Safe core exercises for maintaining pelvic floor integrity 

If you are pregnant, early postnatal or post gynaecology surgery, a more gentle yet deeper approach to abdominal exercises is recommended during these phases, where these muscles are considered at risk. This approach is preferable in order to achieve a strong and flat stomach whilst preserving/strengthening your pelvic floor muscles. If possible, seek advice from a continence and women’s health physiotherapist or a qualified fitness professional to check which of the pelvic floor safe exercises are best for you. 

Your abdominals strength may exceed your pelvic floor strength and some 'traditional' abdominal exercises can also result in excessive pressure on these already weakened muscles. Therefore, It is important to build up your pelvic floor muscles control first and then you will be able to progress to doing some more challenging abdominal exercises again.

Here are a number of ways to modify your core exercises to protect your pelvic floor and maintain or strengthen your deep abdominals

• Cease strong abdominal exercises. See below for core exercises to avoid
• Reduce the level of your abdominal muscle exercise program. A little often is best. 
• Avoid breath-holding by exhaling with effort to prevent excessive intra-abdominal pressure.
• Maintain correct alignment
• Lift your pelvic floor first and hold it during the exercise, then relax afterwards
• Notice how many repetitions you can do before your pelvic floor muscles tire. You may need to add some rests, or reduce the number of repetitions you do in a row, while your pelvic floor muscle fitness improves.

 Example of Pelvic floor safe and effective core exercises

• single leg extension with one leg supported by a hand on stationary knee or moving foot on ball ( avoid if suffering from hypotension when lying on back)
• modified plank on hands or knees with a slight bend at the hips
• wall push ups
• ball bridge (feet on ball or back on ball, +/- single leg lift)
• arm and leg lift on all fours
• leg lift sitting on the ball
• standing balance work on the bosu or balance disc

Please note:  whilst these exercises are pelvic floor safe, you will also need to consider the number of repetitions, abdominal challenge, number of sets, length of rest and your fatigue level - which also affects your pelvic floor function. Correct Technique is also essential so it is always best to seek professional advice.

Core exercises to avoid

• sit ups, curl ups, crunches
• abdominal exercises with medicine ball
• V-sit
• hundreds
• double leg lowers
• plank position on hands and feet (eg ‘hovers’, full push ups)

But how do I get flat abs?

If you’re aiming for a flat tummy then sit ups and crunches aren’t the best option.  They will tone the ‘six pack’ muscles but will not flatten the tummy.  Excessive upper abdominal tension that can occur with lots of sit-ups will often make the lower abdomen appear as a ‘pot belly’, especially whilst  there is abdominal separation ("doming" effect; refer also to  earlier post on Diastasis Recti). Nutrition and low impact aerobic exercise (impact can be increased later postnatally when you are stronger) also play a part to help lose extra abdominal fat;adequate protein intake is also crucial to repairing your abdominal wall.  Pelvic floor exercises, when done correctly with relaxed upper abdominals and normal lower abdominal co-contraction, as well as modified core exercises performed with good technique will also help to achieve flatter abs.