Beyond Kegels: 3 Tips for Improving Pelvic Floor Function in Pregnancy (Featured on My Nestwell)

This summer, Dr. Kat wrote a blog post for My Nestwell, a new online platform for Fairfield and Westchester County moms to connect with maternal healthcare and wellness providers to assist them on their prenatal and postpartum journeys!

Click here to sign up and build your prenatal and postpartum team!

Credit: Stelios Stavrianos  Premier Photography

Credit: Stelios Stavrianos Premier Photography

Pregnancy can be an exciting, yet physically and emotionally challenging journey for women. It is important to honor and tune into these changes in your body. Some of these physical changes that accompany the growing baby will include increased fatigue, weight gain, and  low back/SI joint. The most common, yet least talked about symptoms include:

  • Leaking when you cough or sneeze (urinary incontinence)

  • Intense sudden urge to use the bathroom (stress incontinence)

  • Heaviness in the pelvis or “organs going to fall out” (organ prolapse)

Although we have accepted that these pelvic floor symptoms are “normal” to feel during pregnancy, expecting mothers can alleviate their symptoms through pelvic floor physical therapy. 

Here are 3 tips for all expecting mothers to get started on improving their pelvic floor health:

Get your pelvic floor strength and function tested.

Pelvic floor physical therapists (PTs) are trained to assess the pelvic floor both externally and internally. The internal exam is similar to an OB/GYN exam but the PT will be assessing your pelvic floor strength, tone, and its function. A pelvic floor PT will be able to provide the proper treatment plan which could include pelvic floor strengthening/release, postural work, manual therapy, and therapeutic exercise. Also, every mother is different and should be treated on an individual basis. Treating urinary incontinence can be different from treating pelvic pain, so make sure you see the proper professional!

Practice proper breathing.

Most women are told to practice Kegels to work on the pelvic floor, but proper breathing actually makes the exercise effective. It’s not just about flexing the muscles down there! To start off, simply inhale to fill the belly and exhale to draw the navel in slightly, as if you’re hugging your baby. 

Following proper breathing technique, you can start to incorporate the Kegel exercise. I like to cue pelvic floor contraction by telling patients to imagine there is an elevator at the bottom of their pelvic floor and that they are drawing it all the way up. Inhale, to fill the belly and relax the pelvic floor, and exhale to draw the pelvic floor muscles in and up. 

Stay active! 

Depending on your activity level prior to pregnancy, the goal is to maintain your cardiovascular fitness and strength. If you are starting out, work with a prenatal/postpartum fitness professional or physical therapist.  I like to recommend yoga and Pilates to my expecting patients of all fitness levels, as they are great low-impact exercises that allow you to focus on your breath and pelvic floor! 

Dr. Kathleen Castro, PT, DPT, CSCS, PMA®-CPT, BSPTS-1 Certified Therapist is the lead therapist for PhysioElements Physical Therapy in Greenwich, CT, and enjoys treating a diverse population of patients, especially the perinatal population in addition to children. She works to find the root of the problem and combines manual therapy, Pilates-based therapeutic exercise, and functional strength training in her treatment sessions to work her patients to reach their goals. As an avid Pilates practitioner and long-distance runner, Dr. Kat integrates her passion for fitness and wellness to support her patients and clientele in leading a healthy lifestyle for optimal health and longevity. Connect with Kat on MyNestwell.

Urinary Incontinence

Leaking is a very common, but not normal symptom! About 50% of women experience urinary incontinence including prenatal, postpartum, and active women who have never given birth before.

Only a small percentage of them seek proper care. Although it can be quite embarrassing to initiate discussions about urinary symptoms but most people don’t know that treatment by a pelvic floor physical therapist is available!

