Pelvic Floor Exercises During Pregnancy: A Step-by-Step Guide

Pelvic floor exercises during pregnancy are one of the most evidence-based, universally recommended, and most frequently ignored aspects of antenatal care. Every midwife will mention them; far fewer parents actually do them consistently. This is partly because they’re invisible exercises with no immediately tangible feedback, and partly because the consequences of not doing them — urinary incontinence, prolapse, and reduced sexual function — feel distant and unlikely in the moment. But the evidence is unambiguous: a pelvic floor exercises during pregnancy guide is something every pregnant woman should have access to, because the pelvic floor is the foundation of core health, and pregnancy and birth place extraordinary demands on it. This comprehensive guide explains what the pelvic floor is, why pregnancy affects it so profoundly, how to actually perform pelvic floor exercises correctly, when to start, and how to fit them into a normal life.

Understanding Your Pelvic Floor

The pelvic floor is a group of muscles, ligaments, and connective tissue that form a hammock-like structure at the base of your pelvis. It spans from your pubic bone at the front to your tailbone at the back, and supports the bladder, bowel, and uterus. In pregnancy, this structure bears the increasing weight of the growing uterus — by full term, the uterus weighs approximately 1kg and its entire weight rests on the pelvic floor. The hormones of pregnancy, particularly relaxin (which increases tissue laxity to prepare for birth), also affect the pelvic floor.

The pelvic floor has several critical functions:

• Maintaining bladder and bowel continence — preventing leakage when you cough, sneeze, jump, or laugh
• Supporting the pelvic organs in their correct anatomical positions
• Contributing to sexual function and sensation
• Working as part of the core stabilisation system alongside the deep abdominals and diaphragm
• Facilitating birth by relaxing and stretching to allow the baby to descend

Pelvic floor dysfunction — which includes stress urinary incontinence, urgency incontinence, pelvic organ prolapse, and pelvic pain — is extremely common in women who have been pregnant, regardless of birth mode. Research suggests that up to 70% of women experience some urinary incontinence in the final trimester of pregnancy, and that vaginal birth (particularly prolonged second stage, large babies, and instrumental delivery) significantly increases pelvic floor risk. Even caesarean section carries pelvic floor risk due to the weight of pregnancy itself.

How to Identify and Engage Your Pelvic Floor

The most common mistake women make with pelvic floor exercises is performing them incorrectly — typically by tensing the buttocks, squeezing the thighs, or holding the breath rather than engaging the pelvic floor itself. Incorrect technique provides no benefit and can actually increase intra-abdominal pressure in unhelpful ways.

To correctly identify your pelvic floor muscles, try the following exercise when you have a moment of privacy and are not mid-stream (the old advice to stop mid-stream has been updated — it can disrupt normal bladder function and should not be used regularly):

• Sit or lie comfortably with your legs uncrossed and your buttocks and thighs relaxed
• Imagine you are trying to stop yourself passing urine and wind at the same time
• The sensation should be an internal lift and squeeze — an upward and inward pull, not a downward push
• Your breathing should continue normally; hold the contraction without holding your breath
• Your buttocks, thighs, and abdominal muscles should remain soft

If you are uncertain whether you are engaging correctly — which is very common — a Women’s Health Physiotherapist (also called a Pelvic Health Physiotherapist) can provide a real-time assessment, often with biofeedback, to confirm your technique. Referral is available through the NHS; in the UK, ask your midwife or GP. In many European countries including Germany, France, and the Netherlands, postnatal pelvic floor physiotherapy is standard care provided at no cost.

The Exercise Programme: Step by Step

NICE guidelines on urinary incontinence recommend that pregnant women perform pelvic floor exercises regularly to reduce the risk of postnatal incontinence. The recommended programme has two components: slow contractions (for endurance) and fast contractions (for reactive, reflex strength).

