Apply Pelvic Floor Training

---
name: apply-pelvic-floor-training
description: Use when doing pelvic floor exercises during pregnancy — e.g., "Kegel exercises while pregnant", "how to do Kegels correctly", "pelvic floor strengthening for birth prep", "preventing postpartum incontinence"
source: NICE Antenatal Care NG201 2021; Cochrane Review Pelvic Floor Muscle Training 2017 (Woodley et al.); Bø et al. BJSM 2015
tags: [pregnancy, pelvic-floor, kegel, exercise, postpartum-prevention, health]
verified: true
---

# 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:** This skill provides general educational information, not medical advice. Pelvic floor dysfunction (pain, heaviness, prolapse symptoms) warrants referral to a pelvic floor physiotherapist before starting any PFMT protocol. Consult your healthcare provider before beginning this or any exercise protocol during pregnancy. This skill addresses prevention in low-risk pregnancy.