Physical Therapist Marianne Ryan thinks moms aren’t given enough instruction on strengthening the pelvic floor after childbirth. Today, she rights that wrong.
One of the most common exercises moms are told to do after childbirth are Kegel exercises. Typically, new moms are given a piece of paper at their 6 week check-up that instructs them to “squeeze” their lady parts to help recover pelvic floor muscle strength. The piece of paper usually instructs them to do a series of pelvic floor contractions three times a day - forever.
As a physical therapist who specializes in women’s health and author of the book, Baby Bod®, I think women need more help with recovering from childbirth than that. Today I aim to give you that bit of extra instruction you need to get your pelvic floor muscles back in tip-top condition.
The first thing you need to know is what a pelvic floor contraction should feel like. Once we’ve straightened that out, I will show you a simple exercise that I think is the best way to start exercising your pelvic floor muscles.
What does a pelvic floor contraction feel like?
Did you know that many women who think they know how to contract their pelvic floors actually do it incorrectly? Studies have shown that a large percentage of women hold their breath or even push downwards as they attempt to do a pelvic floor contraction[i]. In fact, if you do a pelvic floor contraction properly, it should feel as if you are “lifting” your “lady parts” upwards, not pushing them downwards.
Here are a couple of lessons that should help you understand how to do a pelvic floor contraction correctly so you are not working against your recovery.
Note: Please read this disclaimer prior to performing exercises.
Method One: Stop the flow of urine
- While you’re urinating, EXHALE gently and try to stop the flow of urine midstream and feel the muscles contract and lift as you hold back your urine.
- Do this ONLY for a few seconds; then continue to urinate and empty your bladder.
- Make a mental note of how it feels to contract your pelvic floor muscles and how it felt when you relaxed your muscles to continue urinating.
CAUTION: To prevent developing urinary tract infections, never do this more than once a week. Do not use this method if you have a tendency to develop urinary tract infections.
Method Two: Use your fingers to feel the increase in tension
- Lie on your back with your knees bent.
- While wearing a pair of panties or thin workout pants, place your index and middle fingers on one side of the outside of the vagina (try the right side first). Make sure you are pressing into soft tissue. If it feels hard, you are pressing too far away from your vagina and into the pelvic bones, so move your fingers a little closer to your vagina and try it again. Use gentle pressure; do not press so hard that it causes pain. If you feel pain, STOP, and try it again with less pressure or wait a few days to try it again. (See the illustration above.)
- EXHALE gently and try doing a pelvic floor contraction by pretending you are stopping the flow of a few drops of urine.
- Hold it for 3 seconds and then relax. Can you feel the muscles tighten a bit under your fingers?
- Once you can feel a pelvic floor contraction on the right side, try feeling for a contraction on the left side.
- Make a mental note of how it felt to contract your pelvic floor, and how it felt once you relaxed it.
If you are still finding it hard to feel the contraction, here’s one of my favorite suggestions that I give my clients:
Imagine you are in an elevator and your boss steps in and you feel like you are going to pass gas. What would you automatically do to prevent an embarrassing situation?” Yup, contract those pelvic floor muscles!
And here’s a couple of things to bear in mind if you find this difficult:
1: Don’t be surprised if it feels as if one side is stronger than the other side; that’s common and should even out with practice and time.
2: Don’t worry if you can hardly feel a contraction during the first month or so after you delivered your baby, with time you should be able to feel a contraction. If not, report this to your health care professional and consider going for pelvic physical therapy treatment.
Now you’ve got the hang of that, let me teach you the best way to strengthen your pelvic floor by showing you an exercise that is in my book. Instead of doing traditional Kegel type exercises, I teach women to do the Pelvic-Core Starter. In order to get your pelvic floor muscles working optimally, you need to a) make sure your body is in good alignment, and b) use correct breathing techniques while contracting your pelvic floor muscles. If you do it conscientiously, it will help give your body the firm foundation it needs so it can once again be strong, healthy, and sexy.
Note: I do not recommend doing pelvic floor exercises if you are in pain or experience pain when having intercourse. If you fall into this category, it would be best to get a full evaluation by a physical therapist or physiotherapist who specializes in women’s health before you start pelvic floor strengthening exercises.
THE PELVIC-CORE STARTER – Beginner Level
- Start Position: Lie comfortably on your back on a firm surface. Keep your head relaxed. You may use a thin pillow or folded towel under your head if you like. Place one or two pillows under your buttocks. After a week or so try it without the pillows.
- Bend your knees and hips keeping your feet flat on the ground, hip width apart.
- Place two fingers of each hand on the top part of your panty line, just inside your pelvis.
- Now, gently EXHALE and perform a pelvic floor contraction, as if you are trying to stop the flow of 1 or 2 drops of urine. Try to hold this contraction for 3 seconds. (Try slowly counting out loud, “O-n-e Mississippi, T-w-o Mississippi, T-h-r-e-e Mississippi”)
- Relax. Then perform 3 quick contractions, where you gently contract then relax your pelvic floor, remember to gently exhale with each contraction. (Try counting out loud, “One – Relax, Two – Relax, Three – Relax”)
- Now relax for 6 seconds.
- Do each set 10 times in a row, 3 times per day.
It should feel as if your abdomen is gently drawing in towards your spine, not bulging outwards as you contract your pelvic floor muscles. Don’t force it by pulling your belly button towards your spine; let it happen naturally. Remember to be gentle! Less is more.
Progression: You can find out how to progress the Pelvic-Core Starter in my upcoming book, Baby Bod®. In it I will teach you how to correct your alignment by doing a Baby Bod® Alignment Check prior to performing the Pelvic-Core Starter in different positions, like when you are sitting and feeding your child, standing and even while you are walking.
To get a sneak preview of the book, you can download a FREE section called “Why You Should NOT Do Sit Ups to Flatten Your Tummy” by clicking here.
And, of course, to get more weekly tips about how to get fit after baby, you can subscribe to this blog using the form at the top of this page.
Lastly, if you would like to speak with me to discuss how the Baby Bod® program can help you get back into shape after having a baby (even if your ‘baby’ is all grown up by now!), drop me a line via the contact form on this site.
Marianne Ryan PT, OCS
Note:  Lila Bartkowski Abbate PT, DPT, OCS, WCS, PRPC came up with this visual, and it has helped tons of my clients understand how to contract their pelvic floor muscles. Thanks Lila!
Reference[i]Bump R, Hurt WG, Fantl JA, et al. Assessment of Kegel exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology. 1991;165:322–329.
MARIANNE RYAN PT, OCS is a physical therapist and board-certified orthopedic clinical specialist. She is the owner and Clinical Director of MRPT Physical Therapy, and a spokesperson for the American Physical Therapy Association Media Corps. With more than 30 years' experience, she specializes in the treatment of the spine, pelvis and jaw, with particular emphasis on the treatment of prenatal and postpartum patients. She has taught physical therapy treatment and exercises for prenatal and postpartum women on the nurse midwifery program at Columbia University School of Nursing, and has also taught at the TMJ clinic at New York University Dental School. A much sought-after media guest, Marianne has appeared on dozens of national TV and radio shows, and has also been featured in Red Book, Fitness Magazine, USA Today, Shape Magazine and the Wall Street Journal. She was also featured in the film Drifting, a documentary about movement produced by the Tribeca Film Institute. Passionate about helping women to restore their stomachs after pregnancy and childbirth, Marianne is author of the book Baby Bod® - Turn Flab to Fab in 12 Weeks Flat.