During the third trimester of pregnancy, pelvic floor exercises should focus on both strengthening and relaxing the muscles that support your bladder, uterus, and rectum to prepare your body for labour and delivery. Key exercises include diaphragmatic breathing, Kegels, pelvic tilts, supported deep squats, and adductor stretches. A quasi-randomised controlled trial published in Midwifery found that women who performed pelvic floor muscle training (PFMT) combined with perineal massage had a 31.63% reduction in episiotomy rates and were nearly three times more likely to deliver with an intact perineum compared to women who received standard care alone.

This blog covers the specific exercises recommended for the third trimester, how often to do them, when to start perineal massage, what the research says about pelvic floor therapy and labour outcomes, and how to tell if your pelvic floor needs professional attention. Whether this is your first pregnancy or your third, these exercises apply at every stage of the third trimester.

Should You Do Pelvic Floor Exercises in the Third Trimester?

Yes, you should do pelvic floor exercises in the third trimester. Pelvic floor exercises in the third trimester serve a dual purpose: they maintain the strength your pelvic floor needs to support your growing baby, and they train the muscles to lengthen and relax for labour and delivery.

The pelvic floor is a group of muscles that stretches like a hammock from the pubic bone at the front to the tailbone at the back. These muscles support the bladder, uterus, and rectum, and they control the openings for urination, bowel movements, and the vagina. During the third trimester, the weight of the growing baby places increasing downward pressure on the pelvic floor. This pressure, combined with the hormonal softening of connective tissues caused by relaxin, can weaken the pelvic floor and contribute to urinary incontinence, pelvic heaviness, and lower back pain. Research estimates that approximately 1 in 3 women experience some degree of urinary incontinence during pregnancy.

The shift in focus during the third trimester is important. In the first and second trimesters, pelvic floor exercises emphasise building strength and endurance. In the third trimester, the emphasis shifts to include lengthening and relaxation, because the pelvic floor muscles must stretch two to three times beyond their normal resting length to allow the baby to pass through during delivery. A pelvic floor that is strong but unable to relax can resist the baby’s descent and increase the risk of tearing. Pediatric and pregnancy chiropractic care supports this process by maintaining pelvic alignment and reducing the muscular tension that can restrict the pelvic floor’s ability to lengthen.

How Can I Strengthen My Pelvic Floor While Pregnant?

You can strengthen your pelvic floor while pregnant by performing targeted exercises that build muscular control, endurance, and the ability to both contract and release the pelvic floor on demand. The following exercises are safe and effective for the third trimester when performed correctly and without pain.

• Diaphragmatic (360-degree) breathing: Sit or lie comfortably on your side. Inhale deeply through your nose, expanding your rib cage and belly so your pelvic floor naturally lengthens and relaxes downward. Exhale slowly through your mouth, allowing the pelvic floor to gently lift. Perform 10 breathing cycles. Diaphragmatic breathing coordinates the pelvic floor with the diaphragm, which is essential for effective pushing during labour.
• Kegels (pelvic floor contractions): Squeeze and lift your pelvic floor muscles as if trying to stop the flow of urine. Hold for up to 10 seconds, then fully release. Perform 3 sets of 10 repetitions per day. Include both long slow holds (endurance) and short quick squeezes (fast-twitch fibre activation). Always release fully between contractions, because the release is as important as the squeeze in third-trimester training.
• Pelvic tilts: Stand with your back against a wall or get on your hands and knees. Gently flatten your lower back by tightening your abdominal muscles, hold for 4 seconds, and release. Pelvic tilts strengthen the deep core muscles that work alongside the pelvic floor and can relieve lower back pain during the third trimester.
• Supported deep squats: Hold onto a sturdy chair, wall, or countertop and lower into a comfortable squat. Keep your feet wider than hip-width apart and your heels on the floor. Practice deep belly breathing in this position to stretch and open the pelvic floor. Hold for up to 60 seconds. Deep squats during pregnancy open and relax the hips and pelvis, which helps prepare the body for the pushing stage of labour.
• Adductor rockbacks: Start on your hands and knees with one leg extended out to the side. Slowly rock your hips back toward your heel to stretch your inner thigh. Perform 8 repetitions on each side. Adductor rockbacks release tension in the inner thigh muscles that connect to the pelvic floor and contribute to pelvic tightness during the third trimester.

