Pelvic Floor Exercises for Pregnancy and Postpartum

Most people learn about pelvic floor exercises as a way to prevent leakage. That's part of it. But the pelvic floor does a lot more than control bladder function, and training it effectively means understanding the full picture: how it works with the breath, how it responds to load, and what happens when it's too tight rather than too weak.

I see both ends of this with clients. Some come in with genuinely weak pelvic floors, leakage with sneezing and impact, and a need to build strength and endurance. Others come in with pelvic floors that are chronically over-contracted from stress, poor breathing habits, or previous training. Both groups need pelvic floor work. The work just looks different.

During pregnancy, the pelvic floor is under increasing load as the baby grows. Postpartum, it's recovering from the mechanical stress of delivery. In both phases, what matters most is coordination: the ability to contract when you need contraction and relax when you need relaxation, in coordination with your breath and your core.

What is the pelvic floor actually doing during pregnancy?

The pelvic floor is a group of muscles and connective tissue forming the base of the pelvis. It supports the pelvic organs (bladder, uterus, rectum), contributes to continence, and works with the deep abdominal muscles and diaphragm to manage intra-abdominal pressure during movement and lifting.

During pregnancy, it's bearing the additional weight of the growing uterus and baby. Research on pelvic floor changes during pregnancy shows that the muscles lengthen and remodel in response to hormonal changes and increasing load. Relaxin softens the connective tissue throughout the pelvis, which gives the floor more range of motion but reduces some of the passive support it normally provides. That's why active engagement matters more during pregnancy than at other times.

The pelvic floor also plays a direct role in labor. A floor that can relax fully, open, and yield under pressure is what you want for vaginal delivery. A floor that's chronically over-contracted can actually resist opening, which is one reason that pelvic floor physical therapists sometimes work on relaxation and downtraining as much as on strengthening.

What does pelvic floor contraction training look like?

The traditional Kegel involves contracting the pelvic floor muscles, holding for a count, then releasing. Done correctly, it feels like gently lifting and squeezing inward, similar to stopping the flow of urine or preventing passing gas. The words that matter most are gently and inward. Gripping hard with the glutes or inner thighs is a common compensation that bypasses the pelvic floor entirely.

The tactile cue that tends to work best is placing fingertips just inside the front hip bones and gently drawing the area inward, then adding the upward lift from below. This is the transverse abdominis plus pelvic floor coordination that also forms the basis of the pre-bracing technique used in strength training.

A basic starting protocol: 10 contractions of 5 to 10 seconds each, with equal rest between. Work up to three sets. This can be done lying down, seated, or standing. Standing is more functional and transfers better to what you're actually doing in daily life and in the gym.

Why does relaxation training matter and who needs it?

Over-tightening is more common than most people realize, particularly in high-achieving women who carry a lot of tension generally. A pelvic floor that doesn't know how to let go creates problems: pelvic pain, difficulty with intercourse, constipation, and, counterintuitively, leakage. A floor under constant tension is fatigued. Fatigued muscles don't contract effectively under stress.

Relaxation training uses a combination of breathing and position to cue the floor to release. The most effective position is typically a supported squat or a wide-legged child's pose. The cue is to inhale and deliberately let the pelvic floor drop and widen, as if the breath itself is pushing gently downward. There should be no pushing or bearing down. Just a softening.

Doing a few minutes of this before bed is useful for women who notice pelvic heaviness or end-of-day tightness. It resets the baseline tension in the floor before sleep, and several clients report it helps with sleep quality overall. If you're waking frequently to urinate and it's a concern, mention it to your OB, as frequent urination can be a normal pregnancy symptom or something worth checking out depending on context.

How does pelvic floor work connect to the bigger lifts?

The pelvic floor isn't a standalone system. It works in a pressure management team with the diaphragm above it, the deep abdominals around it, and the multifidus behind it. Every time you lift, run, or jump, that team has to coordinate to manage the pressure generated by the movement.

What this means practically: the pelvic floor engagement you practice in isolated exercises directly transfers to how effectively your system braces during squats, deadlifts, and rows. Women who develop good pelvic floor coordination during pregnancy tend to lift more comfortably as the belly grows because they've built the habit of pre-engaging before load. Postpartum, that same coordination is what lets them return to heavier training without triggering leakage or pelvic pressure symptoms.

The integration also goes the other way. If you're doing squats with no pelvic floor awareness and you start leaking, the fix isn't to stop squatting. It's to add the pre-contraction, check your breathing pattern, and reduce load until the system catches up. Our diastasis recti guide covers the core-side of this same system, since the two are closely connected.

When should you see a pelvic floor physical therapist?

Ideally, at least once during the second trimester and once postpartum as a baseline assessment, regardless of symptoms. In practice, most women go when something is bothering them: leakage, pelvic pain, or discomfort during intercourse postpartum. Both are fine entry points. Earlier is generally better because it gives the therapist a chance to identify issues before they become more established patterns.

If you have a pelvic floor specialist already, loop your fitness coach in on their recommendations. The two programs should complement each other. What your therapist says about bracing, loading, and relaxation should inform how your workout is structured. A good coach isn't going to override those recommendations. They're going to build the workout around them.