Pelvic Floor Safe Core Exercises – Physio Safe Core Exercises Video

Pelvic floor safe exercises

Safe core exercises video for women teaches you how to correctly activate and exercise the deep core abdominal muscles with a series of pelvic floor safe abdominal exercises.

Presented by Pelvic Floor Physiotherapist Michelle Kenway, this free online abdominal core exercise video includes a series of floor-based abdominal core exercises designed to improve the strength, control and tone of the lower abdominal muscles (deep abdominal muscles) and avoid placing undue pressure on the pelvic floor.

Michelle is the author is Inside Out  the internationally acclaimed pelvic floor safe exercise guide for women.

Please scroll down to view ‘Safe Core Exercises’ video

Who will Benefit from Safe Core Exercises?

 Safe core exercises is a short instructional video designed for women with:

  • Weak pelvic floor muscles;
  • Weak lower abdominal muscles;
  • Pelvic prolapse;
  • Previous prolapse surgery;
  • Previous hysterectomy; and/or
  • Previous bladder surgery.

Safe Core Exercises Video Duration: 9 minutes

Safe Core Exercises Video

Safe Core Exercises video demonstrates and outlines:

  1. How to correctly activate and exercise lower deep abdominal muscles;
  2. Abdominal exercises to avoid with increased risk of pelvic floor dysfunction;
  3. A series of pelvic floor safe exercises for the deep abdominal muscles that place minimal pressure on the pelvic floor; and
  4. Expert tips for correct posture and performance of these exercises throughout.

Why are Safe Core Exercises Important?

Some intense abdominal exercises are unsafe for women with or at risk of pelvic floor problems. Intense core exercises include some abdominal core exercises in regular exercise classes including some intense Pilates and Yoga exercises. Intense core exercises place downward pressure on the pelvic floor causing the pelvic floor to become stretched, floppy and weak.

Unsafe abdominal exercises can increase the likelihood of to:

  • Vaginal and/or rectal prolapse;
  • Recurrent prolapse after previous prolapse surgery;
  • Prolapse after a hysterectomy:
  • Increased pelvic floor muscle tension, and;
  • Incontinence.

Always seek your doctor’s approval before commencing any new exercise program and immediately cease any exercises that cause you discomfort.

Note to ensure the smooth viewing of the video, it is recommended that you press on this play arrow and then when the video starts loading you press the ‘pause’ button until you can see that the entire video has loaded. This will help avoid the video stopping to load while you watch.   

Will Core Abdominal Exercises Flatten your Stomach?

No,  there is a myth that says to flatten the stomach intense abdominal exercises are required. It is just not possible to lose weight from the stomach by “spot reducing” with exercise. Gentle deep abdominal core exercises such as the ones shown in this video may help to flatten the appearance of the lower belly, however to flatten the abdomen weight loss is required from the whole body.

Inside Out Book & DVDABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support, along with Dr Judith Goh Urogynaecologist. The Inside Out exercise DVD and book show women how to strengthen the pelvic floor and exercise effectively with pelvic floor safe exercises.

We Welcome Your Comments



  1. Hello Michelle,
    My name is Paula. I had a total hysterectomy almost 4 weeks ago. The Dr.s were concerned that I had ovary cancer. Thankfully I did not. It was a sever case of endometriosis. Well here I am, I am very interested in getting back into my exercise routine. I am walking 3 miles every other day and I feel pretty good. I have only some tenderness, understandably, in the incision area. I am not sure if you heard of Piyo before. It is a beach body program that involves yoga and Pilates moves. I have had great progress in this program and wondered if you think I will ever get back into it again. I am feeling so lost.

    • Michelle Kenway Physiotherapist says

      Hi Paula
      Great that you’re feeling well and that your results were good. No I haven’t seen Piyo however it’s worth noting those aspects of Pilates & Yoga that you need to take care with especially the intense core abdominal exercises. You can read more on Pilates and Yoga here.
      All the best for your recovery!

  2. Hi Michelle-

    I am realizing I probably have a bladder prolapse…
    I am bummed b/c I am 3.5yrs since having just one child and had a c-section.
    I thought I could have by-passed all of this!
    Good news–no urinary incontinence (yet;).

    So my question…
    I started doing Pure Barre classes recently and I LOVE them.
    A really efficient work-out, but intense core work.
    Alot of tucking and squeezing, etc.
    Do I have to quit?
    I am praying you say no b/c I finally feel like I found a work-out that helps keep me thin and strong.

    • Michelle Kenway says

      Hi M

      Yes unfortunately c section doesn’t guarantee the pelvic floor against a prolapse, and yes good news about your continence.

      It’s great you have found a form of exercise that you really like and I think you have really answered the suitability of some of the Pure Barre exercises for prolapse yourself.

      Many different forms of women’s exercise include some exercises with potential to impact upon the pelvic floor in a negative way, it really comes down to how much you can modify the inappropriate exercises for more appropriate pelvic floor safe exercises and at the same time work on your pelvic floor strength and support to allow you to do more (plus don’t forget the support pessary option too).

      You are probably aware that intense core abdominal exercises do have the potential to overload the pelvic floor and so it just makes sense to avoid or modify these particular exercises if you do have a prolapse. I would suspect that this form of exercise also includes deep forward bend wide leg squat positions too which may increase prolapse symptoms.

      So ultimately see how you go in terms of modifying what you need to and getting your pelvic floor in best possible shape after your bub. It’s great you are exercising, just try to keep what you do safe to help you stay active long-term.

