Best Prenatal and Postpartum Pelvic Floor Workouts

Ask 100 people to describe what physical therapy is and most will paint a picture of an athlete rehabbing a knee injury or a patient post-hip replacement trying to get their strength back. But the benefits of physical therapy extend far beyond to others equally as important but not nearly as visible, like pelvic floor physical therapy (PT).

“Pelvic floor physical therapists often are dealing with 'sex, pee, and poop' as the main complaints for patient quality of life, and these are still more taboo topics,” says Lily Jilk, PT, DPT, a pelvic floor physical therapist with SPEAR Physical Therapy. “Many physical therapy programs still don't have extensive education on these topics, and it is brushed over—leading therapists that want to pursue this field to seek out their own continuing education and/or experiences. This leads to fewer practitioners, less access, and less awareness to the public.”

Despite the fact that the look, feel, and goals of pelvic floor PT may not jive with more traditional methods of physical therapy, it can be equally as important for many people—especially those pregnant and postpartum.

“Everyone should at the very least be made aware of what pelvic floor PT can help with,” says Jilk. “Many pregnant people and new parents experience pains that they have never had before and have no idea that they don't have to feel that way.”

That’s why we’re pulling back the curtain on pelvic floor PT. We spoke with experts in the field about the different types of treatment, what they are used for, and the most beneficial exercises for strengthening the pelvic floor.

What Is the Pelvic Floor?

Before we dive into pelvic floor physical therapy, a quick primer on the pelvic floor. It's the term used to describe the muscles that create a sling across the bottom of the pelvis. It holds the pelvic organs in place which include the bladder, urethra, intestines, rectum, uterus, cervix, and vagina.

“Start to think of the pelvis like a big bowl and the pelvic floor muscles as the inner lining of that bowl,” says Debra Flashenberg, the studio owner and director at Prenatal Yoga Center in New York. “Often times when we think about the pelvic floor, we just think about the superficial pelvic floor muscles but really we have three layers. The deeper layer starts higher in the inlet of the pelvis.”

In addition to holding the pelvic organs in place, the pelvic floor muscles play a critical role in guiding the baby down and out during vaginal delivery.

How to Determine If You Have a Tight or Weak Pelvic Floor

Just like injuries you might experience with any other muscle in your body, most pelvic floor issues stem from the muscles being either tight or weak. While there is some overlap in the effects you’ll experience from a tight or weak pelvic floor, there are a few characteristics of each to look out for that can help direct the exercises you use during PT to heal and strengthen your pelvic floor.

What a Tight Pelvic Floor Looks Like

A tight pelvic floor is often the result of the muscles that surround the pelvic floor not being strong enough. “You want to make sure that the other muscles that surround the pelvis and the hips (the inner thigh, the outer thigh, the glutes, and hamstrings), are all firing and strong," Flashenberg explains. "If those muscles are not showing up to do the work to stabilize the pelvis, then the pelvic floor jumps in and takes over. That’s going to overwork the pelvic floor and lead to tightness.”

Other causes of a tight pelvic floor include poor breathing patterns, constantly tucking your tailbone or pulling your butt under while sitting or standing, always holding it in when you have to go to the bathroom, painful digestive issues such as IBS, and stress.

“Someone with a tight pelvic floor may experience discomfort. They may have tailbone pain, they may have pain around their sit bones,” notes Flashenberg. “They may find that they’re constipated or have leakage or pain with sex.” Painful, frequent urination and pain during or after a bowel movement are also common.

During labor and vaginal delivery, a tight pelvic floor can force the baby into an awkward position that prolongs labor.

“We can think about the pelvic floor muscles almost like a funnel that as the baby comes into the pelvic inlet,” explains Flashenberg. “If the baby’s head meets tight muscles that are not adhering to the pressure of it coming down, it can create a malposition that makes labor stall out.”

What a Weak Pelvic Floor Looks Like

In pregnant and postpartum people, simply carrying a baby to term can cause a weak pelvic floor, regardless of the mode of delivery, notes Flashenberg.

“We’ve got the weight of the baby, the placenta, and the amniotic fluid," she says. "There’s a lot that is sitting on that pelvic floor and lengthening those muscles.” Constipation, which is very common in pregnant people, often leads to a weakened pelvic floor.

While many of the symptoms of a weak pelvic floor overlap with those that come with a tight pelvic floor, the biggest sign of a weak pelvic floor is incontinence.

“It’s a pressure issue," Flashenberg says. "When someone sneezes or laughs or coughs, there’s downward pressure on the pelvic floor. The muscles may not be strong enough to support this pressure, and we may see some leakage.”