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5 Stretches to Ease Pelvic Pain

Pelvic pain can be a life-changing and challenging experience. Some symptoms of pelvic pain can include (for both men and women):

  • Pain in the lower abdominal region,  groin, perineum, or tailbone region

  • Pain with sitting

  • Pain during/after sex

  • Pain during/after using the bathroom

  • Pain/discomfort with OB-GYN exams or tampon insertion

It is often the result of a combination of physical, emotional or even environmental triggers that include

  • Tight pelvic floor, hip, lower extremity musculature

  • Poor posture, weak core musculature,

  • Overactive pelvic floor

  • Emotional/sexual trauma

  • Stress

  • Pregnancy and after delivery

  • Abdominal/pelvic surgeries

  • Endometriosis, Interstitial cystitis, fibroids, prostatitis

Pelvic floor specialist specialist such as MDs and physical therapists can work with you closely to help find the root of your symptoms. If you are experiencing any of the symptoms above, you can see our pelvic floor physical therapists at PhysioElements at our two locations in Manhasset, Long Island and Greenwich, Connecticut.

Here are five simple, relaxing yoga poses we often give to our patients to alleviate their pelvic pain symptoms. We focus on diaphragmatic breathing in each pose, which helps calm down the nervous system and promote relaxation of your pelvic floor muscles.

Breathing cues: Inhale through the nose to fill up the belly first, then the chest. Exhale passively out of the mouth, letting the belly fall and think about “melting” your whole body into the floor.

1. Cat/Cow - focus on pelvic tiLts



2. Supine happy baby


3. Supported hip opener


4. Supported yoga squat

5. Supported pigeon pose


3 Things to know for Post-Partum Exercise

The post-partum period can be a challenging period for if you are a new mother. After spending 9 months carrying your little bundle of joy, you may be awaiting the 6-week mark that your physician sets for you to resume exercise to shed that baby weight. It is important for new mothers to know that this period is a crucial period of recovery mentally and physically, especially when transitioning from your body's state during pregnancy. 

Before you jump into a HIIT class or 6-minute core circuit you found on YouTube, there are 3 things you should know to safely return to exercise.

1. Get checked for Diastasis Recti.


Your rectus abdominus or "6-pack muscle" expands from the tension caused from your growing baby during pregnancy. As a result this can cause a widening and separation of the linea alba, which runs down the middle of abdominal wall. This is called diastasis recti and this can result in the appearance of a "pooch" and affect your core stability.  Your body has to regain its ability to stabilize itself so that you can move efficiently and resume higher intensity exercises such as running or cardio-circuit workouts. 

If you are unsure if you have diastasis recti, you can find a women's heath physical therapist who can assess you and prescribe an appropriate exercise program. 


2. Start with foundational abdominal exercises. 


As mentioned before, crunches and planks are not the best exercises to do right away if you want to tone your abdominals. You want to prevent any further separation of your linea alba, you will want to focus on strengthening the transverse abdominus (TA) for stability and support. You want to avoid any exercises that involve crunches and head lifting until you are able to demonstrate the ability to contract the TA in any static and dynamic position. 

3. Find a team to help you with your postpartum fitness goals! 

There are a wide variety of health and fitness professionals who are trained to work specifically with post-partum women including physical therapists, pilates instructors and personal training. It is important to work with someone who is experienced in working post-partum conditions such as diastasis recti and incontinence to safely return back to regular exercise!

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At PhysioElements, we offer a Core Elements Program for women to help them transition out of the post-partum phase of pregnancy. We provide services such as orthopedic physical therapy, pelvic floor physical therapy, pilates, yoga and personal training. During your initial evaluation ,we screen for diastasis recti, pelvic floor conditions such incontinence and organ prolapse and overall general fitness. We will work with you to create a specialized program to help you reach your pregnancy goals! 

For more details and to schedule your Core Elements initial evaluation, please contact us here or call 516-365-3455.


Today, we will be sharing a nut-free fat-ball recipe that Kat adapted from the blog “Lee From America”. These are incredibly easy to prepare and you can alter the recipe by subbing in other ingredient to fit your nutritional needs. Kat added matcha for its antioxidant properties and to increase energy levels and collagen peptides for a protein boost.

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