic floor exercises but regular strength training, has made pregnancy with a toddler SO much more manageable. Look up the weight of your car seat and stroller - things you’ll be getting in and out of your car. I highly recommend training for this! )
So if kegels aren’t all there is to pelvic floor exercises, what should you do instead?
The best way to strengthen your pelvic floor during pregnancy - it’s not all about kegels
For some pelvic floor issues during pregnancy, it *can* be helpful to start with kegels, and I recommend working with a pelvic floor therapist if you aren’t sure, so you can an individualized plan that helps you reach your goals quickly without trial and error.
But if you ONLY do exercises like kegels and core exercises on a mat, and never progress to bigger challenges, functional positions, and exercises that encompass larger body regions, the effects will only go so far. (So if your pelvic PT ONLY has you doing these things…HIRE SOMEONE ELSE!)
Although kegels have their place, the best way to strengthen your pelvic floor is through actually…Strength training! (What a concept!)
If that sounds intimidating to you, it doesn’t have to be (and if you need more support with this, I got you mama!)
Some of the best exercises for functional pelvic floor strengthening during pregnancy are:
Lunges
Squats
Hip bridges
Deadlifts
Research shows that these exercises activate your pelvic floor muscles more than kegels - and they are more functional too.
What do I mean by functional? Functional exercises mimic the bigger movements you need in everyday life. As a mom, you’ll soon find you need a LOT of strength to do things like:
Squat down to pick up something off the floor while holding your 30 lb toddler
Lean over baby’s crib to pick him up without aggravating your back
Pickup your new baby’s car seat off the floor at the pediatrician and lift it into the car
Travel solo by air with a baby- trust me, they never travel light (that’s a WHOLE other blog post)
Wear your baby while wrangling your toddler at the playground
And having this type of functional strength helps to minimize pelvic floor problems that can arise like incontinence, pain, and pressure during both pregnancy AND postpartum.
Read: Kegels aren’t going to help you lift that fancy Doona stroller (20 lb plus the weight of your baby) in and out of the car.
Bottom line: when it comes to pelvic floor exercises for pregnancy, some people may need to incorporate kegels to coordinate the pelvic floor muscles with the larger muscles that control movements like squatting, bending, and carrying, but eventually moving into functional strength training is going to bring the best bang for your buck.
Need somewhere to start?
Save these reels on Instagram for some ideas of functional pelvic floor strengthening workouts that are safe for all trimesters of pregnancy:
Stability and strengthening workout (Great for all three trimesters)
Fun pelvic floor and hip strengthening exercises to do with your birth ball
Pelvic floor strengthening exercises for pregnancy are great to help you have energy during pregnancy, mitigate aches, pains, and incontinence, and prepare your body for the physical demands of motherhood.
AND - having a super strong pelvic floor isn’t what you need to have a smooth birth. Keep reading as we discuss the equally important exercises to RELAX the pelvic floor.
And don’t forget, if it feels too overwhelming to create an exercise program on your own, seeing a pelvic floor therapist can help you identify your weak areas and if any more specific, localized pelvic floor training is necessary.
Pelvic floor exercises for pregnancy that RELAX the pelvic floor (and when to do them)
If there’s anything you need to know about preparing your pelvic floor for birth, it’s that it needs to get the F out of the way! That means that, though strength training has its place, you actually need to learn to RELAX the pelvic floor as an essential strategy to prepare for birth.
Plus, if you don’t know how to relax your pelvic floor muscles, you may end up squeezing them at the very time they need to be opening up so your baby can get out!
Doing Pelvic floor relaxation exercises during pregnancy is helpful to:
Calm your tissues after a harder strength workout or running
Minimize issues like incontinence (leaking)- (yes, incontinence isn’t always a result of a weak pelvic floor, though it can be)
Prepare to manage contractions during labor
Mobilize your pelvis for birth
Improve your pushing mechanics to minimize pelvic floor issues like prolapse, hemorrhoids, and tearing during birth
When should I start doing pelvic floor relaxation exercises during pregnancy?
ANYTIME!
While I would emphasize these over excessive strengthening in the third trimester, it is never too early to start priming your pelvis for birth. In addition, relaxing your pelvic floor can also help to mitigate the uncomfy aspects of being pregnant, and possibly help to prevent issues like prolapse, incontinence, and hemorrhoids.
The best pelvic floor relaxation exercises for pregnancy
There are many exercises to relax your pelvic floor during pregnancy, but it all starts with YOUR BREATH.
Did you know that during normal inhalation, your pelvic floor naturally descends and “lengthens” - aka, relaxes - and on exhalation, it ascends and contracts?
So, to relax your pelvic floor, we are going to bring more intention and awareness to your breathing to maximize the benefits.
My favorite position to practice breathing to relax the pelvic floor is lying down with feet up at a 90 degree angle, like a table top.
If you’re SUPER pregnant and can’t lay on your back, you can bolster your upper body up with pillows, lay on your side, or sit on a birth ball. You can even practice this on all 4s.
