Understanding & conditioning your pelvic floor for pre & postpartum health!

Did you know that during pregnancy, as the baby grows and the uterus becomes heavier, it is the pelvic floor that bears the weight and can drop as much as 2.5cm! Oh and then there's the fact that towards the end of your pregnancy, the baby likes to use the pelvic floor as a trampoline (making the bathroom your new best friend!). So, needless to say, gaining control over your pelvic floor muscles is essential if you want to avoid the wide range of delightful pre and postnatal problems that us women are often faced with such as urinary (and even faecal) incontinence.

But before I talk more about the importance of gaining control over your pelvic floor, let's start with the basics of what exactly is your pelvic floor? Well, first off, the name 'pelvic floor' is a bit misleading really as the muscles of the pelvic floor are actually all slanted at different angles and layers and don't really form a 'floor' at all (yeah thanks anatomy - as if there isn't enough confusion about our lady parts already!). Here comes the fancy technical talk; there's actually three muscles that make up the pelvic floor; the Pubococcygeus, the Iliococcygeus and the Ischiococcygeus. These three muscles connect your pubic bone (at the front) to the coccyx (your tailbone) and your sitting bones at the back and form a kind of layered triangular mesh of muscular support for all of the pelvic contents, the uterus, the bladder and the bowels.

The positioning and structure of these pelvic floor muscles gives them a vital role in carrying the extra load of your growing uterus and baby during pregnancy, meaning that the muscle fibres get progressively weakened. What's more, the huge hormonal changes and fluctuations that happen during pregnancy can also negatively impact the pelvic floor muscles. The other huge factor for pelvic floor damage though is, of course, child birth, especially if you have a long or prolonged second stage of labour with excessive pushing, a large or awkwardly positioned baby, deep tearing or complications leading to medical interventions (such as forceps and episiotomies).  Needless to say, it's pretty crucial that we learn to correctly engage and control our pelvic floor muscles prenatally to help us prevent or, at least, manage (as best as possible) the damage.

A well conditioned pelvic floor will not only help prevent those embarrassing pre and postnatal moments like wetting your pants in the middle of a workout (usually wearing your favourite skin-tight bum sculpting leggings and in front of the hottest member of the personal training team!) but it can also help with the labour itself and with the post-natal healing process. Let's just point out here that we've been talking about pelvic floor control or condition rather than strength. Why? Well we don't just want the muscles fibres of our pelvic floor to be super strong but with no elasticity! Like with all, well conditioned muscles, we want our pelvic floor muscles to be both strong and flexible; to work properly they need to have the right amount of tone and length to support us through pregnancy but also be able to adequately relax and allow the baby to come out during labour (without causing tearing or without having to have the dreaded episiotomy!). What's more, being able to correctly re-activate the pelvic floor as soon as possible postnatally will help improve circulation to the weakened muscles and can actually help speed up recovery! 

A balanced pelvic floor conditioning program should, therefore, include exercises to engage and strengthen but also release and lengthen. As per my own personal prenatal pelvic floor programme, I advise that you focus more on pelvic floor engagement and strengthening before pregnancy and throughout the first trimester, then focus on activation and relaxation work during your second trimester but focus mainly on pelvic floor relaxation during the last few weeks of your pregnancy (in preparation for the birth!).  Postnatally (as soon as any excessive swelling and pain has subsided) you can start re-activating your pelvic floor, focusing on the engagement and strengthening work.  It's also important to note that the pelvic floor is, of course, part of your overall core. I like to think of it as the 'floor of your core'! So, its often useful to engage both the pelvic floor and the abdominal muscles of the core in the same exercise to provide a thorough full core engagement (very useful prenatally to help manage back and pelvic aches/pains caused by your constantly changing pregnancy posture). However, sometimes it is also useful to focus purely on the engagement and release of the pelvic floor (to work the PF muscles in isolation). 

To correctly condition (and re-condition post baby) your pelvic floor muscles, I advise including a mixture of some pelvic floor/core engagement exercises and some pure pelvic floor exercises in your pelvic floor programme. Usually in any dynamic (moving) pelvic floor exercises you will need to gently engage the whole core to help support and control and safely perform your movement. Here's some of my favourite exercises that helped me maintain a well conditioned pelvic floor during my pregnancy and helped me re-condition my pelvic floor after giving birth to my enormous (9lb9!) baby boy!

