SECOND PREGNANCY: 6 PELVIC FLOOR STRENGTHENING EXERCISES
Being a mum, by now you are more than likely acquainted with the pelvic floor. Whether you gave birth vaginally or via C-section the first time around, you will know something about pelvic floor from your pregnancy and motherhood journey.
Whether you are intrigued because things are fine “down there” but you are on your second pregnancy (or more) and are feeling some of the strain on your pelvis, lower back or tummy… currently pregnant the second time around and want to prepare your pelvic floor for pregnancy… or perhaps you have some unresolved issues from your first pregnancy or birth, you are in the right place!
Read on as Lenny Rose Active founder, physio and 3x mum gives you the downlow on all things pelvic floor exercise for the seasoned mum!
HOW PELVIC FLOOR MUSCLES CHANGE AFTER FIRST BIRTH
Your pelvic floor is a sling or hammock of muscles that underlies the pelvis and has deeper layers that support the pelvic organs. The deeper layers have a role in childbirth, sexual function, pleasure, and the extra surface layer helps to control the passage of urine and faeces (for lack of a better way to put it!).
For a small hammock of muscle, it sure plays an important role in our physical (and often mental health). So, the more armoured you are with knowledge about your pelvic floor muscles, the more confidently you can tackle pregnancy and the postpartum journey.
Whether you gave birth “normally” last time, (what a silly term, but that’s how the medical world will pen it if you gave birth vaginally), had a “normal” delivery with intervention (forceps, episiotomy, ventouse) or had a c- section, there will undoubtedly be some effect on the pelvic floor structure and function.
Simply by the act of carrying the weight of your baby to the order of a number of kilos on top of the pelvic floor, you will give this area some stretch and strain throughout pregnancy – before you even consider the birth process.
It’s no wonder that stress urinary incontinence is extremely common in pregnancy – but we can go a long way to prevent and manage symptoms with the right pelvic floor exercises.
If there was some damage in delivery your first time around, it’s going to be very variable. It will depend on how the pregnancy went and the extent of change or impact to the pelvic floor.
The best way to know is to see a Trained Women’s Health Physiotherapist for an assessment to set you on the right path! Download our free prenatal exercise ebook here.
I would stress this especially if you have any symptoms like pain, especially with sexual intercourse, incontinence of any kind or a sense of heaviness in the vagina, all warrant a check up and guidance on the right path to resolving your symptoms.
If you are currently pregnant for the second time, wait until you are in the second trimester to see a Women’s Health Physiotherapist. This will help target your pelvic floor strength exercises at the right level for success.
Our pelvic floor should be working a little bit, all of the time, to counteract the bladder. However, it needs to relax in order for us to pass #1’s and 2’s and preemptively activate when we cough, sneeze, jump etc. This reflex is often lost after childbirth, but the good thing is, it can be retrained in most cases relatively easily. Read on to learn about “the knack” or how to do kegels exercises!
A common issue is also constipation, especially during pregnancy due to hormonal and digestive changes, as well as in the early postpartum period.
So ensuring you have good bowel health is a cornerstone to reducing the stress and strain on your pelvic floor and allowing you to achieve success with your pelvic floor strengthening exercises in pregnancy (which we will cover later in this guide).
HOW TO KNOW IF YOU ARE DOING PELVIC FLOOR EXERCISES CORRECTLY
The best way to check if you are doing your pelvic floor exercises correctly is to have an assessment by a trained women’s health therapist… Do I sound like a broken record yet?
It may be sufficient to do an ultrasound assessment (external) or many times in internal assessment is needed to correctly and accurately assess the pelvic floor. This sounds daunting, but is generally not as unpleasant as a pap smear nor is it painful.
Since the pelvic floor isn’t an area we can see for ourselves and both, pregnancy and birth are big drivers in pelvic floor dysfunction, having an assessment during pregnancy and starting a pelvic floor strengthening regime during pregnancy will go a long way to making life easier post birth – regardless of how smooth your labour and delivery goes.
