How to Care for Your Pelvic Floor During Pregnancy

Pregnancy is an incredible journey — full of transformation, anticipation and yes, sometimes discomfort. As a physiotherapist with a special interest in women’s health, one of the most common areas I help women with during pregnancy is pelvic floor preparation. And trust me, this often-overlooked part of the body can make a big difference in both your pregnancy experience and your recovery after birth.

Why the pelvic floor matters

Your pelvic floor is a group of muscles that sit like a bowl inside at the base of your pelvis. These muscles support your bladder, uterus, bowel and the openings of your urethra, vagina and anus. During pregnancy the pelvic floor muscles carry the extra weight of your growing baby and need to move out of the way and relax during vaginal birth.

A well-functioning pelvic floor can:

• Prevent urinary leakage
• Support your lower back, hips and pelvis
• Improve your birthing experience
• Aid in a faster postpartum recovery
• Allow pain-free intimacy
• Allow for easy bowel movements

How pregnancy hormones affect your body

Pregnancy brings many changes and behind the scenes a big reason for those changes are hormones. Hormones act as your body’s messengers, telling organs and systems how to adjust as your baby grows. While they play a vital role in preparing your body for birth, they also come with some side effects that may leave you wondering, “Is this normal?”

1. Your heart: More work, more blood

Hormone responsible: Progesterone and Estrogen

• Your blood volume increases by up to 40-50% during pregnancy to support the growing baby.
• Progesterone helps relax blood vessels, which lowers your blood pressure in early pregnancy.
• This extra workload can make your heart beat faster and that’s why some moms feel out of breath or dizzy.

2. Your bladder: Frequent trips & sometimes leaks

Hormone responsible: Human Chorionic Gonadotropin (hCG), Relaxin, and Progesterone

• In early pregnancy, hCG increases blood flow to the pelvic area, which means you may feel the urge to urinate a lot.
• Progesterone relaxes the bladder muscles, which can lead to leaks (especially when you sneeze, laugh or exercise).
• Relaxin softens and “stretches” tissues, including those supporting the bladder.

How to support your bladder:

• Do gentle pelvic floor exercises
• Avoid “just-in-case” toilet trips too often as this trains your bladder to empty prematurely
• Drink enough fluids (remember your urine output is more, therefore you will feel the need to urinate more often)

3. Your joints: More flexible, but less stable

Hormone responsible: Relaxin

• Relaxin is released to soften your ligaments and help your pelvis expand for birth.
• Unfortunately, it affects all joints, not just the pelvis, which might make you feel loose, wobbly or unstable.
• This can also lead to pelvic girdle pain or back pain.

How to protect your joints:

• Be mindful with high-impact movements
• Ask your physiotherapist about pelvic support belts or targeted exercises
• Strengthening exercises

4. Your muscles: stretching and adapting

Hormone responsible: Estrogen and Relaxin

• As your uterus grows, your abdominal muscles stretch, especially the rectus abdominis, which can separate. This is called diastasis recti.
• Some muscles work harder to compensate, which may cause tightness, especially in the lower back and hip flexors.

How to support your muscles:

• Practice gentle core stability work
• Avoid sit-ups and planks in late pregnancy and post partum
• Stretch regularly with safe, guided movements
• Strengthening exercises

5. Your pelvic floor: Under pressure

Hormone responsible: Relaxin, Estrogen, Progesterone

What you can do to take care of your pelvis during pregnancy

1. Start pelvic floor exercises

Your pelvic floor needs to be strong enough to provide support but also have the ability to move out of the way and relax fully during birth. Gentle but consistent pelvic floor exercises help build awareness of these important muscles. The key is doing them correctly and doing the right type of pelvic floor exercise, it is not “one size fits all” or just “Kegels”. More often pelvic floor relaxation exercises are needed for birth preparation.

Tip: See a physiotherapist trained in pelvic health to assess if you’re doing them correctly — research shows that many women benefit from this guidance!

2. Learn to relax the pelvic floor and work on your hip mobility

Try:

• Deep belly and diaphragmatic breathing
• Slow and long exhales
• Gentle stretches of the hips and pelvic floor
• Birth-focused relaxation techniques
• Relax your jaw and face

3. Maintain good posture and body mechanics

As your belly grows, your centre of gravity shifts — which can strain your back, hips and pelvic floor.

Support your body by sleeping with a pillow between your knees, wearing comfortable shoes, sitting with your back supported or wearing a maternity belt. Birth prep sessions with a women’s health physio will include exercises and tips to help with this.

4. Prepare for birth with perineal massage (from 34 weeks)

Perineal massage helps improve tissue elasticity and may reduce the risk of tearing during vaginal birth. The aim is to prevent tearing into the anus.

• Use clean hands and a natural oil or lubricant
• Gently stretch and massage the perineal tissue between the vaginal opening and anus for a few minutes daily (from 34 weeks) – your pelvic floor physiotherapist will explain and demonstrate this.
• Ask your partner to help you if your belly is in the way

5. Stay active and strong

Safe movement during pregnancy keeps your circulation flowing, supports your pelvic floor, prepares your body for labour(which can feel like a proper workout) and supports your body post-partum.

Tip: Always listen to your body and speak to your health care provider about your options

Consider:

• Pilates or yoga (especially with a physiotherapist)
• Walking
• Strength training
• Cardio
• Aquatic training

Pelvic floor tips from a Pelvic floor Physiotherapist:

• Focus on long and slow exhales
• Relax your jaw
• Learn how to relax the pelvic floor muscles
• Avoid straining when going to the toilet
• See a pelvic floor physiotherapist for a personalised plan
• Work on hip internal rotation

What to expect during Birth Prep sessions at our practice:

• Pelvic floor assessment
• Perineal massage education and techniques
• Pelvic floor relaxation
• Breathing techniques
• Labour education and positions
• Hip and pelvis mobility exercises to make birth easier
• Treatment of any pregnancy related pains or problems

Final Encouragement

If you’re pregnant and unsure where to start, you’re not alone and you don’t need to figure it all out by yourself. These hormonal changes are your body’s way of creating the perfect environment for your baby. They may come with some challenges, but you’re not alone and you don’t have to just put up with discomfort. Pelvic floor problems are common during pregnancy but NOT normal and shouldn’t be ignored.

By understanding what’s happening and getting the right support, especially from a women’s health physiotherapist, you can ease symptoms and prevent complications.

Remember: Every woman’s pregnancy journey is different, advocate for your and your baby’s health and safety. If you’re experiencing pain, pressure or insecurity, contact us for an appointment.

Book an appointment with Liza, our Pelvic floor Physio here: https://just-physio.bookem.com/