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Is it safe? · Pregnancy Smart

Pelvic floor-safe exercise selection during pregnancy

Assigned clinical reviewerSharyn Harrison· CNM, NPDraft · pending clinical reviewUpdated

What does the evidence say about pelvic floor-safe exercise during pregnancy?

  1. In a trial of 97 healthy pregnant women around 21 weeks of pregnancy, a 6-week supervised program combining high- and low-impact aerobic choreography, strength conditioning, stretching, and pelvic floor muscle training produced significantly higher pelvic floor muscle activity during contractions and better relaxation ability, and participation did not negatively affect incontinence. 1
  2. That program's benefits applied specifically to women who could already contract their pelvic floor muscles correctly and had no pre-existing incontinence, which is why the researchers frame it as an option for people accustomed to higher exercise intensity before pregnancy rather than a universal prescription. 1
  3. In a larger study of 260 women following a similar high-low impact program with pelvic floor training and biofeedback from the second trimester through birth, significantly fewer trained women reported incontinence affecting their life at 2 months postpartum (22% versus 35%) and at 1 year (14% versus 28%) compared with a control group. 2
  4. That program specifically taught "the knack," pre-contracting the pelvic floor just before a moment of increased pressure such as lifting or coughing, using electromyography biofeedback, and was recommended only for continent women without pre-existing pelvic floor disorders. 2
  5. A review of pelvic floor muscle training during and after pregnancy notes that ensuring proper technique, checked through palpation or biofeedback, matters for the training to work as intended, rather than assuming any pelvic floor contraction attempt is equally effective. 3
  6. General guidance calls for at least 150 minutes of moderate-intensity aerobic activity a week during pregnancy, with examples including brisk walking, some forms of yoga, water aerobics, and bike riding, and specifically advises trying to avoid activities that require lying flat on your back after the first trimester. 4

Is pelvic floor-safe exercise safe in each trimester?

  • First trimester. Early on, most people can continue their usual activity level with typical pregnancy guidance, and this is a good time to start learning correct pelvic floor engagement and the knack technique before weight and pressure increase later in pregnancy.
  • Second trimester. By the second trimester, avoid exercise positions that involve lying flat on your back, since this is generally discouraged from this point on due to reduced blood flow. This is also when a supervised program in one trial began, combining aerobic movement with pelvic floor training.
  • Third trimester. In the third trimester, weight-bearing exercise may feel less comfortable as ligaments loosen and balance shifts, and swimming or other non-weight-bearing options can help you stay active if impact starts to feel like too much, without needing to stop pelvic floor-focused movement altogether.

Pelvic floor-safe exercise technique checklist

SituationWhat research supportsPractical takeaway
Lifting, jumping, or strainingThe knack, pre-contracting the pelvic floor before pressure rises, was linked to less postpartum incontinenceBreathe out and gently engage before the effort, not after
High-impact aerobic movementA supervised high-low impact program did not worsen incontinence and improved pelvic floor strengthHigh-impact isn't automatically off-limits with correct technique and supervision
Checking your techniquePalpation or biofeedback with a professional is highlighted as important for effective trainingDon't assume a contraction is correct just because it feels effortful
Lying flat on your backGenerally discouraged after the first trimester due to reduced blood flowModify to side-lying or inclined positions as pregnancy progresses
Existing leakage or pelvic floor symptomsStudy benefits applied to continent women without pre-existing disordersGet an individual assessment rather than following a general program

Frequently asked questions

Do I have to avoid all high-impact exercise to protect my pelvic floor?

Not necessarily. In one trial, a supervised program combining high- and low-impact aerobic movement with pelvic floor training did not worsen incontinence in pregnant women and actually improved pelvic floor muscle strength and relaxation, though the women in that study could already contract their pelvic floor correctly before starting.

What is "the knack" and why does it matter?

It's a specific technique: learning to gently contract your pelvic floor right before a moment of increased pressure, like lifting, coughing, or the impact of a jump, rather than after. A program teaching this technique alongside biofeedback was linked to significantly less incontinence at 2 months and 1 year postpartum compared with a control group.

Should I hold my breath when lifting something heavy while pregnant?

General guidance favors breathing out during the effort of a movement rather than holding your breath and bearing down, since that combination increases pressure on the pelvic floor. Pairing your breath with a pelvic floor contraction, the knack technique, is the specific skill studied alongside this.

Does every pregnant person benefit from this kind of exercise program equally?

No. The research behind this comparison specifically applied to continent women without pre-existing pelvic floor disorders who could properly contract their pelvic floor muscles at the start. If you already have symptoms or can't identify the right muscles, a supervised assessment matters more than following a general program.

Why does lying on my back matter for pelvic floor safety?

After the first trimester, lying flat on your back is generally discouraged during exercise because it can compress a major vein and reduce blood flow. It's a separate caution from pelvic floor technique, but it affects which exercise positions make sense as pregnancy goes on.

How do I know if I'm engaging my pelvic floor correctly during exercise?

It can be hard to tell without help. Research on pelvic floor training highlights checking technique through palpation or biofeedback with a professional as important for making sure the training actually works, rather than assuming a contraction is correct because it feels like effort.

What if I already have leakage or pelvic floor symptoms before starting?

That changes the picture. The programs behind this brief's evidence were studied in continent women without existing pelvic floor disorders, so if you already have leakage, pressure, or other pelvic floor symptoms, an individual assessment, rather than a general prenatal exercise program, is the more appropriate starting point.

Is walking enough, or do I need a structured program?

Walking meets the general activity guideline on its own and is a reasonable base. But if pelvic floor function specifically is your goal, the research showing measurable benefit combined structured aerobic movement with dedicated pelvic floor technique training, not aerobic activity alone.

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References

  4. Pregnant & Postpartum Activity: An Overview

    CDC · https://www.cdc.gov/physical-activity-basics/guidelines/healthy-pregnant-or-postpartum-women.html

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.