During pregnancy, is an increased risk of incontinence (involuntary loss of urine). The three major contributing factors are:

• the increased pressure on your bladder and pelvic floor as your uterus expands

• the increasing amount of space your uterus occupies within the pelvis as your pregnancy progresses, which makes it impossible for your bladder to hold as much urine as before

• the hormone relaxin, which softens the structures of the pelvic floor so that they become less efficient in holding up your pelvic organs. This can also add to the discomfort of vulval varicose veins and haemorrhoids.

When you pull, push, lift or carry loads, cough, sneeze, vomit, run, jump or laugh heartily you increase the pressure within your abdomen, which will jeopardize an already “at risk” situation even further. The pelvic floor muscles ma not be able to gold against this extra pressure and stress incontinence may be the consequence. (Stress incontinence in the involuntary leakage of urine caused by an increase in impact or stress pressure within the abdomen.) The best defence you have is to avoid situations that place added strain on your body and to improve the strength of your pelvic-floor muscles.

If you find that you have some degree of incontinence when you cough, sneeze, laugh, lift, push, pull, run, jump, walk fast or, in fact, do any other activity you should:

• strictly practice and increase you repetitions of the exercises given bellow

• seek professional treatment.

Pelvic-floor bracing
For everybody protection against the effects of gravity and the increasing weight of your uterus during pregnancy, you need to improve the holding (isometric) tone should do the following exercises often throughout the day.

Bracing
Imagine yourself tightening around your urethra, vagina and anus, then lift up internally, hold the position for a few seconds (without holding your breath) and then release it slowly. Repeat this exercise several times. To improve the strength of your pelvic-floor muscles, aim gradually to increase the length of your hold and the number of repetitions that you do. Hold this brace and lift in all your upright postures and especially when there is increasing pressure on the muscles from above as, for example, when you lift, cough or sneeze.

Lift, Release, Lift, Release
This is a short hold, followed by a rest of the same length, done repetitively to help strengthen the pelvic-floor muscles required when you cough or sneeze suddenly.

Implications for exercise.
You need to develop a pelvic-floor strengthening regime the becomes a part of you daily life. This is the best way to minimize the impact of pregnancy on your pelvic floor. Even if you were already practicing pelvic-floor exercises daily before you became pregnant, you will need to work at them harder during pregnancy.

You can reduce at risk of stress incontinence when exercise by:

• avoiding high-impact activities, such as running, jumping and bouncing

• bracing your pelvic-floor muscles before you do any sit-up style of exercise or any - lifting or resistance work with weights because of the increased intra-abdominal pressure during these exercises

• being aware of tightening, or bracing, your pelvic-floor muscles during all upright exercises.

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