Strengthening your pelvic floor during pregnancy comes down to a combination of targeted contractions (Kegels), functional movements like squats, and breathing techniques that coordinate with your deep core muscles. Starting early and staying consistent matters: women who train their pelvic floor throughout pregnancy can reduce postpartum urinary incontinence by up to 37% and significantly lower their risk of severe tearing during delivery.
Why Your Pelvic Floor Needs Extra Attention Now
Your pelvic floor is a group of muscles that sit like a hammock at the base of your pelvis, supporting your bladder, uterus, and bowel. During pregnancy, these muscles take on the additional load of your growing baby. As the weeks progress, the increasing weight and hormonal changes that loosen your ligaments can weaken these muscles, leading to urinary leakage, pelvic pressure, and discomfort that may persist well after delivery if left unaddressed.
There’s a second reason pelvic floor training matters: labor itself. During birth, these muscles need to both contract and relax on demand. A well-trained pelvic floor can shorten the pushing stage of labor, particularly for first-time mothers. In one study, women who followed a pelvic floor program had a 32% reduction in episiotomy rates and were more than twice as likely to deliver with an intact perineum. Rates of severe third- and fourth-degree tears also dropped significantly.
How to Do Kegels Correctly
Kegels are the foundation of pelvic floor training. You perform them by squeezing the muscles you’d use to stop the flow of urine, holding that contraction, then fully releasing. The release is just as important as the squeeze. If you’re not sure you’re targeting the right muscles, try stopping your urine stream once as a test (but don’t make this a regular habit, as it can interfere with normal bladder function).
Start simple: tighten your pelvic floor for three seconds, then relax for three seconds. That’s one repetition. Do five to ten repetitions in a set, and aim for two sets per day, one in the morning and one at night. As you build strength over the coming weeks, work up to holding each contraction for five seconds with a five-second release, doing ten repetitions per set, three sets per day. If a five-second hold feels easy, you can gradually extend to ten seconds.
A few technique tips that make a real difference: don’t hold your breath while squeezing. Keep your stomach, thighs, and buttocks relaxed so the work stays in the pelvic floor. And always match your relaxation time to your contraction time. Rushing through the release trains your muscles to stay tight rather than to coordinate properly, which can cause its own problems.
Add Squats for a Deeper Workout
Kegels work in isolation, but squats recruit the pelvic floor as part of a larger movement pattern. Some research suggests squats can be up to 30% more effective than Kegels alone for strengthening the pelvic floor, partly because they engage multiple muscle groups and joints at once. Squats also build the leg and hip strength you’ll rely on during labor, and a squatting position can open the pelvis by 20 to 30%, creating more room for delivery.
A particularly effective variation is the deep squat hold with a pelvic floor contraction. Lower into a squat (feet slightly wider than hip-width, toes turned out), then at the bottom of the squat, perform a Kegel by squeezing your pelvic floor as if stopping the flow of urine. Hold for about ten seconds, then stand back up. Five repetitions is a good starting point. If a deep squat feels unstable, hold onto a chair or countertop for balance, or use a shallower range of motion and work deeper over time.
As your belly grows in the third trimester, you may need to widen your stance or reduce your depth. Listen to your body. If you feel pelvic pressure or pain during squats, back off and focus on Kegels and breathing work instead.
Use Diaphragmatic Breathing as a Training Tool
Your diaphragm and pelvic floor move in sync. When you inhale deeply and your diaphragm contracts downward, your pelvic floor naturally relaxes and lengthens. When you exhale, your diaphragm lifts and your pelvic floor gently contracts. Practicing diaphragmatic breathing (sometimes called belly breathing) strengthens this coordination and helps you develop better awareness of your pelvic floor, which is especially useful if you struggle to feel whether you’re doing Kegels correctly.
To practice, sit comfortably or lie on your side. Place one hand on your chest and one on your belly. Breathe in slowly through your nose, letting your belly expand while your chest stays relatively still. Exhale slowly through your mouth, feeling your belly draw inward. As you get comfortable, try gently engaging your pelvic floor on the exhale. This pairing of breath and contraction mimics the natural rhythm your body uses during labor and everyday movement.
Diaphragmatic breathing also helps manage the pressure inside your abdomen, which increases steadily throughout pregnancy. Learning to control that pressure protects your pelvic floor from being pushed downward during activities like lifting, coughing, or getting out of bed. Research has shown this type of breathing can even reduce symptoms of urinary urgency.
A Simple Daily Routine
You don’t need to carve out a dedicated workout block. Pelvic floor training fits easily into your existing day:
- Morning: One set of 10 Kegels (hold 5 seconds, release 5 seconds) while brushing your teeth or waiting for coffee.
- Midday: 5 deep squat holds with pelvic floor contractions. Pair these with any bodyweight exercise you’re already doing, or do them on their own.
- Evening: One set of 10 Kegels, plus 2 to 3 minutes of diaphragmatic breathing before bed.
Aim for three sessions spread throughout the day rather than one long session. Pelvic floor muscles respond well to frequency. Most women notice improved bladder control within a few weeks of consistent practice, though the full benefits for labor and postpartum recovery build over months.
When Tighter Isn’t Better
Not every pelvic floor problem comes from weakness. Some women have a hypertonic pelvic floor, meaning the muscles are stuck in a state of constant contraction. Symptoms include difficulty starting urination, feeling like you can’t fully empty your bladder or bowels, constipation, pain during sex, and a general aching or pressure in the pelvis, low back, or hips. If any of this sounds familiar, doing more Kegels can actually make things worse by adding tension to muscles that are already too tight.
If you notice pain with pelvic floor exercises, or if you’re experiencing leakage despite consistent training, this may be a sign of a hypertonic floor rather than a weak one. The focus in that case shifts from strengthening to learning how to fully relax the muscles, often with the guidance of a pelvic floor physical therapist.
Signs You’d Benefit From Professional Help
Pelvic floor physical therapists specialize in exactly this area, and pregnancy is one of the most common reasons people see them. Between 70% and 86% of pregnant women in the U.S. experience low back pain or pelvic girdle pain, and a specialist can determine whether pelvic floor dysfunction is contributing. Consider seeing one if you’re dealing with persistent leakage, pelvic pain or heaviness, pain during intercourse, difficulty with bowel movements, or if you simply can’t tell whether you’re doing Kegels correctly. A therapist can assess whether your pelvic floor needs strengthening, relaxation, or a combination of both, and tailor a program to where you are in your pregnancy.