A systematic review and meta-analysis published in the Tzu Chi Medical Journal found that women who performed PFMT daily during their third trimester experienced a significant reduction in the incidence of perineal tears, with particularly strong results for grade 3 and grade 4 tears. Exercise rehabilitation programmes can be customised by a physiotherapist to match your trimester, fitness level, and any pregnancy-related complications.

Can I Do Squats in My Third Trimester?

Yes, you can do squats in your third trimester as long as you feel comfortable, use support for balance, and avoid straining. Supported deep squats are one of the most beneficial exercises for the third trimester because they open the pelvis, stretch the pelvic floor, and strengthen the gluteal and thigh muscles that support labour positions.

Use a wall, sturdy chair, or countertop for balance. Keep your feet wider than your hips with toes turned slightly outward. Lower into the squat only as far as feels comfortable, and breathe deeply into your belly and pelvic floor while holding the position. Do not push through pain, pressure in the pelvis, or dizziness. Squats should feel like a stretch, not a strain. Boston Medical Center recommends holding each deep squat for up to one minute while practicing deep belly breathing.

Avoid heavy weighted squats, barbell back squats, or any squat variation that involves holding your breath or bearing down forcefully. The goal in the third trimester is to open and relax the pelvis, not to build maximum strength. If you were squatting with weight before pregnancy, your physiotherapist can help you modify the load and depth to keep the exercise safe and productive during the final weeks.

How Often Should I Do Pelvic Floor Exercises in the Third Trimester?

You should do pelvic floor exercises daily during the third trimester, aiming for 3 sets of 10 Kegel contractions per day plus 5 to 10 minutes of breathing, stretching, and relaxation exercises. Daily practice builds the neuromuscular control and tissue flexibility that the pelvic floor needs for labour, and the effects are cumulative over the weeks leading up to delivery.

The World Health Organization recommends that pregnant women without medical contraindications engage in at least 150 minutes of moderate physical activity per week. Pelvic floor exercises count toward this total and can be incorporated into your daily routine without requiring a gym or special equipment. Kegels can be performed sitting at your desk, standing in line, or lying on your side before bed. Stretching and breathing exercises take 5 to 10 minutes and can be done at any time of day.

Consistency matters more than intensity. A short daily practice produces better results than a long session performed once or twice a week. The pelvic floor responds to regular, repeated training the same way any other muscle group does: through progressive adaptation over time. If you miss a day, resume the next day without trying to “make up” missed sessions.

What Is the Best Position for Pelvic Floor Exercises While Pregnant?

The best positions for pelvic floor exercises during the third trimester are side-lying, hands-and-knees, seated upright, and supported standing. Avoid lying flat on your back for extended periods during the third trimester, because the weight of the baby can compress the inferior vena cava (the large vein that returns blood to the heart), which may reduce blood flow and cause dizziness or light-headedness.

Side-lying is the most comfortable position for Kegels and breathing exercises in the third trimester. Place a pillow between your knees and under your belly for support. The hands-and-knees position works well for pelvic tilts, adductor rockbacks, and cat-cow stretches because it takes the weight of the baby off the pelvic floor and spine. Seated upright on a firm chair or exercise ball is effective for Kegels and breathing because the upright posture engages the core muscles that coordinate with the pelvic floor. Massage therapy can complement pelvic floor exercises by releasing tension in the lower back, hips, and gluteal muscles that restrict pelvic floor mobility during the third trimester.

When Should I Start Perineal Massage?

You should start perineal massage at 34 to 36 weeks of pregnancy. Research published in the British Medical Journal found that perineal massage performed in the weeks leading up to delivery reduces the risk of perineal tearing and episiotomy, particularly in first-time mothers.

Perineal massage prepares the perineal tissue (the area between the vagina and the rectum) to stretch during delivery. The technique involves using one or both thumbs to apply gentle, sustained pressure at the opening of the vagina, pressing downward toward the tailbone and holding for 10 seconds or longer, then moving in a U-shaped motion along the lower vaginal wall. Perform the massage for 5 to 10 minutes, daily or several times per week. Use a natural lubricant like olive oil or coconut oil to reduce friction.

