Why You Should Do Pelvic Floor Exercises — Besides Kegels — Even if You’re Not Pregnant Yet

Pelvic floor exercises aren’t limited to just kegels — and they can be helpful even if you’re not pregnant yet. / Photograph courtesy of Getty Images

Here’s a bit of Monday morning trivia for everyone: What do all of the following conditions have in common?

• The Sneeze Pee. When you sneeze and inadvertently urinate a bit due to some level of incontinence.
• Spare Tire or Mummy Tummy. An extra layer of fat in the lower abs, which can often be connected to a condition known as diastasis recti. Diastasis recti occurs when the muscles along the middle of your abdomen separate.

• Uterine Prolapse. When your pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or sticks out of the vagina. (Seriously.)

Answer: All of these issues can develop after a woman gives birth. More importantly, you can mitigate, and sometimes even prevent, them if you give a little love to your pelvic floor — the muscle that is the common thread in all of the above conditions — prior to ever getting pregnant.

Womxn, say hello to your pelvic floor.

This crucial area consists of three layers of muscle, as well as ligaments and connective tissues, that line the bottom of your pelvis, providing support and reinforcement for the organs and tissues in that region. During pregnancy, the baby puts extra pressure on your pelvic floor, which can make it more prone to dysfunction.

My own journey to understanding the importance of this muscle began when my back went into spasms, leaving me immobile for a couple weeks. I’d mentioned the issue to my friend Ashley Burnley, a pelvic floor and core specialist who knew I was trying to get pregnant, she jumped at the chance to help me. She told me she wanted to strengthen my glutes and abs not only to heal my back issues but also to begin preparing my pelvic floor for pregnancy. “With all the work that the pelvic floor does,” she said, “it is not uncommon for it to be overworked, especially when there is decreased stability in the connecting muscles and tissues.”

She also wanted to focus on breath work. These exercises would help my back and pregnancy prep by re-establishing the connection between my pelvic floor and my diaphragm, which helps regulate breathing. When we breathe in, our diaphragms flatten out and push everything below our abs (the stomach, intestines, bladder, etc.) toward our pelvic floor. In order to accommodate that increased pressure, the muscles of the pelvic floor, located between your pubic bone and tailbone, relax and lengthen. The opposite occurs when you breathe out, the diaphragm expands, and the pelvic floor contracts. This diaphragm-breath-pelvic floor connection is why, when one of them is out of balance, the others have to compensate, which can lead to other issues — like back pain.

I hadn’t realized or known there were exercises, beyond kegels, that I could (and should!) be doing in order to prepare my body for pregnancy. I’m not alone. Crystal Widmann, a postnatal specialist who runs a “core restore” series for postpartum women out of her Mount Airy barre and yoga studio Y2B Fit, told me that “most women don’t know about the pelvic floor or do anything to strengthen it for pregnancy prior to getting pregnant.” Moreover, she says, many healthcare practitioners “aren’t talking about pelvic floor prep and if they are asked about it, they tend to refer out to other specialists.” This is slowly changing; recently, healthcare practitioners from Life Cycle Women’s Care in Bryn Mawr took Widmann’s classes so they could be more informed in order to better address patient questions and concerns.

If you’d like to try out some of these exercises on your own, Burnley was kind enough to detail a few for breath work and pelvic floor strengthening. However, remember that you should always seek the oversight and advice of a physician before adding anything new into your workout regimen.

Diaphragmatic breathing

1. Lie on your back with your knees bent on the floor.
2. Tuck your chin slightly and think about someone pulling you from the crown of the head to lengthen the back of the neck. Relax your shoulders to the floor.
3. Place your hands on the side of your rib cage, right under the bra line.
4. As you inhale, pay attention to the air expanding out into your hands (your hands should move out to the side) and into your mid-back. Try to feel the air travel all the way down to the pelvic floor as the muscle lengthens and relaxes.
5. On the exhale, engage the front and back of your pelvic floor, flatten and tighten your low abs, and feel your ribs come in and down toward the belly button. (Your hands should move closer together.)

Note: Make sure your pelvic floor fully relaxes on each inhale and that your neck, shoulders, and glutes stay relaxed the entire time.

Squats

1. Stand with your feet hip-width apart, keeping them flat on the floor.
2. Bend at the knees to bring your glutes toward the floor, going only as low as is comfortable. Keep your back straight and leaning slightly forward. Your knees should be in line with your toes.
3. Focus on tightening your buttocks and pelvic floor while returning to a standing position.
4. Repeat this exercise for a total of 10 repetitions.
5. Rest before performing any additional sets.

Side Planks

1. Lay on your side with your forearm flat on the floor, with your bottom elbow lined up directly under your shoulder and both legs extended out in a long line.
2. Your feet can either be staggered for more stability or stacked for more of a challenge. You can also do this from your knees if you’d like to modify. Engage your core and lift your hips off the floor, forming a straight line from your head to your feet (or knees, for the modification).
3. Hold for 15 to 30 seconds. Your top hand can be on the side of your hip (easier) or reaching up to the ceiling (harder).