Pelvic floor: what it is and how to do pelvic floor exercise after birth

The pelvic floor is the layer of muscles that stretches like a hammock across your pelvis, holding up your womb, bladder and bowel and tightening to stop leaks when you cough. SGH says pregnancy and childbirth can weaken it, even after a caesarean. Pelvic floor exercise, also called Kegels, builds it back up, and SGH asks new mothers to keep it up for at least four months.

What your pelvic floor does

SGH describes the pelvic floor muscles as a hammock that holds the womb, bladder and bowel in place, and as a control valve around the urethra. They tighten when pressure in your tummy rises, such as when you cough, so urine stays in, and they relax when you want to pass urine.

Pregnancy loads those muscles for months. SGH says up to 70% of women leak urine in pregnancy, especially when they cough, laugh or sneeze, and that this usually improves after the birth. Up to 30% have some urinary incontinence at some point after childbirth, and over the years a weak pelvic floor can lead to prolapse of the vagina or womb.

How to do pelvic floor exercise

SGH's routine:

1. Stand, sit or lie with your legs slightly apart.
2. Slowly tighten and pull up the pelvic floor muscles as hard as you can, without tightening your tummy or buttocks.
3. Slow pull-ups: hold for at least 5 seconds if you can, then relax. Repeat at least 5 times.
4. Fast pull-ups: pull up quickly and tightly, then relax straight away. Repeat at least 5 times.

After the birth, SGH says to do this set at least 10 times a day as soon as you are not too sore, and to keep going for at least 4 months. If you cannot find the right muscles, the NHS suggests squeezing as if you are holding in wind and stopping the flow of urine, without pulling in your stomach. SGH says it is often better to learn from a physiotherapist at first.

The NHS pairs these squeezes with deep stomach exercises to help close a diastasis recti gap.

Pelvic floor help in Singapore hospitals

Physiotherapists visit new mothers on the wards. At SGH they teach pelvic floor exercises as part of postnatal care, and SGH's Postnatal Assessment Service, started in January 2015, follows up mothers at higher risk of leaks, such as those who needed forceps or had a serious tear of the perineum.

KKH's physiotherapy team runs incontinence management and pelvic floor rehabilitation. Treatment can include pelvic floor exercises, bladder retraining, electrical stimulation and lifestyle advice.

If you still leak, raise it at your 6-week postnatal review. The NHS says leaking a little when you laugh, cough or move suddenly is quite common after birth, and that your doctor may refer you to a physiotherapist if the exercises are not helping. Our guide to postpartum pelvic floor recovery in Singapore covers the next steps.

Frequently asked questions

When can I start pelvic floor exercise after giving birth?

SGH says to start as soon as you are not too sore, building up to at least 10 sets a day and keeping going for at least four months.

How long should I hold each squeeze?

SGH says at least 5 seconds to start, holding longer as you get stronger. KKH's going-home advice starts at 3 seconds and builds to 10, and the NHS says no longer than 10 seconds.

Is leaking urine after birth normal?

It is common. The NHS says many women leak a bit of pee when they laugh, cough or move suddenly, and SGH says up to 30% of women have some leakage at some point after childbirth. Tell your doctor if exercises do not help.

Do I need pelvic floor exercise after a caesarean?

Yes. SGH says childbirth may weaken the pelvic muscles even after a caesarean section, so the same routine applies.

Related terms

• Diastasis Recti: A gap between the two six-pack muscles that opens in pregnancy and usually closes within about eight weeks of birth.
• Perineum: The skin and muscle between the vagina and anus, which stretches in birth and can tear or be cut.
• 6-Week Postnatal Review: Your own check-up with a doctor four to six weeks after birth, covering healing, mood, feeding and contraception.
• C-section (Caesarean Section): An operation to deliver your baby through a cut in your tummy and womb, planned ahead or done in labour.
• Episiotomy: A small cut in the perineum during birth to widen the vaginal opening, closed afterwards with dissolvable stitches.

See every term in the glossary