Pregnancy can be an enriching, life-transforming experience. Yet, the many physiological and anatomical changes that take place during pregnancy are often ignored and seldom discussed, which can lead to Old Wives’ Tales — like bladder leakage, or even urinary incontinence, being inevitable during pregnancy. They’re not; these experiences are the result of weak pelvic floor muscles. And there are plenty of exercises, called Kegel exercises, that you can do to strengthen your pelvic floor and prevent or curb bladder problems during pregnancy.

Pelvic floor muscles are thick and firm layers of muscles that help support your bladder, uterus and bowel (colon), organs that sit in the space within your pelvis, or hip bones. The muscles stretch like a trampoline from the tailbone to the pubic bone (front to back), and from one hip to the other (side to side). The urethra, the vagina and the rectum pass through the pelvic floor muscles. Aside from supporting these organs and surrounding these passages, pelvic floor muscles also maintain continence, optimum intra-abdominal pressure, and facilitate childbirth.

During pregnancy, pelvic floor muscles become extra important. As the fetus grows over nine months, pressure inside the abdomen gradually increases, which in turn increases the burden on the pelvic floor. More often than not, the pelvic floor muscles withstand the added stress, but sometimes these muscles begin to sag and weaken. Hormonal changes during pregnancy may also play a role on muscles’ functioning. Relaxin levels increase during pregnancy, and studies suggest this hormone could be an exacerbating factor to stressed and weakened pelvic floor muscles.

When the pelvic floor muscles weaken, maintaining bladder control gets more difficult. During pregnancy, the growing fetus pushes against the bladder, reducing the bladder’s filling capacity and causing women to need to urinate more frequently. When this excessive pressure is coupled with weakened pelvic floor muscles, women can experience bladder problems during pregnancy — ‘wetness,’ leaking urine or, in extreme cases, even urinary incontinence during pregnancy. Sometimes it’s an involuntary leakage or dribble of urine while coughing, sneezing, or even laughing. This is due to ‘stress’ urinary incontinence, as a result of the mechanism explained above.

Sadly, these symptoms and complaints of lessened bladder control during pregnancy go unreported or are seen as ‘normal’ changes that every pregnant woman goes through. In reality, urinary incontinence in whatever degree during pregnancy is a sign of a weak pelvic floor musculature and requires immediate and prompt intervention and care. Strengthening these muscles can help prevent further damage and, during the initial stages, may even aid in reversing the problem. Strengthening exercises, known colloquially as Kegel exercises, or Kegels, can also ease childbirth; pelvic floor muscles are integral in helping the fetus rotate forward to navigate downward through the pelvis – all while keeping your pelvic organs from descending, too.

But in order to work, Kegel exercises must be performed correctly. A lot of people have difficulty identifying their pelvic floor muscles, as they are not used to voluntarily activating these muscles, or may have never realized when the muscles are being used. Hence, the first step to performing proper Kegel exercises is to identify your pelvic floor muscles.

Imagine you need to use the restroom to empty your bladder urgently, but there’s no toilet in sight — so you must hold on. The action and the muscles used to hold on are the ones that form the pelvic floor.

If you’re still not sure, you could do a quick self-check the next time you visit the restroom. While urinating, stop the flow midway. The action of squeeze, lift and hold is what you must do during Kegel exercises. (It is not advised to use the self-check as an exercise; Kegels are best practiced outside of urination.)

Once you have learned to identify the pelvic floor muscles and their action, gradually look at performing Kegel exercises to build the strength of those muscles. As practice makes it perfect, initially, Kegels may not feel comfortable or correct to do, but as you keep performing them regularly, the pelvic floor muscles will begin to activate better and gradually the exercise sets and repetitions may be increased.

Kegel exercises for pregnancy

Here are three different types of Kegel exercises for pregnancy. Please don’t hold your breath at any point while performing any of the exercises below. It may be a little tricky to breathe normally while performing the Kegel exercises, but aim at maintaining your breathing correctly before advancing.

• Gently lift your pelvic floor muscles. Squeeze and hold for a second. Release. Gradually look at lengthening the hold time to two seconds, then three, and so on.
• Quickly contract and release your pelvic floor muscles in quick pulses. Count how many you can do in a row initially, then progressively add one more each time.
• Gradually tighten the pelvic floor muscles, pulling upwards over a count of three: begin with tight, tighter, tightest, to the count of 1-2-3. Progress to tightening more slowly with greater control, over longer counts — tight, tighter, tighter, even tighter, tightest, to the count of 1-2-3-4-5, for example — as a succession to the exercise.

The benefits of Kegel exercises and strong pelvic floor muscles aren’t limited to pregnancy and birth; a strong pelvic floor is also important to postpartum recovery, which I’ll address in an upcoming article.