Safe Abdominal Exercises – Pelvic Floor Safe Core Exercises

Safe Abdominal Exercises for Women

Safe abdominal exercises are a must for women with or at risk of pelvic floor problems.

This Pelvic Floor Physiotherapist article helps women exercise core abdominal muscles safely and with confidence. It teaches how to identify pelvic floor safe abdominal exercises and and how to recognize potentially unsafe core exercises. abdominal core exercises

Read on now to learn about safe abdominal exercises with:

  • Pelvic floor problems associated with some intense core exercises
  • Is your pelvic floor at risk from unsafe core exercises?
  • Which abdominal core exercises are potentially unsafe?
  • How to modify some frequently performed abdominal core exercises;
  • Pelvic floor safe abdominal exercises to choose; and
  • 5 tips for pelvic floor safe abdominal exercises.

Core Abdominal Exercises and Pelvic Floor Problems

There are two main problems potentially arising from the wrong core abdominal exercises for your pelvic floor:

safe abdominal exercisesProblem 1: Stretched pelvic floor muscles i.e. pelvic floor too loose

Exercises that strongly engage the upper abdominal muscles such as sit-up or abdominal curl exercises increase downward pressure on the pelvic floor. These exercises cause the pelvic floor to stretch and weaken if it lacks the strength to withstand this downward pressure (shown here). For this reason is vital to avoid unsafe abdominal exercises that place pressure on the pelvic floor if it is at risk of injury.

Problem 2: Overactive pelvic floor muscles i.e. pelvic floor too tight

Intense core exercises can cause overactive pelvic floor muscles where the muscles spasm and become unable to relax. Increased pelvic floor muscle tension causes the pelvic floor muscles to become too tight resulting in pelvic pain, bladder and bowel problems and pain with sexual intercourse.

Is your pelvic floor at increased with some abdominal exercises?

If you answer yes to any of the following questions your risk of pelvic floor problems is likely to be increased:

  • Previous gynaecology surgery (prolapse surgery, hysterectomy, bladder repair)?
  • Pelvic prolapse?
  • Incontinence (bladder or bowel)?
  • Menopause or beyond?
  • Recent childbirth?
  • Overweight?
  • Pelvic pain?

Core Abdominal Exercises to Avoid or Modify

Intense upper abdominal muscle exercises are those most likely to contribute to pelvic floor problems. These exercises have the potential to stretch and weaken the at-risk pelvic floor:

  • Sit-up exercisessafe abdominal exercises
  • Swiss ball sit-ups
  • Abdominal crunches
  • Twisting crunches
  • Pilates or Yoga style exercises with both legs raised in the air and your head off the ground (shown right)
  • Pilates or Yoga exercises that involve intense upper abdominal activity such as “The Hover” or “The Plank”
  • Abdominal resistance exercise machines
  • Bicycle legs with both legs raised in the air simultaneously.

Pelvic Floor Safe Abdominal Exercises

The most appropriate abdominal exercises for minimizing pelvic floor pressure are:

  • Seated Swiss ball core stability exercises – this includes exercises such as arm reaching, alternate leg extensions shown in this video link.
  • Gentle lying down core stability exercises that do not involve bracing your abdominal muscles strongly shown in this video link.
  • Whole body exercises that incorporate your abdominal muscles such as swimming.

How to Modify Intense Core Exercises?

Core abdominal exercises can often be modified to reduce the amount of pressure on or tension within the pelvic floor.

  • Pilates-style exercises with both legs raised in the air can be modified to place less pressure on the pelvic floor. This is achieved by raising only one leg at a time off the ground.
  • Intense core abdominal exercises such as The Plank or Hover can be modified by kneeling rather than weight bearing through the feet.  Avoid strong abdominal bracing with these or any abdominal core exercises to reduce pressure on the pelvic floor. Side plank will place less downward pressure on the pelvic floor than prone plank on the hands and knees/feet.
  • Relax the abdominal and pelvic floor muscles having once braced them during exercise.

5 Tips for Pelvic Floor Safe Abdominal Exercises

  • Use your abdominal muscles correctly gently, never brace them strongly
  • Allow your abdominal muscles to rest, avoid constant over bracing
  • Choose seated fit ball exercises and positions for whole body strength exercises
  • Choose lying down abdominal exercises that do not involve raising your head or both legs in the air
  • Avoid sit-ups and abdominal crunch exercises, especially if you are at risk of pelvic floor dysfunction
  • Avoid intense core strength exercises in exercise classes including some Pilates and Yoga classes; speak with your instructor about modifying unsafe abdominal exercises to the intensity of your core exercise.

