Pelvic Floor Exercises: Strengthen Your Core for Better Bladder Control

What Are Pelvic Floor Exercises and Why Do They Matter?

Pelvic floor exercises, commonly called Kegel exercises, involve repeatedly contracting and relaxing the muscles that form the floor of your pelvis. These muscles support your bladder, bowel, and uterus, and help control urination, bowel movements, and sexual function. Regular training can prevent and treat incontinence, improve sexual health, and support recovery after childbirth or pelvic surgery.

The pelvic floor is a complex network of muscles and connective tissue that spans the bottom of your pelvis like a hammock. These muscles have several critical functions: they support the pelvic organs (bladder, bowel, and uterus), help control the release of urine and feces, and play an important role in sexual function. When these muscles become weak or dysfunctional, problems such as urinary leakage, fecal incontinence, pelvic organ prolapse, and sexual difficulties can occur.

Pelvic floor muscle training (PFMT), also known as Kegel exercises after Dr. Arnold Kegel who popularized them in the 1940s, involves voluntarily contracting and relaxing these muscles to improve their strength, endurance, and coordination. Unlike other muscles that you can see working, the pelvic floor is internal, which makes learning the correct technique particularly important. Many people initially struggle to identify and isolate these muscles, but with practice and proper guidance, most can master the technique.

Research consistently shows that pelvic floor exercises are one of the most effective conservative treatments for urinary incontinence, with Cochrane systematic reviews demonstrating significant benefits. The International Continence Society (ICS) and International Urogynecological Association (IUGA) both recommend pelvic floor muscle training as a first-line treatment for stress urinary incontinence and as part of comprehensive treatment for other pelvic floor disorders.

Who Benefits from Pelvic Floor Exercises?

While pelvic floor exercises are often associated with women who have recently given birth, the benefits extend far beyond this group. Anyone can benefit from having a well-functioning pelvic floor, and training can be particularly valuable in several situations.

People who are pregnant or have given birth often experience weakened pelvic floor muscles due to the weight of pregnancy and the stretching that occurs during vaginal delivery. Starting exercises during pregnancy can make postpartum recovery easier, as you'll already have developed the mind-muscle connection needed for effective training. After delivery, gentle exercises can promote healing by increasing blood flow to the area.

Those planning or recovering from pelvic surgery, including prostate surgery in men, hysterectomy, prolapse repair, or incontinence surgery, benefit significantly from pelvic floor training before and after the procedure. Pre-operative training helps you develop the technique while recovery allows you to rebuild strength gradually.

People with chronic coughs, such as those with chronic obstructive pulmonary disease (COPD), experience repeated increases in intra-abdominal pressure that strain the pelvic floor. Strong pelvic floor muscles can help counteract this pressure and prevent stress incontinence.

When Should I Start Pelvic Floor Training?

You can begin pelvic floor training at any time, as everyone benefits from good pelvic floor control. It's especially important to start before known stressors like pregnancy, childbirth, or pelvic surgery. After childbirth, gentle exercises can often begin within 24-48 hours unless you have significant pain. The goal is to develop muscles strong enough that they activate automatically when needed.

Everyone benefits from being able to control their pelvic floor muscles, and this ability can be developed and improved through training. A well-functioning pelvic floor means being able to both tense the muscles when you need to stay continent and relax them fully when emptying your bladder or bowels. This dual capability of contraction and relaxation is equally important, and exercises should address both aspects.

If you know your pelvic floor will face significant stress, such as during pregnancy, childbirth, or surgery, preparing in advance is highly beneficial. Training the muscles beforehand makes post-event recovery much easier because you'll already know how to activate them correctly. Many people find that after surgery or childbirth, the sensations in the pelvic region feel different, making it harder to locate the right muscles if they haven't practiced beforehand.

Training Before and After Specific Events

For those planning a pregnancy or already pregnant, beginning pelvic floor exercises early provides the foundation for maintaining continence during pregnancy when the growing uterus places increasing pressure on the bladder, and speeds recovery after delivery. During pregnancy, the hormones that soften ligaments in preparation for birth also affect the pelvic floor, potentially leading to stress incontinence even before delivery.

Before and after prolapse repair surgery, pelvic floor training helps optimize surgical outcomes and maintain results long-term. Similarly, men undergoing prostate surgery often experience temporary or permanent urinary incontinence, and pre-operative pelvic floor training has been shown to improve post-operative continence rates and speed recovery.