      Best wishes

  3. Mariellen says

    Thank you so much for this web page with the videos. I have ordered a book and a DVD. I have so much to learn and I am willing to do it. I am 66 and in USA.

  4. Hi Michelle,
    I recently had my first child 9 weeks ago and only this week noticed a bulge down below which the GP has confirmed is a prolapse (it was a very traumatic long birth). I have always done my pelvic floors religiously and correctly (this has been checked). I am yet to find out the extent or type of prolapse (likely however my bowel pushing) but have been doing some of your safe exercises and purchased your products in the meantime. My question is….is it normal for your prolapse to ‘come down more or bulge’ even after doing small amount of safe exercises???

    • Michelle Kenway says

      Hi Lys

      It is very early days after the birth of your baby and it will take quite some months to recover your former pelvic floor strength and control after the long traumatic childbirth you describe here. Also consider the effects of physical fatigue including tired core and pelvic floor muscles and breastfeeding which lowers oestrogen levels (so your pelvic floor won’t fully recover until you choose to finish).

      You may find that the prolapse is less symptomatic if you can do a small amount of exercise early in your day and spread your exercises out rather than all together. Also be mindful of correctly activating your pelvic floor and deep core abdominal muscles together when lifting and exercising. You may also choose to incorporate a set of pelvic floor exercises with each small bout of exercise you do.

      Finally has your obstetrician/gynaecologist mentioned the possibility of using a support pessary to help you manage? Pessaries can be an excellent adjunct to pelvic floor rehab. for new mums with prolapse after childbirth.

      I hope this helps you along Lys


  5. I just turned 60. I have been diagnosed with cystocele and have IBS with constipation, although I am controlling those symptoms reasonably well with fiber and probiotics. I know that a number of exercises would not be recommended with the cystocele. My husband has been looking at buying one of the newer ab roller devices that is spring loaded to help you on the return. Would this type of device be one that would present a problem with internal pressure?

    • Michelle Kenway says

      Hi Lee

      The fact that you have IBS, constipation (albeit controlled) and cystocele all mean that you are at increased risk of pelvic floor dysfunction with intense core abdominal exercises. These exercises are the ones that involve strong and or repeated contractions of the outer abdominal muscles in particular. The effect of these exercises is to place pressure on the pelvic floor (and prolapse). Resistance exercises for the abdominal muscles and roller devices usually involve intense core abdominal muscle contractions.

      For more information you may wish to read this information on unsafe abdominal exercises and prolapse.

      Hope this helps you out Lee

  6. I am really bummed that the stretch exercise DVD is not available for US customers. I hope you make a DVD friendly copy for US or make a Yoga video?
    I am also confused about pelvic tilt?? Some PT say tuck your butt which moves forward toward your knees, other say leave the curve which I guess means your booty is more like a shelf and curving naturally which usually tilts the pelvis back toward the backbone? So what exactly do you recommend the tuck butt or the curved butt?

    • Michelle Kenway says

      Hi Samantha

      Thanks for your comment – really helpful in terms of planning my projects for the New Year and a US compatable stretch/Yoga DVD is up there on the list. What would you ideally like to see in the DVD? Would you like it to be a workout you could stretch alon with?

      I understand your confusion with the pelvic tilt and yes I have seen the same inconsistency in terms of where to position the pelvis. Let me just clarify the pelvic tilt for other readers – when lying on your back usually with knees bent the pelvis is tilted by flattening out the curve in the lower back into the mat so that the natural space between the curve of the lower bak and the mat is decreased. On its’ own this is a very nice mobility exercise for the lower back especially for women that have a large lordosis or curve in the lower back. However for core abdominal training this technique should not be used. The reason is that there have been some terrific studies perfomed looking at the optimal position for core muscle activation (pelvic floor and deep abdominal). The investigations have revealed that the best positions for core abdominal and pelvic floor activation are neutral spine (normal inward curve) and also with the lower back in extension i.e. the lower back curve exaggerated. When women flexed their lumabr spines (or slumped their posture) core activation was reduced. I often teach this using the example of the pot belly you often see in elderly with slumped forwards posture – you can almost see how when the curve in the lower back is lost, the ability to contract the abdominal muscles is decreased – just try it yourself sitting and you see how your belly bulges when you slump.

      So to cut a long story short the best position for core deep abdominal and pelvic floor activation is with the neutral or normal inward curve. Hope this clears up this issue for you.

      • Michelle I would love a DVD I could pop into my player and do one or several exercise routines that stretch my body in place of Pilates or Yoga. I love Yoga, and a pelvic floor workout would be great. If you wanted to get fancy you could have choices of workout such as abdominal, pelvic floor and so on. I have ordered your present DVD so dont know yet what is on that one. I am not sure if you have any aerobic routines on DVD that would be a good workout but not damage pelvic floor. DVD are better than trying to watch on a small computer screen. Love your work, you are doing a great service for women world wide.

