It's impossible to speak about exercise during and after pregnancy without placing some focus on Kegels and the pelvic floor muscles. In pregnancy recovery, the pelvic floor muscles should receive top priority. The strength of the pelvic floor is important in maintaining the integrity of the inside passages and the position of the organs they support.

The pelvic floor muscles control the flow of urine, the voluntary contraction of the vagina and the anal sphincter as well. The pelvic floor is composed of several layers of muscle suspended like a hammock at two points: the front and the back of the pelvis. The pressure of pregnancy increases the likelihood that the pelvic floor will sag just as a hammock does.

A healthy pelvic floor has tone and elasticity. However, if after childbirth these muscles are neglected, they sag below the horizontal line and with the help of gravity, continue to sag downward. Excessive sagging over a long period of time can result in serious structural changes and possible impairment of function, namely the bladder, uterus, bowel and their contents. Common problems associated with pelvic floor weakness include:

• You or your partner may feel nothing during intercourse.
• You may have difficulty retaining a tampon.
• Prolapse of the uterus. Over time, the uterus can begin to herniate through the vaginal opening, similar to the way upholstery padding protrudes through a chair when it's supportive base is defective.
• Urinary incontinence, or the involuntary escape of urine when you laugh, cough, sneeze, lift or run.

Not all problems with the pelvic floor are related to childbirth, so I discourage self-diagnosis and urge you to visit your doctor if any unusual symptoms persist.

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