Pregnancy is a crucial time to complete daily pelvic floor muscle training (PFMT).

Being pregnant is a risk factor for pelvic floor muscle dysfunction. This does not mean it’s an inevitability, but it does increase chances of pelvic floor problems if left ignored. It has been shown that by doing PFMT, the risk of urinary incontinence during pregnancy is reduced by 50% and after pregnancy by 35% (1). Urinary incontinence in the first six weeks of giving birth has also been shown to double the chances of postnatal depression (2), making it even more important to complete those daily squeezes.  

In pregnancy it’s recommended that eight to 12 short and eight to 12 long pelvic floor muscle squeezes are completed two to three times per day (3). Be sure to check out how to strengthen the pelvic floor for more info or you can of course visit a pelvic health physiotherapist who will be able to check if you are doing them correctly and give you a more personalised programme for your pelvic floor. Pelvic floor muscle training can help prepare for labour and most importantly they have been shown to have no ill effect on delivery, so they are safe & beneficial to be doing right up until your baby is born.   

One of the side effects of the naturally high levels of progesterone during pregnancy is constipation. Straining to empty our bowels is another risk factor for pelvic floor dysfunction, so, like always, it’s crucial to aim to avoid this as much as possible. All the usual recommendations apply; remain active (just 10 minutes walking per day has been proven to help reduce constipation), eat lots of different types of plant-based fibre (aiming for 30 different sources per week), go on the first natural urge, keep hydration levels high, and when on the toilet keep feet up on a step and wait for the stool to pass whilst doing deep breaths into the abdomen/bump.  

From 34 weeks of pregnancy, if you are hoping for a vaginal delivery, it’s recommended to commence perineal massage. This has been shown to lessen the chance of experiencing a tear during labour, reducing the severity of any tear that might occur and reducing any pain when postnatal (4). For full benefit, it is needed to be done at least three to four times per week for 10 minutes. You can do it to yourself using your own hands or a perineal stretching device (e.g., Ani-ball or the Epi-no), or else someone else can do it for you e.g., your partner or a pelvic health physiotherapist.  

References

WHO (2020) Guidelines on physical activity and sedentary behavior 

Sword et al (2011). Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. BJOG 2011 Jul;118(8):966-77. doi: 10.1111/j.1471-0528.2011.02950.x 

Woodley et al (2020). How effective is pelvic floor muscle training undertaken during pregnancy or after birth for preventing or treating incontinence? Cochrane Library 

Chen et al (2022). Effect of prenatal perineal massage on postpartum perineal injury & postpartum complications: A Meta-Analysis. Comput Math Methods Med. 2022; 2022: 3315638.