Safe abdominal exercises are essential knowledge for women who are at increased risk of pelvic floor injury with exercise. If you can choose pelvic floor safe abdominal exercises, and modify or avoid those exercises most likely to cause pelvic floor problems, then you will help to reduce your risk of pelvic floor problems caused by inappropriate abdominal core exercises.

prolapse exercisesABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out.

Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.

We Welcome Your Comments



  1. So happy I came across this website. For the past 2 months I spend hours reading up on prolapsed bladder. I am 40, I have 3 children, and just recently found out I have a stage 2 prolapsed bladder. I was very upset…..i didnt know this was possible. I have had incontinence problems since my first child 16 years ago. I was told to do kegals when I was pregnant …. I was never told if you don’t your bladder can drop! I am currently going to physical therapy for pelvic floor and feel much stronger.
    I am trying to avoid surgery….I heard a pessary might be a good option. What’s your opinion?

    • Michelle Kenway says

      Hi Jean
      I believe pessary is a great option and addition to help you while you strengthen your pelvic floor. You might like to read a little more on pessaries for prolapse here

      Try to do your pelvic exercises with your pessary in place if you can too

      All the best

  2. Thank you for the expert info. I had rectal prolapse surgery 8 years ago and remember being told not to strain on the toilet. The surgery and recovery were very hellish. I just went to a martial arts class and unfortunaely performed a lot of very intense sit ups and ball exercises. My abdomen stung, and I researched this and found your aricle after the fact. I’m so scared that one lapse of judgement has caused a real problem. Do you suppose I can improve with rest? What should I do next? I really screwed up after being fine for years. Thank you for any advice.

    • Michelle Kenway says

      Hi Allie

      I can’t say whether you have injured your pelvic floor or repair, it may well be abdominal strain however best management involves rest, avoiding intense exercises, manageing bowels really well to avoid constipation and straining, doing pelvic floor exercises and seeking a medical opinion if you are concerned about repeat prolapse.

      Hope this helps you out

  3. Rosa Chicago says

    Thank you for an insightful article. I had a rectocele repair and its been 6 weeks post op. Would appreciate your advice on what excercises to avoid. Prior I did bikram yoga, weight training, pilates, kickboxing. Really need to get back in shape but unsure how to proceed.

    Thanks! In advance

    • Michelle Kenway says

      Hi Rosa

      Most important to avoid high impact exercises (where both feet are off the ground), intense core abdominal exercises (found in Pilates classes), inappropriate Yoga exercises and weight training that involves heavy lifting and unsafe lifting techniques. You can read more about Yoga exercisesto avoid and Pilates core abdominal exercises in these articles.

      Rosa if you are seeking more information you wil find it in Prolapse Exercises book which is for women to teach them how to choose appropriate and avoid inappropriate exercises after prolapse surgery.

      I hope this helps you out
      All the best

  4. Hi I had a bladder prolapse repaired 4wks ago – before op I did ceroc dancing (modern jive) 2/3 nights & spin classes 2/3 nights also cycling – I have been advised to wait 12wks post op before started these classes again – do you agree with this advise? Is spinning a safe exercise after prolapse repair? I am now walk 4-5 miles daily. I am ordering inside out.
    Sheila 26/6/13

    • Michelle Kenway says

      Hi Sheila
      The advice you are given will be speicfic to your surgery and your pelvic floor so should be acted upon accordingly. Re spinning classes – to be honest I really like spinning for pelvic floor safe exercise. I think there are a few modifications for classes or guidelines that should be noted for spinning after prolapse repair, this article on spinningand cycling should help you keep spinning safe for your pelvic floor after prolapse repair.
      Hope this helps

  5. hello everyone,
    i am 2 weeks post surgery,
    vaginal hysterectomy and pelvic floor repair my ovaries and tubes in tact and dont mind saying its been 2 weeks from hell for me,
    for years i have been doing ab crunches etc thinking its been the right thing for my body and had even signed up to a gym promoting everything your page tells you NOT to do.
    until i read the information provided i was unaware the damage that can occur through ignorance…i feel that gym's should be more aware of this and medical professions need to tell all women this as it is defininately NO walk in the park having these types of surgeries.
    thank you for the information and look forward to getting back on track with the right information.
    to all the ladies hope you all have speedy recoveries…Bonita i do hope you have success in your second surgery.

  6. Hi Michelle, I have your book, INside Out and I am eager to get my body back into shape after a davinci vaginal hysterectomy  (late Aug, 2011; ovaries left intact). The reason for the hysterectomy was uterine prolapse and I am 61 and in great walking shape but my natural apple shape has become intolerably fat in the upper abs (lower are fine). I have not actually gained weight, more like it shifted all to my upper belly. I need some strong suggestions for safe ab exercises. I would work with free weights, fitness ball and mat. Thanks for your help!!!!