        • Michelle Kenway says

          Hi Samantha
          Thank you this is great information and I will put this into place for the next DVD. Especially like the idea of choice of workout too. I only make them in response to what readers ask for so this should happen next year. I will keep you posted and announce in a newsletter next year. Thanks so much for taking the time to input your feedback.
          All the best

          • 1. My massage therapist has to repeatedly adjust my piriformis and psoas muscles. I notice when they are acting up my slightly prolapsed bladder has the sensation of a ball in my VG, and I may have OB symptoms. Do these muscles effect or connect with pelvic floor to cause these symptoms? Which of your exercises would help strengthen these muscles?
            2. Another idea on that exercise DVD : When you demonstrate a exercise if could switch to short animation with muscles being moved in color to better visualize what movement is doing inside. Animation should be internal vaginal view top or bottom as applys. Those medical models are Greek to most of us and dont help us identify the muscle being moved as they are cross sections, top sectionsor attached to a skelton??? This way we could see the muscles we are trying to work move. Another problem with a lot of DVD is person doing exercises wearing loose, dark fitting clothing and working out on a dark surface which makes it very hard to see what is going on. Bright colors and contrast with floor. Cant wait to see what you come up with?

            • Michelle Kenway says

              Hi Samantha

              Are you able to relax your pelvic floor muscles completely? If the muscles around your abdomen/pelvis (piriformis/ilipsoas) are in spasm I wonder about what is happening with your pelvic floor muscles? Don’t forget that when the pelvic floor is too tight this also wesakens the pelvic floor worsening prolapse problems in which case the individual needs to learn how to relax the pelvic floor muscles as an integral part of training them for prolapse support.

              Great idea for animation – agreed some kind of ability for women to visualise what ids happening is a great idea. Looks as though I’m going to be busy!

              Stay in touch

  7. Adele White says

    Hi Michelle

    I had a radical hysterectomy through keyhole surgery on the 17th April 2013 due to having cervical cancer,which i got the all clear on my first check up in May :)
    Am now back to work 2 weeks tomorrow and to say its hard work is an understatement but am glad to get back to some kind of normality again. I was wondering if you could advise me on light exercises to do that will strengthen my abdominal muscles and my legs,they sometimes feel heavy & that’s maybe due to standing for periods of time. I go bike riding with my daughter but i know at the moment i couldn’t do it. I lost some weight in hospital & when i came home due to taking a urine infection & generally not feeling well,i had nerve damage to my bladder that my surgeon warned me about and its more common in ops for cancer (mine) i have put a little weight back on my i would love my thighs tone a little. I would be grateful for any info on my post.

    Thanks Adele.

    • Michelle Kenway says

      Hi Adele
      Thank you for your question. It sounds as though you’ve had a really touch time, and getting back into things slowly will be the key. If bike riding is too much, maybe you could consider stationary bike which can be very usefel for rehab. I am not sure where you live but water walking is also a lovely gentle way to start to return to exercise and strengthen leg muscles along with a progressive walking program. It can be very helpful to spread the exercise sessions out into a couple of short sessions daily when recovering such as two five minute sessions rather than one longer session. These times could be gradually progressed as endurance improves. I see that you have seen the gentle abdominal exerciseson this DVD and they are far more appropriate than sit up exercises which will place pressure on your pelvic floor. The other option is seated fitball exercises which are also gentle as shown on this post hysterectomy fitball exercise video.

      I hope this information helps you along a little Adele, let me know if you require any further information.
      Best wishes

  8. Hi Michelle I have your book and DVD now and I just wondered what ab exercises would you advise women to do when they are stronger? Or do you think that more advanced ab exercises are unecessary?Many thanks.

    • Michelle Kenway says

      Hi Carrie
      I think this comes down to the individual woman – her pelvic floor strength/support and with increased individual risks (e.g. previous prolapse surgery or overweight). So it isn’t possible to make a broad statement, and yes I am inclined to think that for women at high risk, I think the benefit outweighs the risk if this makes sense. I think that exercises like modified Plank (kneeling) without straining, wall push ups and progressions on some of the basic supine Pilates exercises (single leg raise/combine arm & leg movements) are suitable abdominal exercises for some women, but really this is very individual. Does this help?

      • Hi Michelle,

        Thanks for your reply. I see what you are saying. So what is the best way to know if someone is strong enough to do certain exercises? Are there signs or internal sensations? How do you know how strong an individuals pelvic floor is? I’m asking as an instructor as I want to educate myself and help women to experience safe classes but also want to train them to become stronger and fitter. Where would you say is a good place to start in terms of educating myself about this?

        There is so little information out there!

        I do so appreciate your advice!

        Many thanks,


        • Michelle Kenway says

          Hi Carrie

          The best way for you to know about your particpants is to screen them really well before they commence your classes. This screening tool will help you identify those at risk. If you have specific concerns about a particular participant, then you will know to explain the risks associated with intense core exercise, ensure that her exercise is pelvic floor safe and perhaps suggest that she sees a pelvic floor physiotherapist for formal assessment if you feel this is appropriate (not that you want to be sending all your partcipants off for pelvic floor assessment but if you learn that a woman is troubled by her pelvic floor, this may be an option). Many women don’t even realise that pelvic floor physiotherapy exists, and this way you can develop some links with pelvic floor physios – they will be happy to know you are screening and providing pelvic floor safe options. There is no way you can know externally other than using a real time ultrasound, the individual capacity of a participant’s pelvic floor.


  9. Wanting to prevent further uterine prolapse, I wonder if my Nordic Sport cross country ski machine would be ok as a good exercise. My family doctor recommended the machine or swimming before the prolapse developed to protect my lower back issues. Is it ok to use on a lower friction setting?

    • Michelle Kenway says

      Hi Dianne
      What is the name and make of your machine or is there an online video that I can see? Yes it is low impact which is good, I would just like to see the resistance, slope and upper body requirement. Can you send me these details?