For those with chronic respiratory conditions causing frequent coughing, each cough creates a sudden increase in pressure against the pelvic floor. Without adequate muscle strength to counteract this force, stress incontinence can develop. Regular training builds the strength needed to maintain continence during coughing episodes.

The Goal: Automatic Function in Daily Life

The ultimate aim of pelvic floor training is to develop muscles that function automatically without conscious effort during daily activities. When you cough, sneeze, lift something heavy, or jump, your pelvic floor should reflexively contract to maintain continence. This automatic response develops over time with consistent training.

Initially, you may need to consciously contract your pelvic floor before activities that could cause leakage. However, with regular practice over months, the muscles become strong enough and responsive enough to activate on their own when needed. This transition from conscious effort to automatic function represents true rehabilitation of the pelvic floor.

What Are the Benefits of Pelvic Floor Exercises?

Pelvic floor exercises can treat and prevent urinary incontinence, improve fecal incontinence, reduce mild pelvic organ prolapse symptoms, enhance sexual function for all genders, speed postpartum recovery, and improve quality of life. Research shows these exercises are effective first-line treatment for stress incontinence, with success rates comparable to surgical interventions in many cases.

The benefits of regular pelvic floor training extend across multiple aspects of health and daily function. Understanding these benefits can help motivate consistent practice and set realistic expectations for what the exercises can achieve.

Treating and Preventing Incontinence

Urinary incontinence affects millions of people worldwide and significantly impacts quality of life. Stress urinary incontinence, where leakage occurs during activities that increase abdominal pressure such as coughing, sneezing, laughing, or exercising, responds particularly well to pelvic floor training. By strengthening the muscles that close off the urethra, exercises help prevent involuntary leakage during these moments.

Urge incontinence, characterized by a sudden, intense need to urinate followed by involuntary loss of urine, can also improve with pelvic floor training. The exercises help strengthen the muscles' ability to suppress bladder contractions and buy time to reach a toilet. Many people experience mixed incontinence with both stress and urge components, and training benefits both types.

Fecal incontinence, while less commonly discussed, is another condition that responds to pelvic floor training. The muscles around the anus are part of the pelvic floor complex, and strengthening them improves the ability to control gas and bowel movements.

Addressing Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic organs (bladder, uterus, or rectum) descend from their normal position due to weakened support structures. Mild prolapse can often be managed conservatively with pelvic floor exercises, which strengthen the muscular support for these organs. While severe prolapse may require surgical intervention, regular training can slow progression and improve symptoms in less advanced cases.

Improving Sexual Health

The pelvic floor muscles play a significant role in sexual function for all genders. For women, these muscles contribute to vaginal sensation and the ability to achieve orgasm. Strengthening them can increase pleasurable sensations during intercourse and make orgasms easier to achieve. For men, strong pelvic floor muscles support erectile function and can help with premature ejaculation.

Many people experience pain during sex due to pelvic floor muscle tension or dysfunction. Learning to properly relax these muscles, which is an essential component of pelvic floor training, can significantly reduce or eliminate this pain. A muscle that functions well must be able to both contract when needed and relax completely between contractions.

How Do I Find the Right Position to Start Training?

Begin in a comfortable lying or sitting position where you can easily feel the difference between contracted and relaxed muscles. Lying on your back with knees bent, lying on your side with a pillow between your knees, or sitting leaning slightly forward are good starting positions. Once you've mastered the technique, progress to standing exercises for functional training.

Finding a comfortable position is the first step to successful pelvic floor training. When you're relaxed and comfortable, it's much easier to sense the subtle movements of contraction and relaxation in the pelvic floor muscles. Different positions work better for different people, so experiment to find what allows you to feel the exercise most clearly.

Lying Down Positions

Lying on your back with knees bent and feet flat on the floor is a classic starting position. You can place a pillow under your knees for additional support and comfort. This position takes gravity out of the equation, making it easier to focus on the muscular sensations without having to support the weight of pelvic organs.

Lying on your side with a pillow between your knees is another excellent option, particularly during pregnancy when lying flat on your back may be uncomfortable. The side-lying position is also helpful if you have back problems that make other positions difficult.

Sitting Position

Sitting on a chair with your upper body leaning slightly forward can make it easier to find the contraction in the front part of the pelvic floor, around the urethra. This position is practical because it can easily be incorporated into daily activities like sitting at a desk or watching television.