Slow contractions (endurance):

• Engage the pelvic floor as described above and hold for 8–10 seconds
• Relax fully for 4–6 seconds between each contraction (the relaxation phase is as important as the contraction)
• Repeat 8–12 times, three times per day

Fast contractions (reactive strength):

• After your slow contractions, perform 8–10 quick squeezes and releases
• These build the reflex response that prevents leakage on sudden increases in abdominal pressure (coughing, sneezing, jumping)
• Repeat as above, three times per day

A helpful memory tool is to associate pelvic floor exercises with routine activities: every time you sit down to eat, every time you stop at a red light if you drive, or after every nappy change postnatally. The key is consistency over time — benefits typically take 3–6 months of regular practice to become fully apparent.

Common Questions and Concerns in Pregnancy

Pregnant women often have specific concerns about pelvic floor exercise, including whether they might harm the baby (they won’t — the baby is well above the pelvic floor in the uterus, which is not being contacted by these exercises), and whether they should do pelvic floor exercises if they have pelvic girdle pain (PGP). If you have PGP or symphysis pubis dysfunction (SPD), you should see a Pelvic Health Physiotherapist before beginning an unsupervised programme, as some exercises may need to be modified.

In the third trimester, it is equally important to practise pelvic floor relaxation as it is to practise contractions. The pelvic floor must be able to fully relax during the second stage of labour for the baby to descend effectively. Techniques for pelvic floor relaxation include:

• Diaphragmatic breathing with a conscious visualisation of “letting go” on the exhale
• Perineal massage from 36 weeks (with partner or independently), which evidence supports for reducing perineal tearing, particularly in first-time mothers

Pelvic Floor Health After Birth

Postnatal pelvic floor recovery is equally important. The NHS recommends beginning gentle pelvic floor exercises as soon as possible after birth — within 24 hours for a straightforward vaginal birth — to reduce swelling and restore muscle function. In the early postnatal period, exercises should begin gently and build gradually. After a caesarean section, pelvic floor exercises can begin when comfortable; the pelvic floor still needs rehabilitation despite the different birth route, because of pregnancy itself.

At the 6–8 week postnatal check (now an NHS standard), you should be assessed for pelvic floor function. Many UK women report that this assessment is cursory or does not happen at all — if this is your experience, please advocate for a referral to a Pelvic Health Physiotherapist. In France, Germany, the Netherlands, and many other EU countries, 10–20 sessions of postnatal pelvic floor physiotherapy are provided automatically; the UK lags significantly behind in this standard of care.

Frequently Asked Questions

How soon should I start pelvic floor exercises in pregnancy?

As soon as possible — ideally from the moment you find out you’re pregnant, or even before. The NHS recommends starting pelvic floor exercises in the first trimester and continuing throughout pregnancy and postnatally. There is no stage at which it is too early to begin.

Can pelvic floor exercises prevent tearing during birth?

Pelvic floor exercises alone do not prevent tearing, but they contribute to the flexibility and coordination of the perineal tissues. Perineal massage from 36 weeks has the strongest evidence for reducing severe perineal tearing and episiotomy in first-time mothers, according to NICE. Warm compresses applied by your midwife during the second stage of labour are also evidence-supported for reducing trauma.

What if I experience pain doing pelvic floor exercises?

Pain during pelvic floor exercises is not normal and should be investigated. It may indicate pelvic floor hypertension (an overactive or tense pelvic floor), which requires a different treatment approach to underactive pelvic floor muscles. A Pelvic Health Physiotherapist can assess this. Do not push through pain.

I’m already leaking urine — is it too late?

No. Urinary incontinence in pregnancy is very common and is not a sign of permanent damage. Pelvic floor exercises and physiotherapy input are effective treatments even for established leakage. If you are already experiencing symptoms, asking your midwife for a physiotherapy referral rather than waiting until after birth will mean you have support in place sooner.

Start Today — Your Future Self Will Thank You

The practical next step is simple: do three sets of pelvic floor exercises today, using the technique described above. Set a daily reminder on your phone if that helps. If you’re uncertain about your technique or have any symptoms — leakage, pressure, or pain — ask your midwife for a referral to a Pelvic Health Physiotherapist. This is one of the most evidence-based investments you can make in your long-term health, and it costs nothing but a few minutes a day.