      • Its a Nordic Sport 450 machine. It mimics cross country skiing.
        Running shoe tips wedged in toe straps of skis set on rollers on two tracks, legs moving forward/back alternating.
        Hands holding handles of a pulley rope. Arms alternate as well, forward and back, slightly behind the body.
        Both leg and arm tensions have graduated friction levels one can set.
        No slope.
        Upper body leans slightly forward resting on a cushioned bar for stability. Its like walking with adjustable resistance for arms and legs.

        • Michelle Kenway says

          Hi Dianne
          I like the fact that friction resistance can be kept low and that it is low impact so that would seem to fit the pelvic floor safe exercise profile. I would start small duration, progress gradually and also be guided by your symptoms too – if you notice any increase in symptoms during or after use then this is usually an indication of loading the pelvic floor and a sign to ease off. Finally don’t forget the importance of your pelvic exercises to keep your pelvic floor supportive for your chosen exercises. Hope this helps! Looks like a great cardio exercise Dianne

  10. Hello again Michelle. I have just watched the DVD! It’s great. I wondered whether to progress certain exercises such as heel slides/leg ext and bent knee fall outs would it be OK to introduce resistance in the form of dynabands as strength increases? For example light tension dynaband around knees for bent knee fall outs? OR light tension dynabands around arch of foot into hands for the geg extesions. What do you think?

    Many thanks for your advice!

    • Michelle Kenway says

      Hi Carrie
      I think your dynaband idea is excellent – I would just start with light resistance dynaband and progress gradually with increased strength and yes for both bent knee fall outs and leg extensions. I would do this when I was sure I had really good core abdominal control without using resistance. I think this idea could require an online video :)

      • Ah thanks so much Michelle.

        It’s a pleasure reading everything on your blogs! I have also ordered your book!

        Kind regards.

  11. I am so happy that I have found your website! I have not seen the doctor yet but I am pretty sure that I have prolapse. I have just started menopause and from all I have read I can see that these problems are unfortunately very common!! Aren;t we women so lucky !?! My question is : is it OK to do Zumba (rotating hips, some jumping etc) with a prolapse? I love it, but I don’t want to make my prolapse any worse! Thanks, Jenny

    • Michelle Kenway says

      Hi Jenny
      Low impact Zumba is a pelvic floor safe exercise so enjoy, try to avoid the high impact jumping and modify jumping during the class to low impact side stepping or mini squats.

  12. Hi Michelle,

    How do shoes with high heels (3,4 inches) and shoes on platform effect pelvic flor muscules?

    • Michelle Kenway says

      Hi Natalie
      This is a good question, yes I believe heels may indeed have a subtle effect on the pelvic floor – I think this is partly due to the increase in the low back curve. We know that when the low back is curved inwards the pelvic floor muscles can work most effectively so it may well be that platforms where the heels are higher than the balls of the feet may be pelvic floor friendly – wish I could be certain on this but that’s what the positioning of the spine in heels would suggest. Having said this, heels can also cause low back problems too, in which case the pelvic floor function would be decreased (pelvic floor muscles don’t work as well with low back pain).

      This is a complex question, I hope I have shed some light on the matter.

  13. Hi Michelle,

    I have an 8 month old baby delivered by Caesarian section.
    I was diagnosed with Diastasis recti (4 fingers wide) which is a huge concern and causing me grief.

    Soon after the birth of my baby, I consulted a local Physiotherapist and have been doing transverse abdominis muscle exercises to strengthen my weak core muscles and close the gap between rectis abdominis, but the condition has not improved and maybe worsened. The exercises are similar to your core strengthening exercises but I have been applying much stronger bracing/ contractions.

    As well, I have been strongly engaging my transverse muscle when lifting my baby or bending over, and I have been attending the Gym and doing strength exercises.

    After reading your core strengthening articles and online videos, I now wonder if I have a weak pelvic floor and possibly a vaginal prolapse, and if I have been exercising wrongly, eg. bracing my abdominals too strongly and placing too much pressure on my pelvic floor.

    I am aware that my baby is growing and gaining weight, and of course I must lift her and carry her.

    I am certain that my condition has not improved and possibly worsened.

    I would very much appreciate your urgent advice on my situation and in particular whether your (comparatively reduced bracing) core strengthening exercises will be effective to repair the Diastasis recti.

    • Michelle Kenway says

      Hi Anastasia

      Thanks for your question re rectus diastasis. There are a number of techniques that can be used to assist women manage this problem. These include:

        1. Bracing the abdominal area (abdominal tubigrip can be very helpful for women in providing abdominal support for looking after a baby, in addition to core exercises). There are some post natal support tights (very expensive) however the support briefs available that come up to under the bust can be provide excellent support too. Not to rely on these, but to use them when working, active and towards the end of the day when the body is fatigued can be helpful.
        2. Gentle abdominal core exercises including gentle lying down abdominal core exercises, seated ball core exercises and functional bracing of the abdominal muscles during every day activities
        4. Avoiding heavy lifting wherever possible
        5. Protecting the abdominal area for coughing/sneeezing by gently bracing the deep abdominal muscles and even manually splinting by holding the outer abdominal wall.

      Let me know if you require any further details, hope this helps a little. Very important that abdominal exercises are gentle in this situation and to avoid overbracing which can make the problem worse.