The quasi-randomised controlled trial published in Midwifery found that women who combined pelvic floor exercises with perineal massage experienced significantly lower rates of episiotomy and severe perineal trauma compared to women who received standard care only. Third-degree tears occurred in 5.18% of the intervention group versus 13.12% of the control group, and fourth-degree tears occurred in 0.52% versus 2.5%. These results demonstrate that the combination of PFMT and perineal massage produces measurable protection for the perineum during vaginal delivery.

Can Pelvic Floor Exercises Help With Labour?

Yes, pelvic floor exercises help with labour by training the muscles to contract, relax, and lengthen on demand, which is exactly what the pelvic floor must do during the pushing stage of delivery. The pelvic floor’s primary job during labour is to relax and move out of the way to allow the baby to descend through the birth canal. A pelvic floor that has been trained to both contract and release responds more effectively to the demands of labour than one that has only been strengthened without relaxation training.

Outcome	PFMT + Perineal Massage Group	Standard Care Group
Episiotomy rate	50.56%	82.19%
Intact perineum	17.61%	6.85%
Third-degree tears	5.18%	13.12%
Fourth-degree tears	0.52%	2.5%

Source: Leon-Larios et al., Midwifery (quasi-randomised controlled trial, primiparous women)

Diaphragmatic breathing is the exercise most directly connected to effective pushing. The diaphragm and the pelvic floor move in coordination: when you inhale, the diaphragm descends and the pelvic floor lengthens; when you exhale, the diaphragm rises and the pelvic floor lifts. Practising this coordination during pregnancy trains your body to use breath to guide the pelvic floor during labour rather than relying on forceful bearing down, which can increase the risk of tearing and pelvic floor injury. A pelvic floor physiotherapist can assess your ability to contract and release your pelvic floor muscles and provide specific guidance on breathing and pushing techniques for your delivery.

How Do I Know If I Have a Weak Pelvic Floor While Pregnant?

You may have a weak pelvic floor during pregnancy if you experience urinary leakage when you cough, sneeze, laugh, or exercise, a feeling of heaviness or pressure in the pelvis, difficulty holding urine until you reach the bathroom, pain during intercourse, or lower back pain that does not respond to position changes. Approximately 1 in 3 women experience urinary incontinence during pregnancy, and pelvic floor weakness is the most common underlying cause.

Pelvic floor weakness during pregnancy results from the combined effects of the baby’s increasing weight pressing downward on the muscles, the hormone relaxin softening the connective tissue that supports the pelvic organs, and the postural changes that shift the centre of gravity forward and alter how the pelvic floor absorbs load. These factors are normal and expected, but they make pelvic floor exercise even more important during the third trimester.

If you are unsure whether you are performing Kegels correctly, or if you experience any of the symptoms listed above, a pelvic floor physiotherapy assessment can determine whether your muscles are weak, tight, or a combination of both. Many women assume their pelvic floor is weak when it is actually too tight, which requires a different treatment approach focused on relaxation rather than strengthening. Pelvic floor therapy at our Markham clinic is delivered one-on-one by a registered physiotherapist in a private treatment room.

Is It Too Late to Start Pelvic Floor Exercises in the Third Trimester?

No, it is not too late to start pelvic floor exercises in the third trimester. Starting pelvic floor exercises at any point during pregnancy provides benefits, and research shows that even programmes begun in the third trimester can reduce the incidence of perineal tearing during delivery.

The meta-analysis published in the Tzu Chi Medical Journal confirmed that daily PFMT performed during the third trimester effectively reduced perineal tear incidence, with significant results for grade 3 and 4 tears. While starting earlier in pregnancy allows more time for the muscles to adapt, the pelvic floor responds to training within weeks, and the third trimester provides enough time to build meaningful improvement before delivery. Perineal massage, which is recommended from 34 to 36 weeks, also contributes to perineal protection even when started late.

The key is to start now and be consistent. A few weeks of daily practice produces measurable changes in pelvic floor control, tissue flexibility, and coordination with breathing. Acupuncture can complement pelvic floor preparation by reducing lower back pain, pelvic discomfort, and muscular tension during the final weeks of pregnancy.

How to Tell If You Are Overdoing It While Pregnant?

You are overdoing it during pregnancy exercise if you feel pain in the pelvis, lower back, or abdomen, experience dizziness or shortness of breath, notice vaginal bleeding or fluid leakage, feel contractions that do not stop when you rest, or cannot hold a conversation during the activity. These are signs that the intensity, duration, or type of exercise needs to be reduced, and you should stop the activity immediately and contact your health care provider.