A weak pelvic floor can also cause the same issues of prolonged labor and delivery as a tight pelvic floor. “A weak muscle tends not to have the same flexibility as a well-toned and balanced muscle, so we may find that same issue that when the baby is moving to the pelvic floor muscle, it’s just not surrendering to the baby presenting against it and receiving it,” says Flashenberg.

What Is Pelvic Floor Physical Therapy?

Physical therapy for the pelvic floor can help improve some of these issues. When it comes to pelvic floor physical therapy, there are two primary methods, internal and external, as well as two primary phases, prenatal and postnatal.

Internal Pelvic Floor Physical Therapy

Internal pelvic floor PT is one of the most effective ways to assess the strength of your pelvic floor muscles, says Melissa Keras-Donaghy, PT, DPT, a pelvic floor physical therapist in Harrison, NY.

“Pelvic floor muscles are like other muscles in the body, they just happen to be in a private place,” she adds. “The most efficient way to test their ability to perform is with an internal pelvic floor muscle assessment.”

To do this, the physical therapist will use a gloved, lubricated finger to assess the pelvic floor muscles’ strength, tone, function, and any pain that is happening. Internal pelvic floor PT is typically done in conjunction with external pelvic floor PT.

External Pelvic Floor Physical Therapy

This is the method that will be more recognizable to people only tangentially familiar with physical therapy. “Usually it can just be spoken in terms of, 'we are going to be doing some exercise in the gym space' or 'we want to decrease the tension in your hips,'” explains Jilk.

She adds that the most effective pelvic floor physical therapy session will likely include both internal and external work. “A patient can frequently benefit from both—spending a portion of the session doing internal biofeedback or internal manual release and then the other portion of the session performing exercises to reinforce the progress and make the patient more independent,” Jilk says.

Prenatal Pelvic Floor Physical Therapy

Just as it sounds, prenatal pelvic floor PT occurs while the person is pregnant. “Pelvic Floor PT can be quite helpful during pregnancy and also for labor preparation,” says Keras-Donaghy. “It is vital to know how to utilize your muscles to allow for more efficient positioning and pushing during labor.”

Both internal and external PT are generally safe during pregnancy, as long as you have been cleared by your OB/GYN or healthcare provider. However, there are certain conditions that make a pregnancy high-risk that may require extra precautions.

Postnatal Pelvic Floor Physical Therapy

The acts of carrying a child and going through childbirth can be traumatic for your body and especially for your pelvic floor. Postnatal pelvic floor PT seeks to address the issues that arise.

“Most commonly, patients can have an internal assessment after being cleared by their midwife or OB/GYN after their six-week postpartum visit,” says Keras-Donaghy. “I have also seen patients as soon as directly from the hospital or birthing center that have experienced birth-related issues including pubic symphysis separation, coccyx injury, or incontinence.”

Best Exercises for Prenatal Pelvic Floor

If you visit a physical therapist, they will help guide you through the exercises they deem appropriate. If you have a weak or tight pelvic floor while you’re pregnant, it can help to address it using pelvic floor physical therapy before you give birth.

There are also exercises you can do on your own. Here are two that our experts recommend to strengthen your pelvic floor during the prenatal period.

360° Breathing

Best For: Tight Pelvic Floor

Flashenberg explains that many people, especially pregnant people, tend to do more belly breathing, or breathing with the front of the body. This leaves the back of the ribs and diaphragm to get stiff and immobile, contributing to the muscle imbalance that creates a tight pelvic floor. “I focus a lot on breathing into the side and back ribs during pregnancy,” she says.

How to Do It: “I have students sit and bring their hands to their lower ribs, then focus their breath into their side and back ribs,” explains Flashenberg. “What this does is when we inhale well with diaphragmatic breathing, the diaphragm drops and spreads, and that gently pushes down into the pelvic floor. The pelvic floor receives the pressure and stretches like a trampoline and then when we exhale the diaphragm lifts and that has a bit of a vacuum effect drawing the contents back up.”

Standing Crunches

Best For: Weak Pelvic Floor

“It is important to note that you have core muscles that consist of four areas, not your abdominals alone,” says Keras-Donaghy. “They include the diaphragm—the main muscle of breathing—your pelvic floor muscles, your abdominals and your spinal muscles.” Movements that will engage and strengthen all four of these areas, such as standing crunches, will help tone weak pelvic floor muscles. Plus, this variation on traditional crunches is safe to do throughout pregnancy, provided you are not at an increased risk for developing diastasis recti (risk factors include multiple back-to-back pregnancies, carrying multiples or a large, heavy baby, and being extremely petite). If you are, it's smart to steer clear of all variations on crunches and focus on breathing exercises like the one above, which can help strengthen a weak pelvic floor as well.