Here’s how to breathe to relax your pelvic floor:
Take a deep breath in, imagining that your belly is a balloon, and you are inflating it as you inhale (NOT pushing it out).
Think about inhaling downward into your sit bones, laterally into the sides of your ribcage, forward into your belly (hi baby!), and backward into your spine.
As you inhale, you may be able to sense your pelvic floor descending (this can be easier if you are sitting on a ball to feel)
This can definitely feel complicated until you’ve practiced it more, and you may need to work with a professional to get the hang of it. Watch this video for an example of what this can look like (I LOVE relaxing my legs up on a birth ball)
Once you’ve got your breathing down, try incorporating this technique into the following moves:
Cat-cow pose - this exercise adds movement in the pelvis and spine while incorporating your breath
Get on all fours.
As you inhale look up and let your belly fall to the ground, arching into your lower back. You should look like an eager puppy :)
As you exhale, push into the floor, bow your head toward the ground, tuck your tailbone under you, and reverse the arch in your back, pushing your belly and spine AWAY from the ground. You should look like an angry cat.
Repeat 10-20 times, inhaling and exhaling.
Variations: try positioning your knees in and your ankles out wide, and repeat the above steps. This knees-in-ankles-out position is GREAT to open the bottom of the pelvis during the pushing stage of labor.
Child’s pose
On all fours, push back onto your heels and rest your belly, spine, head and arms onto the floor. Breathe into your sit bones, and on the exhale, envision yourself becoming even more heavy as you sink into the ground.
Variation: Try this with knees and ankles parallel, or play around with varying ankles of knees OUT and ankles IN,
If this is too uncomfortable with your pregnant belly, you can prop your chest and belly with a few pillows.
Hip rock backs
Start out on all 4s. Hinge backward, rocking back onto your heels, then, instead of going into child’s pose, hinge back up to the start position. Try to keep your back straight throughout the movement and don’t let your tailbone tuck under - imagine you are kissing the wall behind you with your sitbones.
Variations: Do 10 with your knees out wider than ankles, then 10 with your knees pointed INward, with ankles out wide.
You can also place one knee slightly forward to change it up. Just make sure to repeat on the opposite side.
Figure 4 stretch (modified)
Sitting against a wall (or you can lay down, this gets harder the bigger your belly), bend your knees and cross one knee over the opposite knee to create a “4”. Pull both knees toward your chest, or hinge your hips so that you are leaning over your knees. You should feel a stretch through your butt muscles. Repeat on the opposite side.
If you have a birth ball, try these moves:
Hip circles
Figure 8s
Pelvic tilts
Check out this reel on Instagram for a demonstration and more ideas!
REMEMBER: Make sure you are breathing intentionally throughout all of these exercises to maximize the relaxation of your pelvic floor.
How pelvic floor exercises for pregnancy can help you prepare for a smooth birth and recovery
As I mentioned before, your pelvic floor needs to get the hell out of the way so your baby can get out. Easier said than done if you’re a chronic butt clencher, belly sucker-inner, or generally holding tension in your pelvic floor from stress.
The above exercises are a great place to start to practice CONSCIOUSLY mobilizing your pelvis for birth while using your breath to relax the pelvic floor muscles.
Adding in strategies like perineal massage, mindset work, and meditation can help you feel confident and prepared for an amazing birth.
Plus- working on your breath is the BEST place to start working on to help your pelvic floor heal after birth, redevelop your core, and manage the stress of motherhood. Having tools in early postpartum to introduce gentle movement will help you get back to all the activities you love to do for exercise - and, of course, lift that heavy-ass car seat with ease.
How to know when you need to seek out more help for your pelvic floor
In this blog, we’ve talked about all the major points you need to know about pelvic floor exercises for pregnancy - when to strengthen, when to relax, and why it’s important to work on BOTH during pregnancy.
But sometimes you’ve got issues that you shouldn’t have to handle on your own. I encourage you to seek out support during this season so you can address pelvic floor issues like incontinence (leaking urine), tailbone pain, back pain, SPD.
This is where pelvic floor physical therapy comes in. Pelvic floor physical therapists can help you diagnose the problem or problems youre experiencing, and come up with an individualized exercise plan (that may include some of the above exercises) catered to your specific problems, needs, and lifestyle. Furthermore, seeking help from a pelvic floor therapist can help you feel your best during pregnancy, and confidently prepare for birth and a juicy postpartum recovery
I’d be happy to support you in this journey mama - please reach out!
Speaking of postpartum recovery, make sure you grab my Free Postpartum Recovery Checklist with all the supplies you need to make a juicy transition into motherhood, care for your pelvic floor in those early postpartum days, and nourish your body for optimal healing. Get it here!
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If you’re looking for more support on your fertility, pregnancy , or postpartum journey - whether that’s to understand your pelvic floor and how to keep it healthy during this season of new motherhood, fueling your body’s nutrition needs as you grow your family, how to exercise during and post-pregnancy, or preparing and recovering from birth, I’m your girl!