You may not have known anything about pelvic floor muscles until pregnancy or after having a baby. Most likely, you’ve heard two things 1) you should do kegels to strengthen them, and 2) problems with these muscles can cause incontinence.

Those two things are a good start, but I’d love to provide you with a bit more education so that you feel empowered to care for these muscles and/or continue to exercise if you’re dealing with pelvic floor muscle dysfunction. In this post, we’ll talk about where the pelvic floor muscles are located and their function, common problems that can occur, and four ways to engage and protect them during your workout routine.

What are pelvic floor muscles?

Your pelvic floor muscles form a hammock-like layer across the base of your pelvis. They stretch from your pubic bone in the front to your tailbone in the back. I’ve also heard them referred to as a trampoline, which should be taught and durable. Here are a few things to know about their function:

When these muscles contract, they lift up and support your pelvic organs.
When you bear down, like when sneezing or lifting something heavy, the pelvic floor stretches and lengthens to accommodate the pressure created in your abdomen.
Additionally, your pelvic floor muscles play a role in sexual function. When these muscles are too tight you might experience painful intercourse. Strong functioning pelvic floor muscles can help you achieve greater sensation during orgasms.
Pelvic floor muscles play a role in continence, allowing you to have control over elimination, including passing gas.
Lastly, they play a role in spinal and pelvic stability as a member of the core muscle-stabilizing team.

Common Pelvic Floor Issues in Moms

Factors like pregnancy, childbirth, and aging can impact the function of these muscles. They may weaken due to the weight of the uterus, or they may become too tight due to the birthing process. Either way, if they’re not functioning as they should, it can lead to incontinence, prolapse, and impact your core strength.

Most of you are probably aware of the connection between pelvic floor muscle function and incontinence. Did you know that there are two types of incontinence?

Stress incontinence causes leaking of urine when you cough, laugh, sneeze, or during exercises that involve impact, breath holding, or bearing down.
Urge incontinence is when you have the sudden urge to urinate and may not be able to hold it. An example often given is that you know you have to use the bathroom and right before you get to the toilet the urge gets stronger and you can’t prevent urinating.

The majority of incontinence for moms is stress urinary incontinence, however, some moms will also struggle with fecal incontinence which is the inability to control bowels. This can happen due to trauma during the delivery process.

Another condition that involves the pelvic floor muscles is pelvic organ prolapse. Because the pelvic floor muscles support your organs, if there is a dysfunction this can cause organs like your uterus or bladder to drop into the vaginal wall. Picture a hammock or trampoline that can’t support the weight of the person on it…it begins to sag toward the ground. In some cases, the organs can extend outside of the vagina.

The good news is that pelvic floor physical therapy is more widely available and we’re learning more about lifestyle changes and exercise that can treat, improve, or help you cope with these conditions. Additionally, qualified exercise professionals should be able to prescribe exercises that support your efforts to improve pelvic floor function.

Four Ways to Engage, Strengthen, and Protect Your Pelvic Floor During Exercise

As I mentioned, either while you’re in pelvic floor physical therapy, or after you’ve been discharged, a qualified exercise professional can help you engage, strengthen, and protect your pelvic floor during strength workouts. Here are a few strategies you can implement during your workouts:

Coordinate your breath: Your pelvic floor muscles are the basement of your core, where the diaphragm is the ceiling. The cylinder which is your core will function optimally when both of those muscles work in synergy. When you exhale your pelvic floor muscles are lifted and when you let the breath out your pelvic floor relaxes. The diaphragm should move in the same direction, descending on your inhale and rising on your exhale. Coordination of these two muscles isn’t always easy, especially when movement is involved. However, it’s important enough to master so that you’re not putting excessive pressure on the pelvic floor muscles.
“Close the holes” or "Blow before you go”: I can’t take credit for these terms as I’ve heard them from several pelvic floor physical therapists. The strategy is to engage the pelvic floor muscles right before you’re about to lift something heavy. Imagine closing your anus as if you’re trying to not pass gas. This will activate your pelvic floor right before there is increased abdominal pressure. You can also try “blow before you go”, which means that right before you’re going to lift, you begin the exhale. Again this can help manage pressure pushing down on the pelvic floor muscles.
Avoid impact exercises postpartum until you’ve dedicated time to resistance training: The postpartum running guidelines suggest a minimum of 12 weeks of progressive exercise, including resistance training. However, if you’re having symptoms of pelvic floor muscle dysfunction, this may take longer. When you’re ready to add higher impact activities, start with fewer reps and shorter duration. Take your time to progress and build up. You wouldn’t go from lifting a 5-pound dumbbell straight to 50 pounds, would you? It’s worth mentioning that there aren’t prenatal running guidelines and plenty of moms do run during pregnancy, but if you’re noticing symptoms, that may mean your pelvic floor muscles can’t handle the impact and it’s probably best to move to low impact options.
Remember that pelvic floor muscles are muscles: We all understand the concept of challenging a muscle in order to make it stronger and stretching muscles to relax and lengthen. The same goes for pelvic floor muscles. If you have a weak pelvic floor, you don’t want to avoid core training altogether because it’s going to need the challenge of the exercise to get stronger. If you’re not having symptoms, it’s also important to learn how to contract and relax those muscles. The easiest way to do this is by focusing on breath and core stabilization during strength training. If your core muscles are working together, your pelvic floor muscles will maintain/gain strength. If you prefer isolated exercises, you can throw in kegels of different durations (long contractions and quick contractions).