Pelvic floor exercises are often called kegels, or even PC exercises (after one of the main pelvic floor muscles, Pubococcygeus) but they are essentially the same thing. Learning how to do kegels will be the cornerstone of your pregnancy exercise, we’ll take you through our favourite pelvic floor strengthening exercises, especially for seasoned mums!
HOW LONG DOES IT TAKE TO STRENGTHEN PELVIC FLOOR MUSCLES
Just like going to the gym to strengthen your arms and legs, you do need to put in some consistent effort and bide some time to see reward for your effort. There is good evidence to suggest that improvement in function and reduction of symptoms can be made within 4-8 weeks. This will of course depend on the current state of your pelvic floor (mild, moderate or severe pelvic floor related symptoms). Sometimes when the pelvic floor muscle is quite severely weak, basic strengthening won’t be enough on its own.
EXERCISE 1: PELVIC FLOOR LIFT WITH EXHALE BREATH IN LYING OR SITTING
How to do & benefits
You may want to try this exercise lying down if you are a pelvic floor newbie. Otherwise, sitting up can be a great starting position as you will get a bit more of a sense of the lift against gravity. Sitting with a small rolled up towel under your perineum (groin area, where your pelvic floor lies) can also give you some sensory feedback on the sense of lift of the pelvic floor.
Start with a couple of rounds of easy breathing
Then take an inhale breath
On the exhale, lift your pelvic floor. Start by tightening your back passage, then front passage, and then drawing the muscles in and up – like an elevator rising up into your pelvis.
Always use the exhale breath to lift, and your inhale breath to release.
Once you feel you have mastered this, then you can try holding the lift for a couple of seconds (without holding your breath), keeping buttocks, face and jaw relaxed.
Then release on an inhale breath.
Because of the common nature of weakness and overactivity occurring at the same time, I often like to suggest five relaxing and releasing breaths between the strengthening and lifting.
Tightening your back and front passage is similar to the sensation of trying to stop a fart (!), then trying to stop a wee (!) and then, adding an additional “lift”. Visualise a jellyfish as it lengthens and elongates on the “lift” and flattens and softens on the release. This may help you to better connect to this exercise.
It’s really important to coordinate the breath and the movement, and to get this basic action right, which is why seeing a women’s health physiotherapist is a great idea if you aren’t sure on technique!
In pregnancy and early motherhood, it’s also a good idea to get into the habit of using your exhale breath and a pelvic floor lift BEFORE you do anything that will usually bring on your symptoms, or a sense of strain in this area.
For example, coughing, sneezing, lifting something heavy (like your other children!) – this is known as “the knack”.
EXERCISE 2: PELVIC FLOOR RELEASE EXERCISE
As important as strengthening the pelvic floor is, it’s just as common to have an “overactive,” or “tight” pelvic floor. The pelvic floor can be both weak and tight at the same time.
An overactive pelvic floor can cause difficulty emptying your bladder and bowel, and can be a cause of painful intercourse. For childbirth, we also want the pelvic floor to relax and release to allow for an easy passage of your baby into the world.
Check out this pelvic floor exercises video which includes strengthening and relaxation, as well as pelvic tilt exercise in sitting – with Physio + Mama Rosie:
Seated, in cross legged sitting or butterfly the knees out. Perhaps on a blanket or pillow to allow your spine to be tall and supported.
Tilt the pelvis back and forth a few times to find the middle ground and create a tall spine.
Start with a few easy breaths
On an exhale breath, lift the pelvic floor
On your inhale breath, release and let the pelvic floor go.
On subsequent breaths, try to continue to release, relax, and let go of this area, (rather than the hold and relax in exercise 1).
It’s important for your buttocks, face, and jaw to be soft, and that you really visualise the softening of your pelvic floor. Think of your pelvic region like a lotus flower opening up.
