Pelvic Floor Anatomy & Strengthening during Pregnancy

Figure 1- Pelvic Floor Muscles from a side view.

Before we get into the quick & simple exercises we must first go over the anatomy of the pelvic floor. The pelvic floor consists of three muscle layers. These muscles stretch from the pubic bone in the front of the body, to the tailbone (as seen in Figure 1). There are many small muscles that work together to make up the pelvic floor. Figure 2 shows the criss cross layering of muscles, looking from bottom to top.

Figure 2: Three layers of muscles make up the pelvic floor muscles. Here are the muscles from a bottom to top view. 

As your pregnancy progresses the pelvic floor muscles will continue to stretch and support the growing fetus. 

During your pregnancy you should perform pelvic floor exercises daily. A strong pelvic floor will help assist you in labor, as well as help prevent urinary incontinence later on.

3 Pelvic Floor Strengthening Exercises

1. Kegels: To find your pelvic floor muscles first try to stop the flow of your urine midstream. This tightening in the basic move of a Kegel. Make sure you have an empty bladder before you start these exercises.

Dr. Heppe @ 22 weeks pregnant performing a modified Kegel.

• First lay down in a comfortable position
• Focus on your pelvic floor muscles only, avoid flexing your glutes, thighs, or abdomen
• Breathe in and out with each set of Kegels
• Squeeze for 5 seconds, release for 10 seconds, repeat 10 times
• Do these 3 times a day

**Kegels strengthen the pelvic floor, but they can also pull the sacrum (tail bone) inward towards your pubic bone. This promotes more weakness of your surrounding hip and low back muscles. During your pregnancy make sure you do all three of these exercises together. Too many kegels and not enough deep squats and bridges can lead to pelvic floor disorder (PFD).**

2. Deep Squat: A deep squat helps to strengthen your glutes and pelvic floor. These will help you after birth as you squat down to play with your new baby.

Dr. Heppe performing a deep squat at 22 weeks pregnant. Please use a chair or do near a wall for extra support.

• Stand on the floor with your feet shoulder-width apart, turn your feet outward slightly to help maintain balance.
• Stand on the floor with your feet shoulder-width apart.
• You can bring your arms over your head or in front of your heart
• Take a deep breath and as you exhale, bend your legs into a deep squatting position. 
• When you get low you can hold the squat for 5-10 seconds before coming up
• Breathe out, exhale as you slowly come back up
• Repeat 10-15 times

** As you gain weight during pregnancy , it is easy to overarch your lower back. Concentrate on keeping your tailbone relaxed. When you overarch your low back this can cause 

3. Bridge: This strengthening exercise targets your glutes and pelvic floor muscles. 

• Lie on your back with your knees beng and feet on the floor
• Extend your arms along the floor, palms flat
• Press your feet and arms firmly into the floor. Exhale as you lift your hips toward the ceiling.
• Draw your tailbone toward your pubic bone, holding your buttocks off the floor. Do not squeeze your glutes or flex your buttocks.
•  Press your weight evenly across all four corners of both feet. Lengthen your tailbone toward the backs of your knees.
• Hold for up to one minute. To release, exhale as you slowly roll your spine along the floor, vertebra by vertebra. Allow your knees to drop together.
• Perform 5x in one set 3x a day