Education should be empowering. As you learn more about your body, don’t let it cause fear. Research around core stability exercises benefiting the pelvic floor muscles is increasing, which is an incredibly positive thing. So whether you’re experiencing any of the named conditions, or if you’re concerned about atrophy as you age, or if you just want a well-rounded core program, take the time to become familiar with your pelvic floor muscles.

If you’re ready to put core training to reduce your risk of incontinence and back pain into practice, consider my free 5-day core course.

Happy training!

The physical changes to your body during pregnancy don't immediately disappear postpartum. One common change is diastasis recti abdominis (DRA), also known as abdominal separation. While this might sound intimidating, it's essential to recognize that DRA is a natural part of pregnancy in order to make room for your growing baby. It's also important to note that if you have abdominal separation, with the right guidance, you can regain core strength and confidence, and return to physical activity and exercise.

Understanding Diastasis Recti:

Diastasis recti, or abdominal separation, occurs as the linea alba (the connective tissue that runs vertically in the middle of your abs) widens and weakens to accommodate your growing baby. This caused your rectus abdominis (six-pack abs) to separate from each other. For some moms, the linea alba naturally tightens post-birth, bringing your rectus abdominis muscles closer together again. For others, the separation can persist, leaving a gap. The opinion about diastasis recti has shifted to such that rehabilitation is less about closing the gap, and more about being able to create tension so that your core can act as the stabilizer that it is designed to be.

Pelvic Floor Physical Therapy/Women’s Health PT

Many moms will look toward physical therapists for support. During your treatment, you'll focus on core muscle activation and breathing. This may result in your gap closing, but even if it doesn't you'll learn to have a strong and functional core so that your DRA doesn't impact your quality of life. It’s important to trust the process even if the exercises feel too basic. The basics are what create a strong fitness foundation so that you can progress and reach your postpartum fitness goals.

Exercise After Physical Therapy

After you've focused on core muscle coordination and have regained some strength, you'll be discharged from PT. You may then wonder what's next and still have questions about what exercises are safe. The key here is to realize that there is no one-size-fits-all approach. It's about personalizing your fitness program and performing exercises that allow you to have core strength and control. I've worked with many postpartum moms returning to exercise while managing abdominal separation, or after pelvic floor physical therapy and I’m happy to share my insight with you.

Tips & Strategies for Exercising with Diastasis Recti

Note, that it is recommended you work with a qualified postnatal fitness professional or see a pelvic floor physical therapist if you're looking for diagnosis or treatment.

Gradual Progression: Start with exercises that focus on activating your deepest core muscle the transverse abdominis. Move to coordinate that muscle activation with breath and pelvic floor. Progress to more complex movements gradually, incorporating resistance, repetitions, and different positions.
Manage the pressure you create within your abdominal cavity: Be mindful of everyday activities that increase your intra-abdominal pressure, such as sneezing, coughing, or lifting. Use your transverse abdominis activation strategies and breath to help manage the pressure and force on your healing abdominal wall.
Exercise Selection: Choose exercises that align with your core strength and function. There isn’t a definitive list of “bad exercises” or “exercises to avoid if you have diastasis recti”. Rather it should be based on your personal ability. If you can lift 20 pounds fairly easily without having to bear down or hold your breath, then that exercise may be appropriate. However if someone else goes to bench press 20 pounds and struggles and grunts and has to create a lot of pressure in the abdomen to perform the movement, then that exercise should be avoided until the core is stronger and the tissue is more healed. Most people will void high-impact or heavy-lifting activities initially.
Muscle Recruitment: Pay attention to recruiting the right muscles at the right time. For example, many people think of the chest, shoulders and arms for a push-up and don’t realize that it is very much a core exercise. To stabilize the spine during a push-up your core muscles should engage. Ensure your deep abs activate for stability before movement.

Avoid back pain and incontinence

Although more research needs to be done when it comes to diastasis recti impacting pain and incontinence, many moms that I work with who are concerned about abdominal separation are also concerned about incontinence and back pain. Both of those conditions are common during and after pregnancy so their concerns are valid. Rather than fearing these conditions, I created a free 5-day program to empower you and educate you on how to have a strong and functional core in order to reduce your risk of pain and leaking when you sneeze or cough. By understanding your body and following a tailored fitness approach, you can confidently navigate your fitness journey with diastasis recti or any other condition resulting from pregnancy.

Ready for more tips? Download 5 Tips for a Stronger Core After Pregnancy.

Taking Care of Your Pelvic Floor During Exercise