Care of the pelvic floor and perineum

The pelvic floor is made up of the deep muscles that cover the bottom of your pelvis. They support the womb (uterus) and help to control the bladder and bowel. Throughout pregnancy, your baby is supported in the pelvis by your pelvic floor muscles. During birth, the same muscles become very stretched, which can then cause many common pelvic floor problems including loss of bladder and / or bowel control, pelvic organ prolapse and reduced sensation or satisfaction during sex.

Exercising the pelvic floor muscles during pregnancy and after the birth of your baby can help to prevent problems happening. Pelvic floor muscle exercises are easy to perform and can be done anywhere.

It is important to concentrate on the right group of muscles when exercising your pelvic floor. You shouldn’t be working the muscles in your legs, buttocks or above your tummy button and you mustn’t hold your breath. Feeling some slight tension in your lower abdominal muscles is normal. Tighten the muscles around your back passage (as if trying to stop yourself passing wind) and draw them up and forwards. At the same time, tighten the muscles around your front passage (as if trying to stop passing urine). You should feel a ‘lift and squeeze’ inside.

Try to squeeze and lift your pelvic floor muscles each time you pick up anything heavy (e.g. your baby, car seats etc) and before you cough or sneeze. This helps your pelvic floor muscles to support the downward pressure on your body. It is safe to gently restart your exercises even  if you feel a bit sore or have stitches. If you have had a catheter (tube to drain urine from your bladder) wait until this is removed and you are passing urine normally. Initially you may find it difficult to feel your pelvic floor muscles working. It takes some weeks to build their strength back up. Take the exercises slowly at first but do keep trying because you will soon be aware of the pelvic floor muscles contracting and relaxing. Remember to include these exercises as part of your daily routine. Find times that work for you, perhaps in the bath, when resting in bed, or whilst feeding or cuddling your baby. It will take weeks of regular exercise to improve your pelvic floor muscles and perhaps several months to regain their previous strength. If you do your exercises three times a day, you should notice a difference after about six weeks. You can then reduce to doing the exercises to once a day. You need to do these exercises every day for the rest of you life. If you find the exercises difficult and they don’t seem to be working after six weeks, talk to your midwife/health visitor or GP. They can refer you to a women’s health physiotherapist for extra help.