  14. hi, i gave birth 8 months ago.
    i have prolapse which strongly interfers while having intercourse, its quiet painful and takes the pleasure away for both me and husband as i always have to direct him and tell him when its ‘safe’ to go deeper in.(i find doing it slowly helps)
    as i’ve been reading on ur site, i should be doing pelvic floor exercise; meaning the exercise where u pull up those muscles and hold repeating 8-10 times or is it the heel exercise etc? sorry just not clear about it. also its my first child, does that mean im in for worse as i get older??:(
    thank you,

    • Michelle Kenway says

      Hi Emma
      It is great that you are doing your pelvic floor exercises, the research tells us that these exercises can help to reduce prolapse symptoms and lift the pelvic floor higher within the pelvis. It is not yet known how prolapse progresses in women – prolapse may progress rapidly, not at all, while others do their exercises and find that their prolapse symptoms actually improve.

      It is worth mentioning that after childbirth the pelvic floor will be weak, and that symptoms often improve for women as their pelvic floor recovers however the physical work of a new bub, and the fatigue don’t help the situation either.

      It may be interesting for you to know that some women find that intercourse more comfortable when lying on their side facing away from their partner. This can help them control the depth of penetration and reducing discomfortand this article on prolapse and sex may give a little more information too.

      I hope this information helps you, sorry I can’t be more exact on the rate of prolapse progression – studies are needed in this area.

  15. hi ya
    i had tvt surgery on the 19 oct, i am only 37 and dont know where to start on my rehab. I have been told not to do anything for two weeks and then start to do small walks. It doesn’t seeem to matter who i ask but no-one seems to know what to do, i got up to a decent standard of fitness and notice that the problem just seemed to be getting worse.After watching your video i now know i was doing the wrong exercises and was making the problem worse.Any tips on how to get going again would be gratefully recieved.



    • Michelle Kenway says

      Hi Kristie

      Yes it is tough knowing where to start, and how to avoid too much pressure on your pelvic floor. I think with TVT it is still very important to keep the impact and intensity of your exercises low with pelvic floor safe exercise. You want your tissues to grow through your tape and hold well. This should be promoted with walking exercises as instructed in the initial stages. These walking guidelines were written for walking after hysterectomy but the same general principles apply to protect your pelvic floor as you recover.

      In very simple terms keep to low impact exercises (one foot on the ground at all times), avoid intense strength training and read these safe strength training protection principles, and definitely avoid intense core abdominal exercises.

      I hope this gives you some idea of where to move with your own rehabilitation. Oh and don’t forget your pelvic floor exercises after surgery to make sure that your pelvic floor is functioning really well to support your return to exercise.

      Best of luck Kristie


    Hi Michelle,


    I have been diagnosed with a vaginal prolapse. I love yoga but am aware there are probably certain positions I should avoid. Could you please let me know which these are? I have been told that my prolapse isn't too bad currently, does this make any difference to what I can and cant do?





    • Yoga and vaginal prolapse

      Hi Megan,

      Yes, you are correct! Some yoga postures can increase pressure on the pelvic floor.

      When you state that your prolapse isn’t too bad, this doesn’t necessary reflect the condition of you pelvic floor muscles. What matters is the function and condition of your pelvic floor muscles in determining which yoga exercises are suitable and which yoga exercises are not. If your pelvic floor muscles are particularly weak then there will be more that you are unable to do and will have to modify compared with if your pelvic floor muscles are stronger and functioning quite reasonably then they should theoretically be able to hold better against certain exercises.

      Particular exercises/postures to be mindful of include:

      • Wide leg stands;
      • Deep squat positions;
      • Intense core exercise positions with plank and hover positions and;
      • Deep wide leg forward bends.

      Hope this helps Megan, Michelle.

  17. I have lower back problems and prolapse issues. Have read info on this site with great interest. Have ordered your book. I live in uk and have to wait for it to arrive from USA! am doing a daily pilates programme for backs. Have already cut out curl ups but doing a simple version with soles of feet together and upper body not lifting as much. Should I cut out this too. My tabletop is 4 point kneeling, sliding opposite arm and leg,. Is that ok? Also I am doing daily stretches from osteopath which involve (a) bending forward from crossed legged (b) bending forward one leg straight other bent with sole of foot against knee (c) gluteal stretch both legs raised with one leg bent at knee and other foot resting on bent knee. Also in pilates prog. The rest position bottom resting on heels back curved forward arms outstretched. This is always after certain exercises. Help do I need to cut out these. I do these every day

  18. Dear Michelle
    Thankyou for the confirmation ! It is very appreciated !
    Yourself and my physio have really helped me get a clear picture now of how it all works, and to KEEP going :)….thanks again for the expertise and effort that is given in responding to my queries; very helpful!
    Kind Regards

    Thankyou so much for this very helpful and informative site. I have purchased the "Inside Out e Book after discovering that I have a small prolapse problem…probably from exercising the WRONG way many years ago!
    I have been trying really hard to ensure when I carry out the pelvic floor strengthening exercises that I don't use my abdominals as my physio told me I have to learn to relax them first before I can strengthen the rest.
    I felt I was actually getting somewhere and can now definitely feel when I engage pelvic floor- either standing or sitting, but I am paranoid I am still using the wrong abdominals….sometimes I am ready to give up but just need to know-when engaging pelvic floor and identifying pelvic floor-that's a good start? even if (maybe) using abdominal still?
     Thankyou so much for your reply.

