Sarah was 26 weeks pregnant with her first baby when she sneezed in the grocery store and felt something she’d never experienced before. She leaked. Right there in the cereal aisle. She laughed it off to her partner that evening, but when it happened again during a work meeting the next day, she started Googling. That search led her here, and if you’re reading this for similar reasons, you’re in the right place.

Pelvic floor exercise in pregnancy isn’t just about preventing leaks. It’s about preparing your body for one of the most physically demanding events it will ever go through: childbirth. Women who train their pelvic floor during pregnancy have shorter pushing stages, fewer perineal tears, and faster postpartum recovery compared to women who don’t.

The good news is that these exercises are simple, safe, and take less than 15 minutes a day. This guide covers exactly what to do in each trimester, what to avoid, and when to get professional help.

Why Your Pelvic Floor Matters During Pregnancy

Your pelvic floor is a group of muscles stretching from your pubic bone to your tailbone. These muscles support your bladder, uterus, and rectum. During pregnancy, they take on an enormous extra load.

As your baby grows, the weight pressing down on your pelvic floor increases every week. By the third trimester, your pelvic floor is supporting the weight of your baby, the placenta, amniotic fluid, and your enlarged uterus. That’s a significant amount of pressure on muscles that weren’t designed for constant heavy loading.

At the same time, pregnancy hormones like relaxin loosen your ligaments and connective tissue to prepare for delivery. This is necessary for birth but also means your pelvic floor has less structural support at the exact time it’s under the most strain.

The result? Without attention, these muscles can weaken, stretch, or lose coordination. That’s when symptoms like urinary leaking, pelvic pressure, and lower back pain show up.

Already experiencing symptoms? Our prenatal and postpartum physical therapy program is designed to address exactly this. Call (208) 667-1988 to schedule. No referral required.

Pelvic Floor Exercises During Pregnancy: A Trimester-by-Trimester Guide

Not all pelvic floor exercises during pregnancy are appropriate at every stage. What works at 10 weeks may need to be modified at 35 weeks. Here’s a trimester-by-trimester guide to prenatal pelvic floor exercises.

First Trimester (Weeks 1-13)

This is the ideal time to establish your pelvic floor exercise in pregnancy routine. Your body hasn’t changed dramatically yet, so you can focus on learning correct technique.

Kegels during pregnancy (the foundation exercise):

1. Sit comfortably or lie on your back with knees bent.
2. Identify your pelvic floor muscles by imagining you’re stopping the flow of urine.
3. Contract and lift those muscles up and in. Don’t squeeze your glutes or thighs.
4. Hold for 5 seconds while breathing normally.
5. Relax completely for 5 seconds.
6. Repeat 10 times. Do three sets throughout the day.

Diaphragmatic breathing with pelvic floor coordination:

1. Place one hand on your chest and one on your belly.
2. Breathe in through your nose, letting your belly rise. Your pelvic floor should gently relax and descend.
3. Exhale slowly, and as the air leaves, gently lift your pelvic floor.
4. Practice this connection for 5 minutes daily.

This breathing pattern is the single most important skill to develop. It teaches your pelvic floor to coordinate with your diaphragm, which becomes critical during labor and pushing.

Cat-cow stretch:

1. Start on hands and knees, wrists under shoulders, knees under hips.
2. Inhale, let your belly drop toward the floor, lift your head (cow).
3. Exhale, round your spine toward the ceiling, tuck your chin (cat). Gently engage your pelvic floor on the exhale.
4. Repeat 10 times.

Second Trimester (Weeks 14-27)

Your belly is growing and your center of gravity is shifting. Pelvic floor exercises during pregnancy now need to account for these changes. The focus shifts from learning technique to building endurance.

Modified Kegels (seated or standing):

By the second trimester, lying flat on your back for extended periods isn’t recommended because the weight of your uterus can compress major blood vessels. Switch to doing Kegels while seated or standing. The technique stays the same: contract, lift, hold 5 seconds, release 5 seconds, repeat 10 times.

Wall squats with pelvic floor engagement:

1. Stand with your back against a wall, feet shoulder-width apart, about 18 inches from the wall.
2. Exhale and engage your pelvic floor as you slide into a shallow squat.
3. Hold for 5 seconds.
4. Inhale and slide back up, relaxing your pelvic floor.
5. Repeat 10 times.

