Strengthen pelvic floor after childbirth
Your post-pregnancy body - NHS
Having a baby changes your body. Here’s some advice to help you feel comfortable with your body.
Physical problems after pregnancy
There may be physical problems after having a baby.
They can be related to pregnancy or birth, or the things you do while caring for young children, such as lifting and bending.
For some problems, you can do a lot to help yourself. For example, if you have a leaky bladder (incontinence) or a heavy feeling between your vagina and anus, you may need to strengthen the muscles around your bladder by doing pelvic floor exercises.
Also, if you have back pain, you may need to learn how to look after your back and do some exercises to strengthen it.
If a physical problem is bothering you, ask a GP or health visitor for help at any time. They can advise you and the GP can refer you to a specialist if necessary.
Your postnatal check
Your postnatal check at around 6 to 8 weeks after the birth of your baby is a good time to talk to the GP about any physical or mental health problems you've had since the birth.
Find out more about what happens at your postnatal check.
Separated stomach muscles
It's common for the 2 muscles that run down the middle of your stomach to separate during pregnancy. This is called diastasis recti, or divarication.
The amount of separation can vary. It happens because your growing womb (uterus) pushes the muscles apart, making them longer and weaker.
The separation between your stomach muscles will usually go back to normal by the time your baby is 8 weeks old.
After you have had your baby, you can check the size of the separation with this simple technique:
- Lie on your back with your legs bent and your feet flat on the floor.
- Raise your shoulders off the floor slightly and look down at your tummy.
- Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button. See how many fingers you can fit into the gap between your muscles.
Do this regularly to check that the gap is gradually getting smaller.
If the gap is still obvious 8 weeks after the birth, contact the GP as you may be at risk of back problems. The GP can refer you to a physiotherapist, who will give you some specific exercises to do.
Regular pelvic floor and deep stomach muscle exercises can help to reduce the size of the separation between your stomach muscles. It's also important to stand up tall and be aware of your posture.
Pelvic floor muscle exercises
Pelvic floor muscle exercises strengthen the muscles around your bladder, vagina and bottom.
This can help to stop incontinence, improve prolapse and make sex better too.
You can do these exercises lying down, sitting or standing. With practice, they can be done anywhere and at any time:
- Squeeze and draw in your bottom as if you're holding in wind.
- Squeeze around your vagina and bladder (urethra) as if you're stopping the flow of urine or squeezing during intercourse.
- Long squeezes – hold for as long as you can, but no longer than 10 seconds, then relax.
- Short squeezes – quickly squeeze the muscles and then let them go immediately. Do this until your muscles get tired.
Aim to build up to 10 repeats of each exercise, at least 3 times a day.
It's important to keep breathing normally while you do these exercises. Make sure you don't pull in your stomach when you squeeze.
Sitting on the toilet can be a good reminder to do your exercises. Just make sure you do them after you've finished.
Visit the Chartered Society of Physiotherapists website for more tips to strengthen your pelvic floor.
Stomach exercise
This exercise can help you tone your stomach muscles:
- Lie on your side with your knees slightly bent.
- Let your tummy relax and breathe in gently.
- As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline.
- Squeeze your pelvic floor muscles at the same time.
- Hold for a count of 10, breathing normally, then gently release.
Repeat up to 10 times.
Ways to ease back pain
These practical tips may help to relieve an aching back:
- while feeding your baby, sit with your back well supported and straight.
Put a small pillow or cushion behind your waist to support your lower back. Make sure your feet can reach the floor - kneel or squat (do not bend your back) to do tasks that are near the floor, such as picking up toys or bathing your baby
- change a nappy on a raised surface. You could kneel on the floor next to a sofa or bed. Never leave your baby unattended on a raised surface, in case they fall off
- keep your back straight and bend your knees when lifting
- Keep your back straight when you push your pram or buggy. Or, carry your baby in a well-fitting sling
More on your wellbeing after birth:
- Coping with stress after having a baby
- Keeping fit and healthy after a baby
- Managing sleep and tiredness
Page last reviewed: 22 October 2019
Next review due: 22 October 2022
Pelvic floor exercises | Pregnancy Birth and Baby
Pelvic floor exercises | Pregnancy Birth and Baby beginning of content5-minute read
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Pelvic floor exercises help to strengthen the muscles of the pelvic floor.
These muscles come under great strain in pregnancy and childbirth.
The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the lower end of the backbone.
If your pelvic floor muscles are weakened, you may find that you leak urine when you cough, sneeze or strain. This is quite common and you needn’t feel embarrassed. It's known as stress incontinence and it can continue after pregnancy.
