apply-pelvic-floor-training

Apply Pelvic Floor Training

Execute an evidence-based Kegel protocol to prevent incontinence and prepare the pelvic floor for labor.

Why This Is Best Practice

Adopted by: NICE, ACOG, Pelvic Obstetric and Gynaecological Physiotherapy (POGP) — all recommend pelvic floor training as standard antenatal care. Impact: Pelvic floor muscle training (PFMT) reduces urinary incontinence in late pregnancy by 56% (Cochrane 2017, 38 RCTs, n=9,832). Postpartum incontinence risk reduced by 26% when training begins in pregnancy (Woodley et al., 2017). Why best: The pelvic floor supports uterine weight throughout pregnancy and must stretch/contract through delivery. Untrained muscles increase urinary incontinence, pelvic organ prolapse, and perineal tearing risk.

Steps

1. Identify the correct muscles: stop urine mid-stream once to locate the muscles — do not use this as regular practice, only for identification.
2. Confirm isolation: contract pelvic floor without squeezing buttocks, thighs, or abdomen. Place hand on abdomen — it should not tighten.
3. Slow hold contractions (strength):
   • Contract and hold for 10 seconds
   • Fully relax for 10 seconds
   • 10 reps × 3 sets/day
4. Quick contractions (power/reflex):
   • Contract and release rapidly 10–15 times
   • 1 set after each slow hold set
5. Positions: lying on side, sitting, standing — practice in all three to prepare for functional use.
6. Progression: increase hold time by 1 second per week up to 10 seconds; increase to 15 reps/set by third trimester.
7. "The Knack" technique: contract pelvic floor just before coughing, sneezing, or lifting — this reflex closes the urethra before pressure surges.

Rules

• Never hold breath during contractions — breathe normally throughout.
• Never contract during Braxton Hicks contractions.
• Stop if pelvic pain or pressure increases — consult pelvic floor physiotherapist.
• Consistency beats intensity: 3 sets/day every day > 10 sets one day/week.

Examples

Morning routine: 10 slow holds (10-sec each) + 10 quick contractions while lying in bed before rising. Functional integration: Contract before every sneeze, cough, and lifting action throughout the day.

Common Mistakes

• Gripping buttocks or thighs instead of isolating the pelvic floor — this substitutes large muscles and trains the wrong pattern.
• Not relaxing fully between contractions — partial relaxation prevents strength gains.
• Stopping training after delivery — the postpartum period is when continuation is most protective.

Health Disclaimer: Pelvic floor dysfunction (pain, heaviness, prolapse symptoms) warrants referral to a pelvic floor physiotherapist before starting any PFMT protocol. This skill addresses prevention in low-risk pregnancy.