1. Sitting pelvic floor engagement - slow into fast 

• Sitting upright (on a chair or a fitness ball), feet hip width apart, your weight even on both sitting bones and your spine lengthened and neutral, breathe in to prepare.

• Breathe out and, keeping your buttocks relaxed, gently squeeze your back passage (anus) as if trying to prevent yourself from passing wind, then bring this feeling forward towards your pubic bone as if trying to stop yourself from passing urine. Continue to gently draw your pelvic floor muscles up inside you. If you are not yet pregnant or are postnatal, you should feel your lower abdomen automatically begin to hollow.

• Imagine that you ae engaging an internal zip from back to front and up inside you (as if you are 'lifting' the floor upwards), If you are pregnant, you will probably feel your bump lift gently. 

• Maintaining this pelvic floor engagement, breathe normally for 5 breaths, allowing the lungs and ribcage to expand (so you are taking full breaths) but without it being strained.

• Then fully relax the pelvic floor.

• Repeat the above process to engage the pelvic floor muscles but much more quickly - on an in breath, draw up your pelvic floor as quickly as you can and then, on an exhale, release fully and quickly. Repeat x8-10 repetitions.
• Modification: to make this exercise more functional, progress to performing it standing (sanding tall with a neutral and stable pelvis and spine).

2. Four Point Kneeling pelvic floor engagement with full core connection

• In four-point kneeling (table top) position, with your hand directly underneath your shoulders and your knees directly underneath your hips, gently rock your pelvis to settle it in the mid position where your pelvis is neutral and your spine retains is natural curves (neutral spine). Lengthen your whole spine from the crown of your head to your tailbone.

• Breathe in to prepare, breathe out as you gently squeeze your back passage (anus) as if trying to prevent yourself from breaking wind, then bringing this feeling forward towards your pubic bone. Then draw your muscles up inside until you feel your abdominals automatically begin to hollow or draw your bump up and in (as if you're 'hugging' your baby upwards towards your spine). Imagine a corset wrapping around your whole torso as well as the ‘floor’ drawing up inside you to gently activate the whole core!.

• Breathe in to fully relax the pelvic floor and to allow the bump to release so you are fully releasing the deep abdominals of the core (really let your bump release as much as it wants to).

• Repeat x8-10 repetitions

3.  Four Point kneeling to child's pose with pelvic floor engagement & release 

• Starting in four-point kneeling (table top) position, with your hand directly underneath your shoulders and your knees directly underneath your hips, and a neutral pelvis and spine.

• Breathe in and shift your weight forward, over your wrists, closing and drawing up your pelvic floor muscles (without tensing your buttocks) and using the same method as in the above exercises (starting by closing the back passage, drawing it forward towards your pubic bone and then drawing up inside you). 

• Then breathe out and shift your weight back and (with your feet together and your knees wide) sit your buttocks all the way back onto your heels, lengthening your spine, stretching your arms out long and resting your head on the floor. Fully release your pelvic floor as you sit back, feeling your sit bones widen to allow a full release.

• Repeat x 8-10 repetitions of this shifting forward and back, engaging and releasing the pelvic floor, finishing by relaxing in the child’s pose for a few breaths, relaxing the pelvic floor completely.

4. Squats with pelvic floor engagement & release 

• Standing with your feet wider than hip width and a neutral pelvis and lengthened spine, hands can be on your hips/waist or crossed over (so out of the way), breathe out to prepare.

• Breathe in to bend the knees and squat, sending the weight back into the heels (making sure that knees don't go over the toes) and fully releasing the pelvic floor muscles at the same time.

• Breathe out to stretch the legs and stand back upright (pushing through the heels) closing and drawing up the pelvic floor muscles at same time. The buttocks will naturally engage but keep your focus on the engagement of the pelvic floor. Only squat as low as you feel comfortable (keep the range smaller as you become more heavily pregnant) and without the torso collapsing. 

• Repeat the squat with pelvic floor release/engagement x8-10 repetitions and then completely release the pelvic floor muscles at the end.