A common occurrence during pregnancy and the postpartum period is urinary incontinence, which is an involuntary loss of urine. It can occur with activities, such as coughing, laughing, sneezing, or jumping, or with environmental triggers, like opening the door. A concern many express is whether exercise is safe to perform during and after pregnancy and whether it will worsen or help prevent leakage.
Luckily, physical activity during pregnancy and postpartum has not be found to contribute to urinary incontinence. Approximately 32-64% of women will experience urinary incontinence during pregnancy and 15-30% will experience urinary incontinence during the first year postpartum.1 Just because urinary incontinence is common does not mean it is normal!
Pelvic floor muscle training, or kegels, performed during pregnancy has been found to significantly reduce the development of urinary incontinence. A study demonstrated that 95.2% of women who participated in a pelvic exercise program had no leakage by week 36 of pregnancy as compared to 60.7% of women who did not participate in an exercise program.2 Pelvic floor muscle training during pregnancy also reduces the likelihood of urinary incontinence from 6 weeks to 3 months postpartum delivery.3 Therefore, performing pelvic floor contractions three times per week up to one time daily is beneficial during the pregnancy and postpartum period. You can find specifications on how to perform pelvic floor contractions in the “3 Pelvic Floor Exercises To Do During And After Pregnancy” blog. Even more beneficial than performing pelvic floor contractions, or kegels, individually, is combining the pelvic floor with other exercises.
The first exercise I would recommend during pregnancy and postpartum is Cat Cow. This exercise occurs in an all 4s position where hands are placed shoulder width apart and knees are hip width apart with the belly facing the ground. Breath into your belly as your dip your spine down like a sway back cow. Slowly, exhale while arching your spine like a cat on Halloween. To gain even more benefit, allow the pelvic floor to relax fully during the cow portion and perform a pelvic floor contraction (kegel) while exhaling and moving into the cat position. You will achieve a 41% greater contraction of the pelvic floor when combining with the Cat Cow exercise.4
Research supports the idea that the pelvic floor and abdominal muscles, specifically the lower muscle called the transverse abdominis, work together.5 Therefore, performing lower abdominal exercises without and with a pelvic floor contraction can be beneficial. Start by laying on your back and place your fingertips on the front pelvic bones and move inwards about 2 inches. Practice using your lower abdomen to bring your hip bones together and gently bring your belly button toward your spine. You should feel tension primarily in the lower abdomen. You can also practice taking a relaxed inhale followed by a pelvic floor contraction (kegel) while using your transverse abdominis and exhaling while maintaining these contractions. To increase the level of difficulty, bring your arms up as if you are reaching toward the ceiling and your legs in a 90-90 position so your knees are facing the ceiling while laying on your back. Maintain this position while performing the lower abdominal and pelvic floor activation for increased pelvic floor recruitment.6 Make sure that your abdomen is not bulging out and away from your body. That means you are exerting too much force and need to reduce the difficulty of the exercise.
Another beneficial exercise is called hovering. Hovering is very similar to a plank except hovering occurs when you are on our elbows whereas a plank occurs when our arms are fully straightened with pressure through the hands. Combining a hover with a pelvic floor contraction creates at 49% greater contraction as compared to an isolated kegel.4 Typically, we don’t need to hold a kegel for as long as we may hold a hover, so I will often have patients either perform quick contractions while maintaining a hover or hold a contraction for a few seconds and then release. If performing this exercise on the ground is too difficult, start on an inclined surface and gradually progress toward the floor. Make sure that your stomach is not pushing outward or bulging. Instead, think about gently drawing your belly button and lower abdominals toward your spine.
Lunges are another wonderful exercise to perform during pregnancy and postpartum. Inhale on the descent and perform a kegel while ascending back to an upright position. When coordinated with a lunge, the pelvic floor produces a 42% increase in strength.4 If a lunge feels too irritating for the body, performing a squat can be an acceptable alternative. While squatting, inhale on the descent and exhale during the ascent while performing a kegel. This will result in a 30% increase in pelvic floor muscle activation as compared to a kegel alone. 4
Another exercise that is beneficial to perform with a pelvic floor contraction is a side lying knee bent lift. You would lay on one side with your knees and hips bent and resting on top of each other. While keeping your pelvis stable and feet together, lift your top knee up from your bottom knee using your hip muscles. Inhale while relaxed and exhale while lifting the top knee and performing a pelvic floor contraction. This will create a 25% increase in pelvic floor activation.4
Please keep in mind that everyone is different. If you are experiencing discomfort or pain with a particular exercise, start by reducing the range of motion, intensity, and/or repetition. If you are continuing to experience discomfort and/or pain, please stop the activity and reach out to a professional for further individualized care. It doesn’t mean that a particular exercise is bad, it may just mean certain adjustments need to be made for your body in order to work up to a particular exercise.
Written by Jordan Schmidt, PT, DPT