By performing pelvic floor exercises, you can strengthen the muscles. Pelvic floor muscle training will help the body cope with the growing weight of the baby. Healthy, fit muscles before the baby is born will mend more easily after the birth and helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do pelvic floor exercises, even if you’re young and not suffering from stress incontinence now.
Even though this condition is common, consult with a doctor if the problem is at all distressing or is difficult to cope with.
What causes weakened pelvic floor muscles?
Being pregnant and giving birth stretches the muscles of your pelvic floor — the muscles that keep your bladder closed. Weakened pelvic floor muscles can’t stop your bladder from leaking. This leaking happens mostly when you cough, sneeze, lift or exercise. You may also find that you can’t wait when you want to pass urine.
Will they get stronger by themselves?
No. You’ll need to help your pelvic floor muscles get strong again. If you don’t strengthen the muscles after each baby, you’re likely to wet yourself more often when you reach middle age. Pelvic floor muscles tend to weaken with age. Menopause can make incontinence worse.
How can I prevent this happening to me?
- Always squeeze and hold your pelvic floor muscles before you sneeze, cough or lift.
- Don’t go to the toilet 'just in case' — this trains your bladder to want to empty more often.
- Empty your bladder completely when you go to the toilet.
- Avoid constipation by drinking plenty of fluids (preferably water) and fibre-rich foods.
- Don’t lift heavy loads too often.
- Don’t do bouncing exercises.
- When sitting on the toilet, lean forward. Your knees should be slightly higher than your hips (you could use a small stool or step to rest your feet on). Rest your elbows on your knees or thighs so that your back is straight. This helps to relax your pelvic floor and sphincter muscles. Gently bulge your abdomen. Relax your pelvic floor and avoid pushing.
To keep these muscles working well, make pelvic floor exercises part of your routine for the rest of your life. You can start during pregnancy and continue after birth. Pelvic floor exercises can be done anywhere — while sitting, standing or lying down.
- Squeeze and draw in the muscles around your anus (back passage) and vagina at the same time as if you are trying to stop a wee.
- Hold the squeeze as you count to 8; relax for 8 seconds.
If you can’t hold for 8, just hold as long as you can. - Repeat as many as you can, up to 8 to 10 squeezes. This equals 1 set. Rest for about 8 seconds in between each lift up of the muscles.
- Try to do 3 sets of 8 to 10 squeezes each day.
- While doing pelvic floor exercises, keep breathing, do not tighten your buttocks and keep your thighs relaxed.
Pelvic floor exercises are not necessarily easy to do correctly. The pelvic floor muscles can be difficult to isolate. When done correctly, they are very effective, but the wrong technique can make a problem worse.
If you are not sure that you are doing the exercises correctly, ask for help from your doctor, physiotherapist or continence nurse.
The Continence Foundation of Australia has produced this video on how to locate your pelvic floor muscles:
You can also find out more about pelvic floor strength on the Jean Hailes website.
How can I remember to do my pelvic floor squeezes?
It’s easier to remember if you do them at the same time as you do something else. Pick something from this list. Each time you do it, do a set of squeezes too.
- after going to the toilet
- washing your hands
- having a drink
- feeding the baby
- standing in line at the supermarket checkout
Weaker pelvic floor muscles can make you break wind more. Just in case you need another reason to get serious about strengthening your pelvic floor muscles — these muscles also help close off the back passage. Many women find that following the birth of their baby they have less control, and find it harder to control wind, or to hold when they need to open their bowel. If you do experience problems, speak to your doctor or midwife since early treatment can be simple yet effective in improving muscle tone.
If the condition is not improving, or it worsens within, say, 2 to 6 weeks of using simple pelvic floor exercises, seek an opinion from a general practitioner who may arrange a referral to a specialist health care provider in this area.
Sources:
Continence Foundation of Australia (Female pelvic floor), Continence Foundation of Australia (About continence: prevention), Continence Foundation of Australia (Pregnancy and childbirth), Jean Hailes (Pelvic floor exercises)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: September 2020
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- Exercising during pregnancy
- Birth injury (to the mother)
- Looking after your body after having a baby
- Preparing for the birth
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Sex after childbirth: training intimate muscles
These muscles are often referred to as the intimate muscles. Well-developed pelvic floor muscles are the key to sexual pleasure: their volume and tone affect the degree of closure of the genital gap and, accordingly, the strength of arousal and orgasm. But very often after pregnancy and childbirth, these muscles weaken and lose their tone.
Why is this happening?