EXERCISE 3: PELVIC FLOOR WITH SIT TO STAND
Once you have mastered the basics, it’s important to make pelvic floor strengthening functional, especially in preparation for the task of motherhood ahead.
Believe it or not, there is actually more pressure on your pelvic floor in the action of moving from sitting to standing, than there is lifting a 10kg weight. That’s why it is important to incorporate “the knack,” or pre tensioning of the pelvic floor into such functional movements.
Start from a sitting position on a chair. A higher chair is easier than a lower couch or stool, so start where you feel you can get this coordination happening.
Simply use your exhale breath and pelvic floor lift just before or as you go to stand from sitting.
Inhale to lower your way back down to the chair.
Repeat 10-15 reps a couple of times.
Try incorporating this Pelvic Floor With Sit To Stand exercise into your everyday life. Trust me, it will go a long way.
EXERCISE 4: PELVIC FLOOR EXERCISE SQUATSHow to do & benefits
Squatting is something we do multiple times every day, especially when you have young kids (and their toys :/) to constantly pick up from a lower to ground level.
Using your pelvic floor as you exhale and stand up will help you to master this squatting exercise with confidence, stability, and less pressure on your pelvic floor and organs.
Starting with a simple air squat
Repeat this 10-15x for a 2-3 sets
Again, consciously incorporating into each time you perform this action throughout the day, will help get you strong for motherhood with more than one baby!
EXERCISE 5: PELVIC FLOOR WITH SQUAT AND BAND PULLHow to do & benefits
Attach a theraband to a pole or secure door handle in its middle section, so that you have 2 even lengths of band to pull on once secured.
With the band in each hand take a few steps away such that your arms are stretched out with decent tension on the band.
On an inhale lower into a squat position, let your arms be pulled forward with the band.
On an exhale, stand up into a squat as you pull the band in a rowing action to the sides of your body.
Practice the movement a few times with the breathing pattern inhale to lower, exhale to stand up.
Once you have mastered this, we will add in the inhale to release pelvic floor as you lower into the squat and exhale to lift your pelvic floor, pull the band into the row, and stand upright. Think about squeezing the muscles of your middle back as you row as well as your butt muscles as you stand up from the squat.
Do this 15-20x for 2-3 sets.
EXERCISE 6: PELVIC FLOOR WITH SQUAT TO ROTATEHow to do & benefits
This is a great functional movement for motherhood as it includes strengthening the lower body, pelvic floor and even adds in a twisting action which you will do multiple times throughout the day. (Note: The twist is not through your belly, but a pivot on the ball of the foot and turning through your upper back).
Get the action right first, then incorporate breath and pelvic floor.
Start in a standing position with arms outstretched forwards, parallel to the floor.
Come up onto the ball of your right foot.
Turn your arms and torso to the left.
Then return to centre and squat.
Stand up and turn to the opposite side with arms still outstretched and on the ball of the left foot as you turn right.
Once you have mastered this action, inhale as you squat, exhale as you stand tall and rotate.
Once you have mastered the movement and breathing combined, add pelvic floor lift on your exhale, release on your inhale – as you have done with all of the previous movements.
Try doing 10 reps (squats) for 2 sets.
You can see more exercises like this in other blog posts our Free Pregnancy Exercise Ebook.
Regardless of your experience of pregnancy and childbirth first time around, getting acquainted with regular pelvic floor exercise for your subsequent pregnancy(s) and motherhood will go a long way to a happy and healthy pelvic floor, pelvis, spine, core.
As we have already explained throughout this guide, strengthening your pelvic floor can help to alleviate any symptoms of stress and other incontinence.
You can see how easy it can be to incorporate into the day as a busy mum, and how important it is that we go beyond “doing kegels at the traffic lights” when you remember to do so.
You got this mama!
Reach out to Lenny Rose Active for further information about our activewear and how we have designed it with YOUR needs in mind (as mums, we know what it’s like!) so that you can feel good and strong during pregnancy, motherhood & beyond.