    • Pelvic floor/ Kegel exercises and abdominal muscles

      Hi Anne

      When it comes to exercising your pelvic floor muscles using the correct technique it can be really difficult to avoid over activating the abdominal muscles as well, however try not to be overly anxious about this.

      When the pelvic floor muscles contract there is also abdominal muscle contraction at the same time, this is normal. This is because some of the abdominal muscles work with the pelvic floor muscles. What needs to be avoided is over activating the abdominal muscles and it sounds as though your physiotherapist has picked up your tendency to over engage your abdominal muscles. This is a common pattern in women, especially in women who move with their tummy constantly pulled in and in women who have performed a lot of upper abdominal exercise in the past.

      To avoid overactivating the abdominal muscles it can be helpful to breathe in deeply using diaphragmatic breathing standing or sitting tall to relax the abdominal muscles before starting pelvic floor or kegel exercise. You will notice that the abdominals are forced to relax when doing this. Then try to activate just pelvic floor muscles and focus on the pelvic floor.

      In summary pelvic floor /kegel exercises do involve some abdominal muscle activation so this is normal. What is not helpful is to strongly draw in the abdominal muscles while doing pelvic exercises (or to walk around with the abdominal muscles constantly braced).

      It sounds as though you are well on your way; keep up your good work Anne!

  20. Hi Michelle,
    I am 43 and have recently (9 weeks ago) had a hysterectomy, posterior repair and bladder lift.  I would like to return to some of my previous sporting activites, running, downhill skiing, yoga and soccer.  I would like to know your advice regarding the timeline, physical requirements (ie level of abdominal/pelvic muscle control etc), and anything I should avoid (ie moguls on the ski hill etc).
    Thanks for your insight!
    PS I really appreciate your website and all the information you provide. 

  21. Hi Michelle,
    I am 42 and have had pelvic floor weakness for the last 8 years. I have worked with physios like yourself you specialise in pelvic strengthening and so have followed the exercises on and off for quite some time, especially following the births of my children. At one point I did my exercises religiously twice a day for over a year and while matters improved, my pelvic floor never fully recovered which I what I had hoped would happen, but clearly this isn’t going to be the case. This year I took up pole dancing which I found helped strengthen my pelvic floor, however from reading Inside Out I gather that it may actually weaken my pelvic floor as it does require strong engagement of your abdominals. What would you recommend? Is pole dancing likely to be too strenuous in the long term on my pelvic floor?

    • Pole dancing and pelvic floor problems

      Hi Amy

      This is a very interesting question, thank you for asking about pole dancing and the pelvic floor. I suspect this may depend on the type of pole dancing performed and your level of expertise, so it is difficult to generalise. The impact on your pelvic floor also depends on your pelvic floor capacity to withstand the associated pressure of these pole dancing exercises, and from what you say you are not entirely confident in your pelvic floor strength.

      I agree with you that pole dancing does involve some intense core abdominal exercise. I suspect that the movement of swinging both legs simultaneously legs up the pole to be above the body that is one movement requires intense core abdominal effort. I would expect that maintaining the hold during body position changes also requires a good degree of upper abdominal effort and control however I cannot say how much, you will be the better judge having not tried this exercise myself. The movement of swinging both legs up the pole simultaneously will increase abdominal pressure and be transmitted to the pelvic floor. The extent of impact is a little unclear because some of the exercises involve you hanging upside down. If you consider some of these movements to be a little like an incline sit up exercise which will increase pressure on the pelvic floor, then yes I would suggest there is potential there for some increased pressure.

      Can your pelvic floor handle this pressure? I am sorry I can’t answer this as it depends on the specific functional ability of your pelvic floor which is unknown to me. So other than what I have written here, I am unable to make a specific recommendation other than to provide you with my impression of these exercises.

      Amy have you noticed any particular pole dancing moves that specifically involve a lot of your upper abdominal muscles? Do you think you could modify them? I will be interested to hear.


  22. Hi Michelle, I was recently diagnosed with pelvic floor weakness and a mild cystocele and urethrocele. Surprisingly, I have been doing step aerobics 2 / wk and weekly pilates and yoga classes for the last 4 years – thought I had become really fit till noticed this small lump ! Am I safe to join a cycling class and swim as the gynaecologist told me to avoid even things like body combat/ aerobics etc. Like some of the others, I may avoid pilates and yoga altogether. Have found your videos v useful and plan to buy the book.


    • Hi Charu
      Yes I am sorry to hear your story. I think cycling is a fantastic exercise for lower body strength, cardiovascular fitness and weight management.To minimise pressure on the pelvic floor it is advisable to keep the gears low and to avoid heavy gears and standing out of the seat (this is in the climbing tracks). Otherwise enjoy with confidence. Swimming and water walking are also lovely low impact exerises and pelvic floor friendly. I think fins increase the pressure on the pelvic floor somewhat however I may stand corrected on this, once again minimal research into this area to really be certain. Aqua fitness classes require some caution with the upper abdominal exercises included (e.g. lying back cycle legs, bunny hops bringing knees to chest).
      I think it is important to remember how important exercise is for women and how it is very possible to exercise safely and effectively despite pelvic floor dysfunction including pelvic prolapse.
      Best of luck

      • Thanks v much Michelle. I will buy your book and the pilates with fitball DVD.

        If I leave out certain exercises on the DVD as advised, the instructions say the others are safe to continue – am I right ?



