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

Pelvic floor exercises are one of the most consistently recommended and evidence-backed things you can do during pregnancy — yet they remain widely misunderstood and often done incorrectly. This guide explains what the pelvic floor actually is, why pregnancy puts it under stress, how to do pelvic floor exercises correctly, and what the evidence says about their benefits.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles, ligaments, and connective tissue that forms the base of the pelvis. These muscles support the bladder, bowel, and uterus, and play a central role in continence, sexual function, and core stability. During pregnancy, the growing uterus places significant and increasing downward pressure on this muscle group throughout all three trimesters.

Why Does Pregnancy Affect the Pelvic Floor?

Several pregnancy-related changes place the pelvic floor under stress:

• The growing weight of the uterus, placenta, amniotic fluid, and baby presses down on the pelvic floor muscles continuously
• Relaxin, a hormone produced during pregnancy, loosens ligaments and connective tissue throughout the body — including in the pelvis
• Increased blood volume and progesterone affect muscle tone
• Labour and vaginal birth — while not always damaging — do place considerable strain on the pelvic floor, particularly if there is prolonged pushing, instrumental delivery, or significant tearing

The result is that pelvic floor dysfunction — including stress urinary incontinence (leaking when you cough, sneeze, laugh, or exercise), pelvic organ prolapse, and pelvic girdle pain — is extremely common during and after pregnancy. NHS estimates suggest up to one in three women experience urinary incontinence after childbirth.

The Evidence for Pelvic Floor Exercises

The evidence base for pelvic floor muscle training (PFMT) during and after pregnancy is robust. A Cochrane review of PFMT in pregnancy and the postnatal period found that women who performed regular pelvic floor exercises were significantly less likely to experience urinary incontinence both during pregnancy and up to six months postnatally. Regular training was also associated with reduced risk of pelvic organ prolapse and faster recovery of pelvic floor function after birth.

The NHS, NICE, and the Royal College of Obstetricians and Gynaecologists (RCOG) all recommend pelvic floor exercises throughout pregnancy and into the postnatal period.

How to Find Your Pelvic Floor Muscles

Many women struggle to identify the correct muscles. Two reliable methods:

1. Stopping urination mid-flow: The muscles you use to do this are your pelvic floor muscles. Note: do not make a habit of stopping mid-flow, as this can interfere with normal bladder function — use it only as a way to identify the muscles.
2. Preventing wind: Squeeze as if trying to prevent passing wind. This engages the posterior part of the pelvic floor.

A correct pelvic floor contraction should feel like a lifting and squeezing sensation inward and upward. You should not feel your buttocks tighten significantly, your thighs press together, or your breath held — these are signs you are recruiting the wrong muscles.

Step-by-Step Pelvic Floor Exercises

Slow (endurance) contractions

1. Find a comfortable position — sitting, lying on your back, or standing all work.
2. Breathe normally throughout. Do not hold your breath.
3. Slowly lift and squeeze your pelvic floor muscles inward and upward.
4. Hold for 8–10 seconds (start with less if you cannot hold this long).
5. Fully release and relax for 4 seconds. The release is as important as the contraction.
6. Repeat 8–12 times.

Fast (power) contractions

1. Quickly tighten your pelvic floor muscles.
2. Hold for 1 second, then release fully.
3. Repeat 8–12 times.

The NHS recommends completing both types of exercise three times per day. A common approach is morning, midday, and evening — many women find linking exercises to existing habits (such as cleaning teeth or sitting down for a meal) helps with consistency.

Common Mistakes to Avoid

• Not releasing fully: The relaxation phase is as important as the contraction. A chronically tight pelvic floor can cause as many problems as a weak one.
• Holding your breath: Breath-holding increases intra-abdominal pressure and works against the pelvic floor. Breathe normally throughout.
• Tightening the wrong muscles: If you feel your buttocks squeeze, thighs press together, or abdomen bulge outward, you are not isolating the pelvic floor correctly.
• Stopping after birth: Many women do pelvic floor exercises diligently during pregnancy and then stop after delivery — precisely the time when continued training is most important.
• Expecting immediate results: Like any muscle training, pelvic floor exercises require consistent effort over several weeks before meaningful improvement is seen.

When to Start and How Long to Continue

The NHS recommends starting pelvic floor exercises as soon as you know you’re pregnant. There is no upper gestational age limit — exercises are safe throughout all three trimesters. After birth, most women can restart gentle pelvic floor contractions within 24 hours of a vaginal delivery (once any perineal discomfort allows). After caesarean section, the advice is similar — wait until comfortable and confirm with your midwife.

Continue exercises for at least three months postnatally, and ideally as a lifelong habit — pelvic floor function declines with age, and the protective benefits of regular exercise apply throughout life.

When to See a Pelvic Health Physiotherapist

If you experience any of the following, a referral to a pelvic health physiotherapist (also called a women’s health physiotherapist) is strongly recommended:

• Urinary leakage during pregnancy or after birth
• Pelvic heaviness, dragging, or a sensation that something is coming down (possible prolapse)
• Pelvic pain during or after pregnancy
• Difficulty with pelvic floor contractions despite regular attempts
• Sexual pain or discomfort after birth

Pelvic health physiotherapy is available on the NHS — ask your GP or midwife for a referral. Wait times vary, but the service is free. Private pelvic health physiotherapy is also widely available and typically costs £60–100 per session.

Frequently Asked Questions

Can pelvic floor exercises prevent tearing during birth?

The evidence is mixed. Regular pelvic floor exercises improve muscle tone and flexibility, which may reduce the risk or severity of tearing — but many factors that influence tearing (including fetal position, speed of delivery, and delivery technique) are outside your control. Perineal massage from 34 weeks is also recommended by the NHS for first-time mothers as a way to reduce the risk of serious tearing.

Can I do pelvic floor exercises if I have pelvic girdle pain (PGP)?

Yes — pelvic floor exercises are generally beneficial for women with PGP and are often recommended as part of management. However, avoid exercises that aggravate your pain, and consult a pelvic health physiotherapist for personalised guidance.

Do pelvic floor exercises help with postnatal recovery after caesarean?

Yes. Although caesarean birth bypasses vaginal delivery, the pelvic floor still undergoes significant stress during pregnancy. Pelvic floor exercises support postnatal recovery regardless of birth type.