Learn about the role your pelvic floor plays during pregnancy and what you can do to prevent long-term problems such as incontinence.
I had just passed the magical 12th week of pregnancy. Until then, only my closest confidants knew my little secret. A baby bump wasn't really visible yet – the slight bulge could easily have been bloating. And yet, I'd already experienced quite a few symptoms: the familiar nausea, debilitating fatigue, circulatory problems – the whole nine yards.
And to be quite honest: I constantly have to go to the toilet. That alone wouldn't be so bad. I got used to this increased urge to urinate over the weeks. According to my gynecologist, it's also hormonally related and will subside after the first trimester.
However, that wasn't the end of it. No sooner had I breathed a sigh of relief after the first trimester was over than I had a completely different experience: One morning I was running a bit late and had to run to catch my bus to work. Just before the doors closed, I heroically jumped on. Instead of relief, I felt something else: My pants were wet. My bladder had indeed given way, and I must have leaked a small amount of urine. Totally embarrassing. Where had that come from all of a sudden?
MamAcademy explains: Pelvic floor weakness during pregnancy
My weakened pelvic floor was the culprit. I learned this via Instagram from MamAcademy, which I became aware of quite quickly as a pregnant woman. I hadn't realized how important this muscle group in my lower abdomen is. Why would I have? It had been working perfectly fine. However, if the pelvic floor is weakened, it makes itself known relatively quickly. Symptoms can include urinary incontinence, lower back or abdominal pain, hemorrhoids, or even pelvic organ prolapse. So it's not uncommon for women to first become aware of their pelvic floor during pregnancy. Namely, when it's potentially subjected to excessive strain for the first time—as was the case when I sprinted for the number 5 bus.
Incontinence already in early pregnancy
Especially during the first trimester, the uterus grows rapidly. While it's about the size of a pear at the beginning of pregnancy, by week 12 it's already the size of a small melon. It's no wonder, then, that the pelvic floor is sometimes surprised by this rapid growth. The resulting discomfort is often related to weakened muscles and not—as pregnant women often assume—to the pressure of the baby on the uterus. The real reason is the hormones that soften the pelvic floor and make the urethra more flexible. And finally, of course, there's the weight of the baby, which puts even more strain on the pelvic floor muscles.
But what exactly is the pelvic floor?
The pelvic floor is a complex network of various muscles, ligaments, and connective tissue. Like a net, this network stretches between the ischial tuberosities, the pubic bone, and the tailbone, holding your organs, such as the bladder, bowel, and uterus, in place. Understandably, your pelvic floor has a lot to do during pregnancy, as it now has to support the additional weight of the uterus, placenta, baby, and amniotic fluid—and as we all know, this weight increases throughout pregnancy, putting more strain on it. The fact that my pelvic floor was already suffering from this strain so early on came as a complete surprise to me, but as I learned, it's not uncommon.
From the second trimester of pregnancy onwards, more than one in three women suffer from at least mild urinary incontinence. This means they occasionally leak some urine during increased exertion.
Dr. Rieke Hermann, gynecologist and co-founder of MamAcademy, confirms these figures. In her gynecological practice, she also observes that this is a taboo subject for expectant mothers. They rarely bring up the symptoms themselves. The topic is shrouded in shame; many downplay the symptoms and assume that this is simply how it is. Furthermore, they hope that this mild bladder weakness will resolve itself after the pregnancy. Unfortunately, this is not the case.
“Approximately half of all women who already have problems with pelvic floor weakness and mild incontinence during pregnancy also have long-term problems with their pelvic floor muscles after giving birth.”
Dr. Rieke Hermann
This realization was naturally frightening for me. But what could I do now to make my pelvic floor stronger?
Are pregnant women allowed to exercise their pelvic floor muscles?
The myth that pregnant women shouldn't exercise their pelvic floor muscles is deeply ingrained. And many pregnant women dutifully follow it, because a soft pelvic floor is supposed to give us an advantage during childbirth and reduce the risk of birth injuries. That's what we all want, isn't it?
The idea of soft muscles isn't entirely wrong. However, it's not quite what you might think: When we train a muscle group, it not only becomes stronger and more stable, but we also gain the ability to consciously control it. In other words, we can contract it, but also consciously relax it. A healthy muscle is therefore both strong and flexible. An untrained muscle, on the other hand, is primarily weak, and we have little access to it and cannot control it properly.
So it's exactly the other way around: women who train their pelvic floor during pregnancy have a clear advantage during childbirth: they can consciously relax it, let it go, which in most cases leads to a shortened second stage of labor.
It is therefore highly recommended to strengthen the pelvic floor during pregnancy.
Strengthening the pelvic floor during pregnancy with yoga
To strengthen your pelvic floor muscles during pregnancy, you need gentle and regular exercises. MamAcademy offers pregnancy yoga with a focus on the pelvic floor – I tried it myself once.
Katharina Charissé, co-founder of the MamAcademy, emphasizes the importance of gentle movements during pregnancy:
“ Our course is more than just a bit of bouncing around on a mat. Women gain a completely new connection to their bodies, which are currently performing a true miracle. At the same time, the exercises are very effective. They help reduce pregnancy discomfort, prepare for childbirth, and strengthen the important pelvic floor muscles in the long term. And: Over time, the mothers really come to enjoy every yoga session.”
Although it took some effort at first to regularly unroll my yoga mat, I soon found I couldn't do without it. I felt much more stable in my core, which, as the pregnancy progressed, grew larger and larger. The weight was considerable, but the yoga sessions helped me stay balanced—both physically and mentally. I also quickly regained more control over my bladder. The birth is still ahead of me, but I now feel much more confident about this physical challenge as well.
Conclusion: Pelvic floor exercises are essential during pregnancy
Even though I had no connection to my pelvic floor until the 12th week of pregnancy, its importance to me and my personal well-being quickly became apparent. It not only plays a special role in preparing for childbirth, but also ensures that I won't have long-term problems with symptoms like urinary incontinence, prolapse, or back pain after pregnancy – provided it receives the attention it deserves now.
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