This exercise supports pregnancy pelvic floor strengthening by working your glutes, legs, and pelvic floor together. It also builds the endurance you’ll need for certain labor positions.

Bird-dog exercise:

1. Start on hands and knees.
2. Exhale and engage your pelvic floor.
3. Extend your right arm forward and left leg back simultaneously.
4. Hold for 3-5 seconds while breathing.
5. Return to start. Alternate sides.
6. Repeat 8 times per side.

This trains deep core stability, which takes pressure off your pelvic floor during daily movements.

Megan, a 31-year-old first-time mom from Coeur d’Alene, started prenatal pelvic floor exercises at 16 weeks after reading about them on our blog. She did Kegels and breathing exercises daily, plus wall squats three times a week.

At 38 weeks, her prenatal physical therapist assessed her pelvic floor and found excellent strength and coordination. Her delivery went smoothly with a short pushing stage and no significant tearing. At her six-week postpartum checkup, she had zero incontinence symptoms. “I’m convinced the prep work made the difference,” she told her therapist.

Third Trimester (Weeks 28-40)

The focus shifts from building strength to maintaining it and preparing specifically for labor.

Perineal stretching:

Starting around week 34, gentle perineal massage can help prepare the tissue between the vaginal opening and the anus for the stretching of delivery. Research shows this can reduce the likelihood of perineal tearing and the need for episiotomy.

Your pelvic floor physical therapist can teach you the technique, or you can ask about it at your next prenatal appointment.

Deep squat holds (supported):

1. Hold onto a doorframe, sturdy chair, or countertop for balance.
2. Lower into a deep squat with feet wider than hip-width.
3. Focus on relaxing your pelvic floor in this position.
4. Hold for 30-60 seconds. Breathe deeply.
5. Repeat 3-5 times.

This position opens the pelvis and trains you to relax your pelvic floor under load, which is exactly what you’ll need during pushing.

Pelvic floor relaxation practice:

This is as important as strengthening. During labor, you need to release these muscles fully.

1. Sit comfortably or recline at an angle.
2. Take a deep breath in, feeling your pelvic floor relax and drop.
3. On the exhale, resist the urge to tighten. Keep the muscles soft.
4. Practice this “letting go” for 5 minutes daily.

Many women are so focused on pregnancy pelvic floor strengthening that they forget the muscles also need to open for delivery. Third trimester is the time to practice both.

Prenatal Pelvic Floor Exercises to Avoid

Pregnancy isn’t the time to stop exercising. But certain movements put excessive pressure on your pelvic floor and can undermine your pelvic floor exercise in pregnancy routine.

Modify or avoid these:

• Heavy weightlifting with breath-holding: The Valsalva maneuver pushes down hard on the pelvic floor. If you lift weights, exhale on exertion and reduce loads.
• Traditional crunches and sit-ups: These increase intra-abdominal pressure and separate the abdominal muscles (diastasis recti).
• High-impact jumping after the first trimester: Box jumps, jump rope, and plyometrics create repetitive downward force.
• Lying flat on your back after 20 weeks for extended periods: The uterus can compress the vena cava, reducing blood flow.
• Deep twisting movements: These can strain the round ligaments and core.

You don’t need to stop being active. You need to be strategic. A women’s sports physical therapist can help you modify your favorite workouts for each trimester so you stay strong without putting your pelvic floor at risk.

When to See a Pelvic Floor Physical Therapist for Prenatal Pelvic Floor Exercises

Pelvic floor exercise in pregnancy works well at home for many women. But there are times when professional guidance makes a real difference.