        • Hi Charu
          I think there is a great lack of understanding regarding safe and unsafe exercises for the pelvic floor i.e. those that will be more likely to place pressure on the pelvic floor and those that won’t. I think it is difficult to say to avoid one specific type of exercise class in favour of others as the most gentle-seeming class may have pelvic floor unsafe exercises whereas a more intense strength training class may be entirely pelvic floor safe. It comes down to understanding those exercises and techniques that are more likely to increase pressure on the pelvic floor and those that are not, in addition to ensuring that your pelvic floor can withstand the pressure associated with the exercises you choose. This is how Inside Out came about – to educate women to make informed decisions about their exercise programs and selecting pelvic floor safe exercises. Follow the directions of your specialist and make informed decisions about the exercises you choose based on the reading in Inside Out which along with the many articles and videos on this site is designed to educate your understanding of this issue. I hope this assists you Charu.
          Best wishes

  23. Hi Michelle,
    I am thinking of buying the fitball and pilates dvd. The three exercises I have just watched on the utube clip – are they featured in the dvd?
    The leg slide exercise, I find, is best done with a towel or blanket on the exercise/yoga mat, for effective slidability.
    I have been using that exercise for myself to particularly strengthen the psoas muscles.
    You are suggesting that the exercises will beneficially affect other core muscles. I have my wife in mind when I say this. She is approaching menopause, and has over many years been limited in her exercise regime, due to mild incontinence when running or performing other high impact exercises. We have both recently started a regular pilates class, so I am following your published information with great interest.

    • Core exercises and pelvic floor problems

      Hi Kevin

      I think there is a lot of misunderstanding about Pilates and the pelvic floor. The major misunderstanding being that Pilates will fix pelvic floor problems such as incontinence and help with prolapse.

      A balanced Pilates program addresses the whole trunk cylinder of support (core muscles including abdominal, spinal and pelvic floor muscles). One big problem is that often the program is not balanced for women with pelvic floor weakness and so the over emphasis on intense abdominal muscle training actually becomes detrimental for the pelvic floor muscles as they are unable to withstand the associated pressure.

      Another issue I see is that there is often some kind of myth that Pilates will fix pelvic floor problems, and this becomes misconstrued to abdominal exercise fixing pelvic floor problems. The fact is that many women’s pelvic floor conditions worsen with Pilates that is not matched to a woman’s pelvic floor status. Pelvic floor problems need to be addressed with dedicated pelvic floor muscle rehabilitation and appropriate abdominal rehab. Sometimes this involves actually teaching women to stop bracing their abdominals constantly or too strongly.

      A good Pilates program would be based on an understanding of a woman’s existing pelvic floor function and be matched to the capacity of her pelvic floor muscles in relation to her overall core muscle activity.

      So you can see that if a woman has pre-existing pelvic floor problems, it is wise to choose Pilates exercises with caution and modify the intense abdominal core exercises where appropriate. This recent article on Pilates exercises and pelvic floor problems may also assist you and your wife in exercise selection.

      Thanks so much for contributing to this discussion Kevin.

  24. I had a hysterectomy and exetnsive prolapse repair in January of this year and have found your vedeo to be very helpful. I am planning to order your book. There does not seem to be much information out there on what you can and cannot do safely after this type of surgery. Are you planning to put any of your videos on DVD so they may be purchased? My computer takes literally hours to download a video, and I would like something I can play and work out with on my DVD player. I have other work out DVD’s but am concerened they will do more harm than good now. Thank you.

  25. I began horseback riding in 2006. Within a year, I had to give it up due to incontinence which I thought, and was told by my doctor, was caused by my prolapse. I had a hysterectomy six months later in 2007 correcting uterine prolapse, cystocele, and a rectocele. Because I did not want to cause damage to my pelvic reconstruction I stopped riding to give my body time to heal.
    In 2010 I again started riding but seven months into my riding the incontinence returned full force and I had to stop again. Quitting did not stop the incontinence but with riding it’s very pronounced, embarrassing, and uncomfortable, making it very difficult to concentrate on form while wetting myself.
    In February of this year, 2011, I had a TOT or mini sling placed. I have healed well and have only had two tiny leaks so far after the surgery during sneezing episodes. My doctor says I am clear to go back to riding but I am terrified that I may re-injure myself and end up worse than before.
    I am purchasing your book so that I may learn how to avoid exercising improperly, especially weight training. Should I wait until I have developed very strong legs before attempting to go back to riding? I pray that I do not have to give up riding forever. Can you offer any advice concerning riding?

    • Hi Donna
      The question of horse riding is a tricky issue. I think it comes down to how much impact is associated with the activity when it comes to determining how pelvic-floor-friendly it is. Just in the way that walking places less impact on the pelvic floor compared with running, I think the speed of the riding will influence the impact on your pelvic floor.
      Having only ridden a horse a few times myself, I recall that a slow trot had more impact on the body that a faster ride, would you agree? You are also probably most aware from when you had previous symptoms as to the speed of riding that caused your symptoms to be most pronounced. I would also guess that riding downhill would increase impact? Does using your feet in the stirrups help to reduce impact when trotting? I am just asking questions to make you think about factors that can create impact.
      I would think that you should be able to modify your horse riding to keep it low impact, especially if you are concerned about the impact on your pelvic floor. So just as we modify exercise to be more appropriate for the pelvic floor, modify your riding by choosing the most appropriate speed ,slope and riding technique if appropriate.

      Good luck Donna, hoping this helps you to continue with your passion.