All-Fours Position

For those who have difficulty locating the muscles or feel heaviness in the pelvic region, positioning yourself on all fours with forearms resting on the floor can be very helpful. In this position, gravity helps the pelvic organs move slightly away from the pelvic floor, making the muscles easier to isolate and contract. Many physical therapists recommend this position for beginners who struggle with other positions.

Progressing to Standing

Once you've found your muscles and developed good technique in easier positions, it's important to progress to standing exercises. The goal of pelvic floor training is to improve function during daily life, which mostly occurs while standing and moving. Training in different positions, including standing, ensures the muscles are strong enough to work effectively in real-world situations.

How Do I Do Pelvic Floor Exercises Correctly?

To perform pelvic floor exercises correctly: relax your abdomen, back, buttocks, and legs; breathe normally throughout; contract the muscles around your anus as if preventing gas, then extend the contraction forward to include the urethra and vagina; hold briefly while maintaining normal breathing; then relax completely. The sensation should be of closing and lifting the openings inward and upward.

Correct technique is crucial for effective pelvic floor training. Many people initially use the wrong muscles or use correct muscles incorrectly, which can actually worsen problems or create new ones. Taking time to learn proper technique, ideally with guidance from a healthcare provider, sets the foundation for successful training.

Step-by-Step Instructions for Finding the Muscles

1. Choose your position: Lie on your back or side with bent knees, sit on a chair leaning forward, or position yourself on all fours with forearms on the floor.
2. Relax surrounding muscles: Consciously relax your back, abdomen, buttocks, and legs. Place a hand on your stomach to ensure it stays relaxed throughout the exercise.
3. Breathe normally: Continue breathing naturally throughout the entire exercise. Holding your breath is a common mistake that increases abdominal pressure.
4. Contract around the anus: Squeeze the muscles around your anus as if preventing gas from escaping. Hold this contraction.
5. Extend forward: While maintaining the back contraction, try to extend the squeeze forward to include the area around the urethra and vagina (if applicable). The sensation should be of closing all the openings.
6. Lift inward and upward: As you become stronger, you should feel not just a closing sensation but also a lift, as if drawing the pelvic floor up and in.
7. Hold briefly: Maintain the contraction for a few seconds.
8. Relax completely: Release the contraction and rest for at least as long as you held the squeeze. Notice the difference between the tensed and relaxed states.
9. Repeat: Perform 10 repetitions, then rest. Complete 3 sets throughout the day.

The Importance of Complete Relaxation

While much emphasis is placed on the contraction phase, the relaxation phase is equally important. For muscles to function optimally, they must be able to both contract strongly and relax completely. If you maintain partial tension between contractions, the muscles don't get adequate rest and you won't achieve maximum training benefit.

Complete relaxation is also essential for proper bladder and bowel emptying. When urinating or having a bowel movement, the pelvic floor must relax fully to allow complete emptying. If the muscles remain partially tense, you may not empty completely, which can contribute to urinary tract infections and other problems.

What If I Experience Pain?

While pelvic floor exercises generally improve circulation and promote healing, they should not cause pain. If you experience pain in the pelvic region or pain when contracting the muscles, do not continue with contraction exercises. Pain may indicate that you need to focus on relaxation exercises instead, or that there's an underlying issue requiring medical evaluation.

After childbirth or pelvic surgery, follow your healthcare provider's specific guidance about when to begin exercises and how to progress. Gentle circulation-promoting contractions can often begin early, but more intense training should wait until healing has progressed sufficiently.

How Do I Know If I'm Doing the Exercises Correctly?

You can verify correct technique by feeling for muscle movement with your fingers (around the anus or inside the vagina), watching for slight movement of the penis and scrotum in men, or using biofeedback devices. You should be able to breathe normally during the contraction, and your abdomen, buttocks, and thighs should remain relaxed. Never practice by stopping urine mid-stream.

Because the pelvic floor muscles are internal and cannot be seen working like arm or leg muscles, many people wonder whether they're doing the exercises correctly. Fortunately, there are several ways to verify your technique.

Self-Assessment Techniques

One simple method is to place your fingertips against your anus (you can do this over underwear) and contract your pelvic floor. You should feel the muscle draw inward and tighten around the opening. If you have a vagina, you can also insert one or two fingers a few centimeters into the vagina and contract. You should feel pressure against the sides of your fingers, or a forward and inward movement.