NO MOTION
“Almost half of women leave the maternity hospital with weakness of the pelvic floor muscles (and even more if it is a repeated birth), says gynecologist Elena Silantyeva. - After all, the muscles of the pelvic floor, like all striated muscles, develop only in work, in active movement. But what kind of life do we lead? Most often - sedentary, which is why the muscles are inactive and atrophy. And during childbirth, when the birth canal is stretched, these flaccid muscles are more quickly stretched and injured. For this reason, a woman may experience a syndrome of "wide vagina" (vaginal relaxation). An infection easily penetrates into a wide open genital slit, thrush, colpitis or vaginitis may develop. And close contact of the vaginal mucosa with linen leads to its drying and partial atrophy. It is not surprising that the sensitivity of the mucosa as an erogenous zone is reduced.
Moreover: during the love act, there is no tight fit of the partner's penis to the inner walls of the vagina. And as a result, not only the woman herself ceases to feel any pleasure during contact, but also the man (especially the elderly one): after all, the strength of his erection largely depends on the degree of fit.
HEALING ORGASM
Weak sensitivity of erogenous zones leads to another serious problem: a woman can experience a pronounced sexual desire, but cannot get an orgasm. And it's pretty bad for her reproductive system. After all, an orgasm not only gives pleasure and provides emotional relaxation, but also supports women's health. “Orgasm causes an instant spasm of the smallest vessels of the arterial bed, blood renewal, an increase in the tone of the venous system,” explains Elena Silantyeva. - If discharge does not occur, then the outflow of venous blood slows down and congestion develops in the vessels of the small pelvis, which manifest themselves later in various painful sensations.
And gynecologists treat these pains with antibiotics, which in turn destroy the microflora of the vagina, and a more serious infection enters the body. Actually, this is another reason to establish a harmonious sex life.
INTIMATE MUSCLES TRAINERS
What should a woman do if her pelvic floor muscles have weakened after childbirth and “wide vagina” syndrome has developed? Elena Silantieva offers several methods.
- Physiotherapy. First of all, immediately after childbirth, in the first day or two, a woman needs restorative treatment using classical types of physiotherapy - a magnetic field, UHF and others that reduce inflammation and quickly heal damaged, stretched muscle tissue.
- Physical exercise. As soon as the muscles have healed (not earlier than a month after the birth), you can gradually start working with them. But when exactly - only the doctor decides. Any physical activity that has no contraindications is welcome.
But Pilates, yoga, and physiotherapy exercises, which were so popular in Soviet times, are especially useful - these complexes usually include exercises that at least indirectly involve the muscles of the pelvic floor.
- biofeedback therapy. This is a hardware-computer complex, with the help of which women learn to do Kegel exercises, specially designed for training intimate muscles. Of course, these exercises can be done at home, but it is very important to master the correct technique under the supervision of a specialist, because women often confuse muscles and pump the wrong thing at all. If the muscles have not worked for many years, how can you know how these muscles feel, how to put them into work? For this, BOS-therapy is needed. What is its essence? An individual electrode is inserted into the vagina. And when the woman tenses and relaxes the corresponding muscles, the electrode receives an electrical impulse from them, and the data is displayed on the computer screen.
If a woman does not relax her muscles well or by mistake uses the muscles of the anterior abdominal wall, the doctor, looking at the screen, coordinates her work, gradually changing and complicating the task. For 15-20 sessions, you can develop a stable skill in order to continue to practice at home on your own. As a result of such exercises, the volume, strength, endurance of intimate muscles, their ability to relax and stretch increases. There is nothing surprising and mysterious in this: just as a man in the gym, pumping up his biceps, increases their volume, so a woman can double - and this is easily confirmed by ultrasound diagnostics - the volume of her levators (those muscles that lie around the entrance to the vagina) . The genital gap closes and becomes tight, the sensitivity of the erogenous zones is restored. - Laser vulvo-vaginal rejuvenation and intimate cosmetology (plasma therapy and mesotherapy) are modern technologies that involve laser exposure or intradermal injections in the intimate area.
They are designed to improve the quality of the mucosa of the external genital organs (and, if desired, change their aesthetic characteristics), improve their flora, and increase the sensitivity of erogenous zones.
Questionnaires conducted by physicians after these procedures have shown that women experience more intense sensations during sex as a result, more satisfaction at the moment of orgasm, and the orgasmic discharge itself occurs more often than before.
Pelvic floor exercises - second youth
In various women's magazines, a lot of attention is paid to diets, hair condition, face and body skin care, body shaping problems, invasive and minimally invasive plastic surgery techniques to change the shape of the ears, eyes, mammary glands, lifting and the right lifestyle. And at the same time, there are very few publications on the problem of pelvic floor muscle failure, vaginal wall prolapse, genital prolapse and urinary incontinence during exercise.