  7. Hello Everyone: I just had the hysterectomy and prolapse repair (abdominal) which my surgeon advised has an approximate 87% success rate as opposed to the vaginal which had a 60% plus success rate. I was pleasantly surprised at my post op check-up to be referred to physical therapy to learn the proper core exercises also. All I have read states no Pilates, Yoga (two of my absolute favorites) or crunches; nothing where head or legs are off the floor putting pressure on the midsection! Bonita, so sorry to hear of your second surgery, good luck. Thanks for this website and all the valuable information. Allice

    • Hi Alice
      Thanks so much for taking the time to tell your story.
      Best of luck with your recovery and return to safe exercise.

  8. Hi Michelle,
    firstly I would like to thank you for the information on this website & in your book, it has really helped me following my abdominal hysterectomy in June. A friend pointed me in your direction & I was so grateful, a) to be able to have something positive to focus on & ‘do’ in the post op period and b) for alerting me to the danger of prolapse. Why don’t the doctors tell us this??
    I’ve been practising the exercises in your book & am gently progressing but as I approach my 12 week post op mark I am looking forward to starting yoga again. Your book is very informative on this subject but I do have one question, its only a small thing, but I am slighly paranoid about my pelvic floor now (! :D ) What is your opinion on sitting crossed legged (tailor pose)? My instinct says this wouldn’t be good for my pelvic floor, but pre-op I used to enjoy the stretch in this position, and so would value your opinion.
    Keep up the good work Michelle…I wish you were available on the UK NHS!!

    • Re Sitting cross legged and pelvic floor/hysterectomy recocvery

      Hi Sarah
      Thanks so much for your comments, I am glad to have helped and I really appreciate your kind feedback.

      Regarding sitting cross legged on the ground I don’t see that it could affect the pelvic floor, especially if you have not had a prolapse repair as well. Perhaps if you had prolapse repair/perineal work done there may be some stretching sensation. I am not aware of any research that has been done in this particular topic.
      When you are seated your pelvic floor is supported, however I would think that sitting cross legged and leaning forward as in some yoga style stretches, the pressure in the abdomen would increase, and be transferred directly to the pelvic floor ( a little like squeezing a tube of toothpaste in the middle). This is not to say that sitting cross legged creates a risk for the pelvic floor, I don’t think this can be said with certainty. I do suspect that legs wide open and leaning forward would increase pressure on the pelvic floor- to what extent I am not sure and I wish I could be clearer. Women with a pre-existing prolapse would I think readily detect a bulging sensation with this type of exercise. Is it dangerous to the pelvic floor? Who knows suffice to say that I would take care with leaning forward cross legged if I noticed it increased pelvic pressure and I had a pre-existing pelvic floor problem.
      Wish I could be more help with this question. Hope you have a great recovery Sarah

      • Thank you so much for your thoughts Michelle. I will proceed with caution … (I haven’t previously had a prolapse – just trying to prevent one happening!)

  9. Bonita-
    I’m right there with you. After I had my daughter I was doing crunches and all types of things that I now know are wrong. I feel like most medical practitioners don’t care about your long term health and just do what they need to do to get you out of their exam room or hospital bed.
    I found out that there are also pelvic rehab places that some hospitals have that can help further advise you on pelvic exercises so maybe you should try that before major surgery. I hate that you have to go through surgery again. :( That’s just awful.

    • Thanks Rhetta for the kind response. I did go to a different ob/gyn group and was told they can do the surgery vaginally as opposed to another abdominal- YEAH! It’s still surgery, but it will be NOTHING like what I went through before. The recovery was HORRIFIC.This new DR. told me she feels any excersise is fine, if you modify it- so I do crunches, but only lift my head until I feel a slight tension in my stomach. I aso do isometrics.
      Good luck with whatever you face.

  10. All this time I ‘ve been doing stomach crunches and other abdominal exercises- thinking I was helping my body. I had an abdominal hysterectomy eight years ago with removal of uterus, ovaries, ovarian cysts,fibroid tumors,repair of vaginal wall, bladder, rectum and rectal hernia.
    I now have ANOTHER bladdr prolapse and am facing major surgery AGAIN.
    I wish someone would have advised me a little better.

    • Pelvic Exercises says

      Dear Bonita I totally understand what you are saying. Unfortunately there is a lack of information for women regarding this huge issue of abdominal exercise and pelvic floor prolapse. Yes it is important for women to exercise and stay healthy and well. I think we need to be kind to our bodies and lay off the intense abdominal exercise, especially if we’ve had vaginal deliveries or if our pelvic floor is at risk such as with menopause, chronic straining and particularly after already having ahd pelvic floor surgery. Good luck with your surgery and with your future safe exercise. Regards Michelle

Pelvic Exercises Physiotherapy


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