Consider scheduling if:

• You’re experiencing urinary leaking at any point during pregnancy
• You have pelvic pain, pelvic girdle pain, or pubic symphysis dysfunction
• You feel pelvic heaviness or pressure
• You want to prepare your pelvic floor specifically for labor and delivery
• You’re unsure whether you’re doing Kegels correctly
• You have a history of pelvic floor dysfunction, prolapse, or difficult delivery
• You’re planning a VBAC (vaginal birth after cesarean) and want to prepare

What Prenatal Pelvic Floor PT Looks Like

At Lake City Physical Therapy, our prenatal program spans from the second trimester through eight weeks postpartum. Your therapist will:

• Assess your pelvic floor strength and coordination
• Teach you exercises specific to your body and your pregnancy
• Prepare you for labor with pushing techniques and perineal preparation
• Set you up for postpartum recovery before the baby even arrives

Our founder, Sheree DiBiase, has spent over 35 years developing this program. We offer it at all eight of our clinics across Idaho and Washington, plus telehealth options for women who can’t easily get to a location.

For a personalized routine you can do at home between visits, check out our custom pelvic floor exercise program.

Postpartum: What Comes After

The work you do during pregnancy pays off after delivery. But your pelvic floor also needs attention in the postpartum period.

Most women can resume gentle Kegels within the first few days after a vaginal delivery, once it feels comfortable. After a C-section, check with your provider but gentle pelvic floor engagement is typically safe within the first week.

A postpartum pelvic floor assessment at six to eight weeks is the gold standard. Your therapist will check for muscle recovery, diastasis recti, and any lingering issues like incontinence or pain. From there, you’ll get a plan for returning to full activity safely. For practical tips, download our free guide: Six Postpartum Health Tips for New Moms.

Kelsey, a 29-year-old from Spokane Valley, came for her postpartum assessment at seven weeks after her second delivery. She’d done prenatal pelvic floor exercises throughout her pregnancy this time, unlike her first. The difference was striking.

After her first baby, she’d leaked for nine months and dealt with pelvic heaviness that made walks uncomfortable. After her second, she had mild leaking for two weeks that resolved on its own. Her pelvic floor assessment showed strong, well-coordinated muscles. She was cleared to return to running at 10 weeks.

Frequently Asked Questions

Are Kegels Safe During Pregnancy?

Yes. Kegels during pregnancy are safe and recommended by the American College of Obstetricians and Gynecologists (ACOG). They strengthen the muscles that support your growing baby and prepare your pelvic floor for delivery. If you have a high-risk pregnancy or specific complications, ask your provider before starting.

How Often Should I Do Pelvic Floor Exercises When Pregnant?

Aim for three sets of 10 Kegels daily, plus 5 minutes of diaphragmatic breathing with pelvic floor coordination. In the third trimester, add perineal massage three to four times per week and daily relaxation practice. Total time commitment is about 10-15 minutes per day.

Can Pelvic Floor Exercises Prevent Tearing During Birth?

They can reduce the risk. Strong, well-coordinated pelvic floor muscles combined with perineal massage starting at 34 weeks have been shown to decrease tearing rates. A physical therapist can also teach you effective pushing techniques that protect the perineum.

What If I’m Already Leaking During Pregnancy?

Leaking is common but not something you should ignore. It usually means your pelvic floor isn’t keeping up with the increasing demands of pregnancy. Start the exercises in this guide, and if leaking continues after two to three weeks of consistent practice, see a pelvic floor physical therapist for an assessment.

Start Preparing Your Pelvic Floor Today

Pelvic floor exercise in pregnancy is one of the most impactful things you can do for your birth experience and your recovery. It takes 15 minutes a day and the benefits last well beyond delivery.

Here’s what to remember:

• Start early. First trimester is the ideal time to build your routine.
• Coordinate breathing and pelvic floor. This connection matters more than raw strength.
• Adjust by trimester. What you do at 12 weeks should look different from 36 weeks.
• Practice relaxation, not just strengthening. Your pelvic floor needs to open for delivery.
• Get professional guidance if anything feels off. A prenatal pelvic floor PT can save you months of postpartum problems.

Ready to prepare your body for birth? Our prenatal pelvic floor specialists have helped thousands of women have stronger pregnancies and smoother recoveries.

Schedule your appointment today:
– Coeur d’Alene: (208) 667-1988
– Spokane Valley: (509) 868-0849
– Find your nearest clinic
– No physician referral required

Your first visit is a conversation about your pregnancy, your goals, and your body. From there, we build a plan around you.

This article is for educational purposes and does not replace professional medical advice. Always consult your OB/GYN or midwife before starting a new exercise program during pregnancy.