Pelvic floor exercises should never cause pain, pressure, or a bearing-down sensation. If you feel heaviness in your pelvis during or after Kegels, you may be pushing down instead of lifting up, or the muscles may be fatigued and need rest. Reduce the number of repetitions and focus on quality over quantity. Avoid holding your breath during any exercise, because breath-holding increases intra-abdominal pressure, which pushes down on the pelvic floor and counteracts the benefit of the exercise.

Do not start new high-intensity exercises you were not doing before pregnancy. The third trimester is not the time to begin running, heavy weightlifting, or high-impact aerobics. Maintain your current routine with modifications as needed, and prioritise movements that prepare your body for labour: breathing, stretching, squatting, and pelvic floor coordination. Chiropractic care during the third trimester helps maintain spinal and pelvic alignment, which reduces the compensatory strain that overworked muscles place on the pelvic floor.

Frequently Asked Questions

Can You Carry a Baby With a Weak Pelvic Floor?

Yes, you can carry a baby with a weak pelvic floor, but a weak pelvic floor may cause symptoms like urinary incontinence, pelvic pressure, and lower back pain that make pregnancy less comfortable. Pelvic floor weakness does not prevent you from carrying a pregnancy to term. Strengthening exercises during pregnancy can improve symptoms and prepare the muscles for delivery. If you suspect your pelvic floor is weak, a physiotherapy assessment can confirm the diagnosis and provide a personalised exercise programme.

What Not to Ignore in the Third Trimester?

You should not ignore sudden or severe pelvic pain, persistent headaches, vision changes, significant swelling in the face or hands, vaginal bleeding, fluid leakage, reduced fetal movement, or contractions that come at regular intervals before 37 weeks. These symptoms may indicate complications like pre-eclampsia, preterm labour, or placental issues and require immediate medical evaluation. Mild discomfort, occasional Braxton Hicks contractions, and increased pelvic pressure are normal in the third trimester, but any symptom that feels different from your usual experience should be discussed with your health care provider.

Can Weak Pelvic Floor Cause Miscarriage?

No, a weak pelvic floor does not cause miscarriage. Miscarriage is caused by chromosomal abnormalities, hormonal issues, structural problems in the uterus, or other medical conditions unrelated to pelvic floor strength. Pelvic floor weakness can contribute to symptoms like incontinence and pelvic discomfort during pregnancy, but it does not affect the viability of the pregnancy itself.

How Many Steps Should a Pregnant Woman Walk a Day in the Third Trimester?

Most pregnant women in the third trimester benefit from walking 3,000 to 5,000 steps per day, or approximately 20 to 30 minutes of walking. Walking is a low-impact activity that improves circulation, reduces swelling, supports cardiovascular health, and helps maintain muscle tone without placing excessive stress on the pelvic floor. Adjust your pace and distance based on how you feel, and stop if you experience pain, dizziness, or shortness of breath.

Do Pelvic Floor Exercises Help With Postpartum Recovery?

Yes, pelvic floor exercises performed during pregnancy help with postpartum recovery by building the muscular control and tissue resilience that the pelvic floor needs to heal after delivery. Women who perform PFMT during pregnancy tend to experience fewer postpartum incontinence symptoms, faster return of pelvic floor function, and reduced risk of pelvic organ prolapse. Postpartum pelvic floor physiotherapy can help rebuild strength and address any issues that develop during delivery.

Wrapping It Up

Pelvic floor exercises during the third trimester prepare your body for labour by building muscular control, tissue flexibility, and the coordination between your breath and your pelvic floor that effective pushing requires. The research is clear: women who combine daily PFMT with perineal massage from 34 to 36 weeks experience significantly lower rates of episiotomy and severe perineal tearing compared to women who receive standard care alone. Start with Kegels, diaphragmatic breathing, pelvic tilts, supported deep squats, and adductor stretches, and practise daily for the best results.

At KC Rehab, our registered physiotherapists deliver pelvic floor therapy one-on-one in a private treatment room, assessing your pelvic floor strength, coordination, and readiness for labour. If you have questions about your pelvic floor or want guidance on exercises specific to your stage of pregnancy, call us at 905-205-1668 to book your initial assessment.