Pelvic floor problems are common during pregnancy.
Pelvic floor muscle exercises are recommended to prevent and treat pelvic floor problems.
But what about training those pelvic floor muscles during pregnancy?
Is that allowed? Isn't it dangerous to make the muscles (through which the baby will eventually be born) too tight?
Can strong pelvic floor muscles make a vaginal birth more difficult?
Well, those are all very clever questions! It took science some time to come up with some clear advice on that...
In the past, it was indeed sometimes thought that exercises would make the pelvic floor too tight. You sometimes heard the gynaecologist or midwife say during childbirth:
"Oy oy... your muscles are too strong" or "Oy oy... have you been exercising a lot? Are you a horse rider or something? Well, those muscles are too strong to give birth without damage..."
We now know for sure that this is not the case...!
Pelvic floor muscles can never become too strong through exercise during pregnancy!
Pelvic floor muscle exercises are a must during pregnancy!
From the beginning until the end. They will not make childbirth more difficult...!
BUT ... there is an important 'BUT'...!
Pelvic floor muscles are quite complex muscles. We can consciously contract and relax them. For example, during exercises.
But the pelvic floor muscles also consist of muscle fibres that unconsciously carry out their work all day long (absorbing pressure, holding up pee-pee and bowel movements, etc.).
Fortunately, no woman in the world is aware that these muscles are constantly at work (all day long).
That would be far too tiring.
We must dare to trust our body's unconscious work.
The body does that quite well, on its own, at its own pace.
Your heart muscle is also an unconscious muscle that does its own thing, let it go!
But sometimes we tend to take control (too much).
Something we as women are probably often tempted to do... 😉 .
However, if you take over control and consciously or unconsciously keep all your muscle fibres tense down there, then you increase the tonus in your muscles, as it were. The "continuous" tension we keep there. We sometimes forget to relax the muscles, just let them go...
And then it becomes difficult...
If your body forgets how to Loosen or Tense the muscles, it can be more difficult to do so during labour and it may seem as if your muscles were too strong...
They are not too strong, but they are too tight all the time.
You may notice it because you have pain during sex, are constipated or have difficulty urinating... These can be subtle signs of an overstrained pelvic floor. And that's what we want to avoid!
Just think of a top gymnast, Nina Derwael, for example... She has very strong, beautiful muscles all over her body. But she can Tense up and Untense them at the right moments and because of that finesse she can also do very limber poses. Her muscles are not too strong for a splits or a bridge exercise. But if she had to keep all her strong muscles tensed and difficult to un-tension, she would look like a plank and those exercises would never work!
So, in summary:
Can your muscles become too strong during pregnancy so that they make giving birth more difficult? No!
BUT it is very important that you learn to tighten your pelvic floor muscles and exercise them for strength. You also need to learn to let go and relax them! Then the strongest pelvic floor in the world will still be able to stretch during a vaginal birth.
That is why it is advisable to have a good pelvic floor and perinatal physical therapist coach you! Who can check with you whether you are stretching and relaxing properly... After all, we know that a brief check-up and a few specific personal tips are usually enough to get you on the right track!
And "on the heat of the moment"? During the birth?
Let go ladies! Nothing to worry about!
Even if it would make you go wee-wee or have a bowel movement? "No worries!
Just do it, let go and let it come, don't tense up any more muscles, just try to undergo it!
Hedwig Neels, pelvic floor physiotherapist
PS: Should you suffer some damage during that vaginal delivery (tear or cut), please know that it was not "your fault"... We can never take over all control... Sometimes it just happens and you have to deal with it afterwards. (Also read the blogs postpartum soon)
These recommendations are scientifically based.
Woodley SJ,Boyle R, Cody JD, Morkved S, Hay-Smith EJC (2017) Pelvic floor muscle trainingfor prevention and treatment of urinary and faecal incontinence in antenataland postnatal women. Cochrane Database Syst Rev 12:CD007471.doi:10.1002/14651858.CD007471.pub3
