Pelvic Floor Exercises During Pregnancy: What's Safe & What to Avoid

Pregnancy puts significant pressure on your pelvic floor muscles, which support your bladder, bowel, and uterus. Approximately 40% of pregnant women experience urinary incontinence, making pelvic floor muscle training an essential component of prenatal care. But not all exercises are created equal—and some common recommendations may not be appropriate for everyone.

At Milton Pelvic Physiotherapy, we help pregnant patients understand which pelvic floor exercises are safe throughout pregnancy, when certain movements should be modified or avoided, and when professional guidance becomes necessary.

Understanding Your Pelvic Floor During Pregnancy

Your pelvic floor muscles must support an additional 11-16 kg of weight during pregnancy, including the baby, placenta, amniotic fluid, and extra blood volume. This significant increase in load can lead to muscle weakness, dysfunction, or over-tightening—each requiring different approaches to exercise.

Evidence suggests that pelvic floor muscle training (PFMT) throughout pregnancy is both safe and effective when performed correctly. The International Continence Society recommends PFMT as a minimally invasive and effective means of preventing and treating pelvic floor dysfunctions during pregnancy.

However, it's important to understand that effective pelvic floor care isn't just about strength—your pelvic floor muscles should be both strong and flexible.

When to Start Pelvic Floor Exercises

The ideal time to begin pelvic floor muscle training is around 12-14 weeks of pregnancy, shortly after your first trimester. Many pregnant people experience increased energy during the second trimester, making it an excellent time to establish a consistent exercise routine.

Starting early helps ensure your pelvic floor muscles are strong enough to support the growing weight throughout pregnancy. Research shows that women who do pelvic floor muscle exercises during pregnancy are less likely to develop bladder leakage, both during pregnancy and in the postnatal period.

Our team at Milton Pelvic Physiotherapy recommends booking your first physiotherapy appointment around this time, as pelvic floor muscle training is most effective when supervised by a physiotherapist—everyone's pelvic floor is different and requires individualized assessment.

Safe Pelvic Floor Exercises by Trimester

First Trimester (Weeks 1-12)

During the first trimester, standard pelvic floor exercises can be performed in most positions. Focus on learning proper technique:

Kegel Exercises (Pelvic Floor Contractions)

Tighten your pelvic floor muscles as if stopping the flow of urine
Hold for 3-5 seconds, then relax for the same duration
Repeat 10 times, 3 times daily
Can be performed sitting, standing, or lying down

Deep Breathing with Diaphragm

Learning to breathe deeply using the diaphragm helps promote stability in the abdomen and low back
Relaxes the pelvic floor, which is crucial during labor
Practice daily to develop this essential skill

Second Trimester (Weeks 13-26)

After the first trimester, avoid exercising while lying flat on your back. This position causes the uterus to put pressure on the inferior vena cava, which may cause dizziness, shortness of breath, or nausea.

Modified Pelvic Floor Training

Continue Kegel exercises in upright positions (sitting, standing)
As pregnancy progresses, you may find upright positions more challenging
Changing positions from upright to anti-gravity (side-lying, on hands and knees) can help continue exercising effectively

Holistic Exercise Programs

Low-impact activities like prenatal yoga or swimming
Pelvic floor muscle training integrated with breathing exercises
Weight management through appropriate activity levels

Third Trimester (Weeks 27-40)

During the final weeks of pregnancy, exercise modifications become increasingly important.

Continued Pelvic Floor Strengthening

Maintain regular Kegel exercises in comfortable positions
Focus on both strength and flexibility
Practice relaxation techniques for labor preparation

Perineal Bulges (Only in Final 3 Weeks)

These exercises should only be practiced in the last three weeks of pregnancy
Should not be practiced often because they can place excessive pressure on pelvic floor structures
Do NOT practice perineal bulges if you have premature rupture of membranes, vaginal bleeding, or pelvic organ prolapse
Always consult with your doctor and physiotherapist before starting

Perineal Massage (Starting at 34 Weeks)

Recommended starting from 34 weeks of pregnancy
May reduce the risk of perineal tear during birth
Can be self-performed or done by a partner
Your pelvic floor physiotherapist can teach proper technique

Exercises to Avoid During Pregnancy

High-Impact Activities

High-impact exercises such as running cause damage to the pelvic floor and should be avoided throughout pregnancy. Pregnant women should avoid:

Running or jogging
High-impact aerobics
Jumping or plyometric exercises
Activities that create excessive stress to the lower back area

Exercises in Certain Positions

Avoid lying flat on your back after 12 weeks during exercise
Avoid exercises that increase intra-abdominal pressure without proper breathing coordination
Avoid holding your breath during pelvic floor exercises

When Kegel Exercises Help (and When They Don't)

Kegel exercises are the most commonly recommended conservative therapy for pregnant women with stress urinary incontinence. However, they're not appropriate for everyone.