And this problem is global, because at least 40% of all women suffer from this disease.
Causes and symptoms of pathology
The very first symptoms of the disease are the gaping of the genital slit when the hips are bred at rest or when straining (straining). With the ongoing progression of the process, there is a slow (over several years) descent of the walls of the vagina and cervix into the formed perineal defect (i.e., through the gaping vagina). In this case, there may be a sensation of some kind of foreign body in the perineal region, pulling pains in the lower abdomen and in the lower back.
In addition, sexual discomfort arises, that is, a woman and a man stop feeling each other the way they did during their youth. This can lead to a feeling of sexual dissatisfaction that loving spouses hide from each other. The consequences of latent dissatisfaction during sexual intercourse can be infidelity of spouses and even divorces, for which, of course, other reasons are put forward.
With further progression of genital prolapse (as scientists call this disease), first a partial, and then a complete prolapse of the uterus and vaginal walls outside the genital slit occurs. In this case, sexual life becomes completely impossible, there are violations of the functions of adjacent pelvic organs - the bladder and rectum, manifested in difficulty urinating or urinary incontinence, impaired defecation, intestinal gas incontinence.
The most common cause of genital prolapse is childbirth. It can be one birth, but rapid, it can be a birth with a large fetus, repeated births, or births in which there were ruptures or a perineal dissection was performed with its subsequent restoration (i.e., suturing). Even when the doctor tells you that there were no ruptures in childbirth, or they were minimal and it was necessary to put 1, 2 sutures on the vaginal mucosa, there may be internal ruptures of the muscles and fascia of the pelvic floor, which subsequently lead to prolapse and prolapse of the genital organs .
What else does the gaping of the genital slit lead to, except for the prolapse of the genital organs, sexual problems and dysfunctions of adjacent organs? Many authors have proven that this pathology often causes inflammatory diseases of the vagina (colpitis, vaginitis), diseases of the cervix (cervicitis, ectopia), which are difficult to treat, due to a violation of the normal biocenosis of the vagina.
Why does the pathology progress before menopause?
With similar problems, women mostly of perimenopausal age turn to doctors. Why is this happening? We have already said that prolapse progresses slowly over 10-15 years. In the initial stages, its development is restrained by estrogenic effects on the muscles and mucous membranes of the pelvic floor. Women at a young age are sexually active, go in for sports, fitness, and this, to a certain extent, is a prevention of the progression of the disease.
In perimenopausal and postmenopausal age, the overall tone of all muscles decreases, including the muscles of the perineum, the stimulating effect of estrogens ceases, and this quickly leads to the progression of the disease. It is at this time that many women notice urine leakage when coughing, laughing, or exercising. Bladder dysfunction often accompanies prolapse and prolapse of the genital organs. What to do in such a situation? How to protect yourself from this disease? Don't give birth? Of course, it is possible and necessary to give birth, but it is necessary to know about the possible consequences of childbirth through the birth canal, how to prevent gaps in childbirth, how to strengthen and train the muscles of the perineum.
Kegel exercises
As a result of training the muscles of the perineum, the blood supply and tone of the muscular-ligamentous apparatus improves. Pelvic floor muscle training in the postpartum period is effective in reducing the risk of early genital prolapse and stress urinary incontinence. The mistake of most women is that they primarily seek to restore the figure in the postpartum period - "remove" the stomach, loading the abdominal muscles. At the same time, they forget or do not know that strengthening the press should be preceded by exercises that strengthen the muscles of the perineum. An increase in intra-abdominal pressure with a decrease in the tone of the pelvic floor muscles ultimately exacerbates the failure of the perineal muscles.
Exercises that strengthen the muscles of the pelvic floor were first published by Kegel back in 1948. The essence of the exercises is that in a certain rhythm it is necessary to contract the muscles of the perineum, while at the same time drawing in the anal sphincter and straining the buttocks.
Exercises must be performed in an anti-orthostatic position on the back, in the knee-elbow, stop-hand, stop-elbow position. Muscle contraction should occur on inhalation, and relaxation on exhalation. The duration of muscle tension is from 2 to 7 seconds, the number of repetitions is from 3 to 8. Harmful can be considered in the postpartum period - jumping, running, jerking movements, straining.
Effective for strengthening the muscles of the pelvis are vaginal simulators. They come in different forms (balls, olives), which are inserted into the vagina and the muscles of the perineum are held in it in a standing position with legs apart from 5 seconds to 1-2 minutes, the weight of the simulators gradually increases.