How to Do It: Stand with your feet hip-width apart, your knees slightly bent and your hands behind your head with your elbows out to the sides. Inhale and engage all your abdominal muscles, then exhale and hinge forward at the hips, keeping your back straight, then lift back up. Do 15 reps.

Best Exercises for Postnatal Pelvic Floor

While it may seem counterintuitive at first, postpartum people can have either a weak or a tight pelvic floor, or both.

“Postpartum women may experience an imbalance in their core/hip muscles, altered breathing patterns, and pelvic floor dysfunction,” notes Maeve McEwen, lead trainer at P.volve, a low-impact, resistance-based workout method with a concentration on pelvic floor strength and mobility. That’s why scheduling an assessment with a pelvic floor physical therapist can be helpful to determine what you need to focus on.

“Breathing exercises can be started immediately postpartum and can certainly assist in the recovery from labor and delivery,” says Keras-Donaghy. “Usually, it is safe to begin exercising a few days after giving birth—or as soon as you feel ready.” You can also wait until your six-week postpartum appointment to get the all-clear from your doctor.

Here are two exercises that could help you recover your pelvic floor strength post-pregnancy.

Happy Baby

Best For: Tight Pelvic Floor

“Try relaxing and breathing into stretches like happy baby,” suggests McEwen. “Focusing on full deep breaths to release tension in your pelvic floor, abdominals and other surrounding muscles during the stretch and throughout your day is helpful.” If this position is not comfortable for you, practicing deep breathing in any comfortable, relaxed position is going to be beneficial for a tight pelvic floor.

How to Do It: Lie on your back on a mat or other soft surface. Bend your knees into your belly, grip the outsides of your feet, and open your knees so they brush against the sides of your ribs. Try to keep your shins perpendicular to the floor. Breathe deeply and slowly, playing with the pressure on your feet as it feels comfortable.

Kneeling Squats

Best For: Weak Pelvic Floor

At P.volve, many of the pelvic floor-centric workouts use a P.ball, a soft ball with connected straps that can be worn up between the thighs during exercises. “This allows for individuals to have a tactile connection with their pelvic floor which can help with reconnecting to that area, and as well can be used to strengthen the surrounding muscles,” explains McEwen. It also gives you something to squeeze during the squats, which is especially helpful for strengthening a weak pelvic floor, she adds.

You can also use a small Pilates ball or exercise ball or even a playground ball for this exercise. The only difference is that the pressure you apply is all that will be holding the ball in place.

How to Do It: Kneel on a soft surface with your knees hip-width apart and toes tucked under. Place the ball high between your thighs. Squeezing the ball to hold it in place, lower your butt to brush your heels, then squeeze your glutes to come back to a tall kneel, fully extending your hips at the top. Do 15 reps.

How to Find a Pelvic Floor Physical Therapist

If you are looking for a pelvic floor physical therapist, your OB/GYN, midwife, or other healthcare provider is an excellent place to start.

“I receive many referrals from midwives, OB/GYNs, urologists/urogynecologists, and other medical practitioners but also from social media, patient referrals, and word of mouth,” shares Keras-Donaghy. The Academy of Pelvic Health Physical Therapy also has a locator tool on its website that you can use to find a therapist in your area.

Does Health Insurance Cover Pelvic Floor Physical Therapy?

It depends on the therapist, but in many cases pelvic floor PT will be covered by insurance. Keras-Donaghy notes pelvic floor physical therapy can be an out-of-network benefit, which means you will receive a bill from the practitioner and then you submit a claim to the insurance company. Provided that they deem the service medically necessary (which you can figure out ahead of time), they will cover a percentage of the cost. However, coverage depends on many factors, including your insurance plan and where you intend to seek care. If your plan covers physical therapy, pelvic floor PT should be included in that.

A Word From Verywell

Despite the fact there is some confusion surrounding the idea of pelvic floor physical therapy, it can be incredibly beneficial for pregnant and postpartum people. Whether the issues you are experiencing stem from a weak pelvic floor, a tight pelvic floor, both, or from something else entirely, seeing a PT can put you on the right track to recovery and help make you a stronger, more powerful parent overall. You can always talk to your healthcare provider to see if pelvic floor physical therapy would benefit you.