  26. Hi Michelle,

    I recently ordered your book ‘Inside Out’, and have found it extremely useful. There is so little information out there for people like myself who have had a hysterectomy and bladder prolapse repair. I have found you are very much left on your own after the operation, in fact my local surgery has never been in contact and my consultant only whilst I was in hospital.

    A few questions which I would be very grateful if you could answer@

    1. Is is OK to sit cross-legged as I would do for yoga? I am nearly 8 weeks post op.

    2. For 10 years or so, I have done yoga once a week. After reading your book suggesting the postions one should not do, is there any point doing yoga at all. One doesn’t want to be singled out in a class and I have found actually that yoga teachers are not aware how some positions are really bad for prolapses.

    3. I have read that it is not a good idea to lift anything heavier than 20 lbs ever again. I am so worried that my bladder will prolapse again, but this means you would be so restricted i.e. when you are travelling with cases, or when you have children to lift.

    Kind regards,


    • Pelvic Exercises says

      Hi Joanna
      Thanks for your great questions. Here we go…
      1. Sitting cross-legged will perhaps depend a little on the type of surgery a woman has and whether she has had any complications post op. For most women this should not be an issue providing it is pain free but once again only your specialist knows what our surgery involved so a good idea to check if you are unsure. Always be guided by what your body ells you post op. and stop any exercise or position that causes discomfort.
      2. Yes I agree there is a tremendous lack of knowledge regarding pelvic floor safety and protection in general exercise classes. You should be free to avoid those exercises you choose to in any exercise class if this means protecting your pelvic floor from injury. I personally think Yoga is a wonderful form of exercise for a woman. I think if you remain aware of those core exercises to avoid with both legs raised and or head raised, plus deep wide squats and prolonged wide leg stances with bend forwards plus the others I mention in Inside Out I think you can protect yourself. Remember the idea is for you to be able to enjoy and feel confident with the exercises you choose and continue to exercise…that’s why I wrote the book.
      3. Yes as far as lifting goes it is very difficult to gauge and the level of restriction seems to vary from one specialist to the next. I think some women would strain to lift 20 lbs and others wouldn’t eg athlete compared with little old lady so I cannot see how a global restriction of the same weight suits every woman. Having said this you need to abide by the rules of your specialist who knows your surgery, and I would add to this two things…a. never strain to lift and b. keep your body strong and fit, the stronger and fitter you are the less strain on your pelvic floor as your oher muscles can support the load. Thanks so much for contributing your questions Joanna, best wishes Michelle

      • I have a follow-up question regarding the yoga poses you mentioned avoiding. I had a hysterectomy and rather extensive reconstructive surgery (bladder and bowel lift, A&P repair) nearly two months ago. What I understand you to say in this response is that someone in my condition should avoid those yoga poses (wide-leg forward folds, deep squats, legs and head raised while laying on back) for the rest of our life. Is this true? Or, would you say it is advisable to avoid these during the recovery period, and one can return to performing these movements once our strength is regained. Like the woman who had the original questions, I have practiced yoga for a long time, and I would very much miss wide leg forward folds, deep squats, etc. if I would not be able to do them for the rest of my life, without jeopardizing all the work my surgeon and I did to repair the prolapse I experienced. Thank you in advance for your clarification on this matter.

        • Hi Kate

          Re: Yoga after prolapse surgery

          Regarding your great questions about yoga exercise long term following AP repair…It really comes down to the capacity of your pelvic floor to withstand increased pressure with specific yoga exercises. This really needs to be determined by a pelvic floor physiotherapist who is working with you. What is important to recognise is that these types of exercise will increase pressure on your pelvic floor (and your prolapse repair) and that the risk of repeat prolapse is increased following prolapse repair.. I understand the feeling of disappointment at not being able to do some specific exercises long-term. I also think that you can modify specific yoga exercises or avoid them altogether whilst still enjoying participation and the benefits of yoga exercise. I am sorry I can’t be more specific with respect to your situation as this is the role of a treating physiotherapist who understands your pelvic floor capacity. I do hope this helps a little, regards Michelle

    • margaret hallie says

      I am wondering how to work my flabby lower abs. I had a rectal prolapse and hysterectomy 1 yr ago. My doctor says I have no restrictions. I am working on losing the extra pounds I have put on. I am currently strength training 3x a week and cardio 3-5x a week. I try to do interval training 3x a week 4 minutes moderate
      1 minute all out effect for 30 minutes. Any advice would be appreciated.

      • Michelle Kenway says

        Hi Margaret
        It sounds as though you are doing really well with the quantity of exercise you are currently achieving. First of all your whole body strength exercises such as lunge will use and exercise your abs, and sufficient moderate intensity cardio work will help you decrease abdominal fat.

        If you want to be more specific in your abdominal exercise, this video is a good place to start with the gentle Pilates-style core abdominal shown. There are many variations on these exercises that can be performed by combining arm overhead raises with the leg movements focusing on stable neutral spine and deep abdominal muscle control. It is difficult for me to suggest more intense options as I am not familiar with the capacity of your pelvic floor muscles to cope with abdominal exercises. Some women do choose to perform modified kneeling Plank holds.

        My personal preference for ladies after previous prolapse surgery is for seated exercise ball work – doing upper body weights seated on the ball with feet close together exercises the lower abdominal muscles, plus they types of seated core abdominal exercises shown in this video hysterectomy recovery abdominal exercise video (these exercises are sutable post prolapse surgery too).

        I hope this gives you some ideas Marg, keep up your great work!
        Best wishes