A very common question among pregnant women is ‘How do I keep my pelvic floor and core muscles strong during pregnancy?’

Firstly – what is The Core?

To a Women’s Health and Continence Physiotherapist like myself, ‘The Core’ is a term to describe the supporting muscles deep inside the trunk, the Pelvic Floor (PF) Muscles and the Transverse Abdominis (TA) Muscle.

Despite popular belief, your six pack muscle (more correctly termed the Rectus Abdominis or RA) is not technically your core. Neither are the two layers of obliques underneath this. Think about the core of an apple – is it simply everything between the top and the bottom of the apple? No – it’s the inner, deeper part. It’s the same with our abdomen.

 

The outer muscles are ‘power’ muscles, and help to move your trunk. While very important, they do not have as much of a supportive function as the PF and TA. In fact, while the PF and TA muscles have an upward, inward motion when contracting correctly, the RA and obliques can create a downward force in the abdomen if used incorrectly and can contribute to common gynaecological issues.

The upward and inward action of the Core, and having optimal support in these muscles, is very important for you in pregnancy and beyond. Having a well-functioning PF, which is assisted by the TA, prevents common issues such as:

The pelvic organs descending (known as pelvic organ prolapse)

Bladder and bowel leakage (called incontinence)

Back and pelvic pain.

Having Core muscles that are able to be correctly contracted, and just as importantly relaxed, will help you to get through your pregnancy with no pain or dysfunction in the pelvic area.


How do I exercise my pelvic floor muscles in pregnancy?

Pelvic floor muscle exercises are done by squeezing and lifting this sling of muscles inwards and upwards, as if stopping wee or wind, or lifting a tampon inside you, and TA exercises are done by gently drawing the lower tummy in like doing up a low button on a pair of jeans.

Ideally it would be great to be able to do some quick lifts and some long holds, and to have a regular program that works on aiming to be able to:

  • Hold the muscle on while still breathing for up to 20 seconds at a time, multiple times in a row, without fatiguing
  • Quickly activate and relax the muscles 10 or more times in a row
  • Activate the muscles in a variety of different positions and with many different movements
  • Activate with as much strength as possible and do enough repetitions to fatigue it a few times a week, to build strength if necessary

Therefore, there is no ‘one size fits all’ training program for the PF and TA muscles, and it really depends on what your ‘focus areas’ are from an individual assessment. What can you already do well and what do you need to work on?

Many women are just handed a brochure or verbally taught pelvic floor muscle exercises, and research shows that about half of women would be inadvertently contracting the core in the wrong way. Common mistakes are:

  • Overusing the abdominal muscles and bearing down into the pelvic floor instead of lifting it upwards. This could obviously cause you to be more at risk of prolapse!
  • Failing to relax the pelvic floor muscle after contracting it. Many people make this mistake and end up with a tense, possibly painful pelvic floor muscle instead of a strong, flexible muscle.

This is why it is essential for your pelvic floor muscles to be individually assessed and an individualized program to be put in place.

How can I have my pelvic floor muscles assessed?

There are physiotherapists, like myself, who specialize in pelvic health and can do pelvic floor muscle assessments. They can be done in two different ways, one more invasive than the other, but one that gives a lot more information than the other.

1. Real Time Ultrasound.

This ultrasound goes on your lower abdomen and looks downwards towards the bladder. When you contract your pelvic floor muscles correctly, the base of the bladder should lift upwards on the screen. We can assess how long you can hold, how well you can relax, and how well you can activate it in different positions like lying, sitting and standing.

It cannot, however, assess strength, tone, pain or prolapse. All of these things are very important to note if you already have symptoms such as bladder leakage or vaginal heaviness.

It is usually good to use as a screening check for those with no current problems who want to pro-actively know if they are using their muscles correctly, for those who would rather not have a vaginal examination, or as a visual learning tool in conjunction with a vaginal examination.

2. Vaginal Examination

I know, I know – it’s not your first choice of a way to spend your day! However, a vaginal examination to check your pelvic floor muscles is the gold standard, and will give you a terrific amount of feedback about the way you’re activating your muscles, how strong they are, how well supported the vaginal walls are, how at risk you are of vaginal prolapse etc.

If you wish to be empowered to make exercise choices that are very specific to your own body and personal risk profile, and to know that the pelvic floor exercises that you’re doing are definitely being done in the best way possible, this is definitely the optimal way to be assessed.

It involves a short (5-10 minutes) assessment with the therapists gloved fingers palpating what the muscles are able to do. It shouldn’t hurt and there are no speculums used like in a pap smear. During pregnancy, you may choose not to have any non-essential vaginal examinations done for the safety of the baby. However, there is no increased risk to this assessment (which does not palpate the cervix) compared to keeping sexually active during pregnancy. Postnatally, these risks obviously don’t have to be taken into account.

In Australia, you can self refer to see a specialist physiotherapist, and you can choose to see one in the private or public sector. To see a list of private sector physiotherapists that work with FitRight, see our Initial Assessment page.

How do I include pelvic floor and ‘core’ exercises in my workouts during pregnancy?

Once you’ve been given a program from your physiotherapists, isolated pelvic floor exercises can be done multiple times a day in different situations. How about trying to remember to do a set of them:

  • When you brush your teeth
  • When you’re in the shower
  • When you lie down in bed at night
  • When you’re waiting for the kettle to boil

They can be done pretty much anywhere that you can properly focus on them and get through a whole set for 1-2 minutes. Which is why doing them at the traffic lights might not be ideal…!

The pelvic floor can be incorporated into modified ‘core’ exercises during your workout too. These exercises should be correctly taught in person, but as an example, you could try swapping sit ups, planks and pull ups for more pregnancy-friendly core exercise options:

  • Sitting ball leg lifts
  • Four-point kneeling opposite arm and leg lifts
  • Modified side plank exercises
  • Standing straight arm theraband pulls

Have a go of the exercise routine shown in this clip – Engage PF and TA, extend single leg, lower it, relax. If you can feel the core muscles contract and relax each time, try 5 or so of each on each leg, and have a go at the progressions shown, with or without theraband:

  1. Push one arm forward as you lift/extend the opposite leg
  2. Push arm forward and twist to look over the opposite shoulder as you lift/extend the opposite leg
  3. Add in extending the back arm straight behind you.

This and other pregnancy-friendly core muscle exercise options can be found on the FitRight social media accounts by searching for #frweekendworkouts. Follow us on Instagram or Facebook at the below links for regular exercise and education tips for pregnancy and beyond.

How do I learn more about Pelvic Floor and Core muscle exercise in pregnancy?

Our information-packed small group PregEd workshops offer a real time ultrasound screening test for your pelvic floor muscles, as well as two hours of essential information about exercise during and after pregnancy. Sign up now to come and join us at one of our upcoming sessions.

The best way to implement Core muscle training into your pregnancy exercise regime is under the direct guidance of a physiotherapist with extra training in the area of pregnancy exercise. FitRight Bump&Me exercise classes provide pilates and low level resistance training for all stages of pregnancy – see the website for more information about these safe, rebatable courses.