When Kegels Are Beneficial

Evidence suggests that pelvic floor muscle training may help:

Prevent and reduce stress incontinence during pregnancy
Develop the ability to control muscles during labor and delivery
Minimize decreased bladder control
Reduce the risk of hemorrhoids
Support proper pelvic alignment

Adherence to the training protocol is the most important prognostic factor for effectiveness—consistency matters more than intensity.

When Kegels May Not Be Appropriate

If a woman continually contracts her pelvic floor (over-tightening), she may experience pelvic or abdominal pain. This is especially concerning for women with:

Pelvic pain or chronic pelvic pain syndrome
Bladder pain syndrome
Vulvodynia or vaginismus
Dyspareunia (painful intercourse)
Urinary urgency or frequency
Endometriosis
Chronic constipation

If you experience any of these conditions, you should seek pelvic floor physiotherapy evaluation before beginning a Kegel exercise program. You may need relaxation techniques rather than strengthening exercises.

When to See a Pelvic Floor Physiotherapist

At Milton Pelvic Physiotherapy, we recommend that all pregnant individuals consider seeing a pelvic floor physiotherapist, ideally shortly after the first trimester. However, certain situations make professional assessment particularly important:

Red Flags Requiring Professional Assessment

Pelvic pressure or heaviness
Any pelvic, abdominal, low back, or hip pain
Leaking urine with coughing, sneezing, or exercise
Difficulty emptying your bladder or bowel
Pain during intercourse
Any symptoms of pelvic organ prolapse

Benefits of Professional Guidance

Pelvic floor physical therapy during pregnancy can address many conditions and concerns:

Individualized assessment: Midwives and physiotherapists should assess pelvic floor muscle function early to identify weakness or dysfunctions
Evidence-based training: Pregnant women should receive structured, evidence-based antenatal education, with preventive pelvic floor muscle training as a standard component
Symptom management: Pregnancy-related pelvic girdle pain (PRPGP) affects 50-84% of pregnant women; physiotherapists can help manage symptoms even though most people see symptoms disappear after birth

By strengthening and stretching the pelvic floor muscles under professional guidance, the risk of tears during delivery may be reduced, and improved muscle tone may lower the likelihood of requiring an episiotomy.

Comprehensive Pelvic Floor Health Care During Pregnancy

Effective pelvic floor health care during pregnancy extends beyond exercise alone. Evidence supports a holistic approach including:

Health education about pelvic floor function and pregnancy
Breathing exercises for core stability and pelvic floor relaxation
Supervised pelvic floor muscle training tailored to your needs
Weight management through appropriate nutrition and activity
Perineal massage in the final weeks before delivery
Holistic exercise programs that support overall pregnancy health

Regular antenatal exercise including pelvic floor muscle training may reduce urinary incontinence three months postpartum, highlighting the long-term benefits of prenatal care.

Getting Started with Safe Pelvic Floor Exercises

If you're pregnant and want to begin pelvic floor exercises safely, consider these steps:

Book an assessment with a pelvic floor physiotherapist around 12-14 weeks of pregnancy
Learn proper technique before establishing a routine—incorrect exercises can be counterproductive
Stay consistent with your exercise program, as adherence is the most important factor for success
Modify as needed throughout pregnancy based on how you feel and professional guidance
Communicate symptoms to your healthcare team if you experience pain, pressure, or leaking

For more information about what to expect during your first visit, read our guide on what to expect at your first pelvic floor physio visit.

Your Pregnancy Pelvic Floor Health Matters

Pelvic floor muscle training during pregnancy is safe, effective, and beneficial for most pregnant individuals when performed correctly and with appropriate professional guidance. Understanding which exercises are safe for each trimester, when Kegels are helpful versus potentially harmful, and when to seek specialized care empowers you to make informed decisions about your prenatal health.

At Milton Pelvic Physiotherapy, Priyanka & Faiza Mastan specialize in pregnancy and postpartum care, providing evidence-based assessment and treatment tailored to your unique needs. Whether you're experiencing symptoms or want to prevent problems before they start, pelvic floor physiotherapy can support you throughout pregnancy and beyond.

Educational Disclaimer: This content is for educational purposes and does not replace professional medical advice. Always consult with your healthcare provider and a qualified pelvic floor physiotherapist before beginning any exercise program during pregnancy.

Ready to support your pelvic floor health during pregnancy? Book an appointment with our specialized team at Milton Pelvic Physiotherapy today.

Reviewed by: Priyanka & Faiza Mastan, Pelvic Health Physiotherapist