For those with a penis, you may observe slight movement of the penis and scrotum when contracting correctly. The base of the penis should draw slightly inward and the scrotum may lift slightly.

What You Should NOT Do

A common recommendation that is actually incorrect is to practice stopping your urine mid-stream. While this can help you identify the correct muscles once or twice, you should never regularly exercise while urinating. When you urinate, the pelvic floor should be relaxed to allow complete bladder emptying. Regularly interrupting the flow can lead to incomplete emptying and increase the risk of urinary tract infections.

Signs of Incorrect Technique

Several signs indicate you may be using incorrect technique. If you find yourself holding your breath during the contraction, you're likely using too much effort and possibly recruiting abdominal muscles. If your buttocks lift off the surface you're lying or sitting on, you're using your gluteal muscles instead of (or in addition to) your pelvic floor. Visible abdominal movement or bearing down suggests you may be increasing pressure on the pelvic floor rather than contracting it.

How Do I Train for Strength?

Strength training involves contracting your pelvic floor as hard as possible, lifting upward and inward, and holding for 5-6 seconds before relaxing completely for an equal duration. Aim for 10 repetitions, 1-3 times daily initially, then 3-4 times weekly once strong. Maximum effort in each contraction is what builds strength.

Strong pelvic floor muscles are essential for maintaining continence during activities that increase abdominal pressure. When you cough, sneeze, lift something heavy, or run, the pressure in your abdomen increases and pushes down on the pelvic floor. Your muscles must be strong enough to resist this pressure and keep the urethra and anus closed.

Strength Training Protocol

1. Choose your training position and ensure surrounding muscles are relaxed.
2. Breathe normally throughout the exercise.
3. Contract your pelvic floor as hard as possible around the anus, vagina (if applicable), and urethra.
4. Lift upward and inward as high as you can without recruiting other muscles.
5. Hold the contraction with maximum effort for 5-6 seconds. If you cannot hold this long, start with shorter durations and gradually increase.
6. Relax completely for at least as long as you held the contraction.
7. Repeat up to 10 times, aiming for maximum effort each time.

The key to building strength is maximum effort. Just as you wouldn't expect to build arm strength by lifting very light weights, you won't build pelvic floor strength without contracting as hard as possible. However, maintain proper technique even when working hard, particularly ensuring you don't recruit abdominal, buttock, or thigh muscles.

Begin with 1-3 sets per day. As you become stronger and more confident in your technique, you can reduce frequency to 3-4 times per week, but at each session, work your muscles to fatigue.

How Do I Train for Speed?

Speed training involves rapid, strong contractions held for 2 seconds followed by 2 seconds of relaxation, repeated 10 times. This trains your muscles to respond quickly to sudden events like sneezing or making an unexpected movement. Practice 1-3 times daily initially, then 3-4 times weekly once proficient.

Sometimes your pelvic floor needs to respond instantly to unexpected events. A sudden sneeze, an unexpected cough, or a quick movement can all put immediate pressure on your pelvic floor. To stay continent during these moments, your muscles must be able to contract rapidly.

Speed Training Protocol

1. Position yourself and relax surrounding muscles.
2. Breathe normally throughout.
3. Contract your pelvic floor as quickly and strongly as possible.
4. Hold the contraction for approximately 2 seconds.
5. Relax completely for 2 seconds.
6. Repeat 10 times in rapid succession.

Speed training complements strength training by developing the neuromuscular coordination needed for quick responses. While strength training builds raw muscle power, speed training improves how quickly your brain can signal the muscles to contract and how fast the muscles can respond.

How Do I Train for Endurance?

Endurance training involves holding a moderate-intensity contraction for as long as possible, with the goal of reaching one minute. This trains your muscles to provide sustained support throughout the day and when you need to hold on to reach a toilet. Perform this long hold at the end of each training session.

Your pelvic floor muscles work continuously throughout the day to support your pelvic organs and maintain baseline continence. They must also be able to sustain a contraction when you need to delay urination, such as when you feel the urge but cannot immediately reach a toilet. Endurance training develops this sustained function.

Endurance Training Protocol

1. Complete your strength and speed exercises first.
2. Position yourself and relax surrounding muscles.
3. Contract your pelvic floor at moderate intensity (not maximum effort).
4. Hold the contraction for as long as possible, working toward a goal of one minute.
5. If you lose the contraction, try to re-engage the muscles and continue.
6. Relax completely for at least as long as you held the contraction.

Endurance contractions are performed at moderate rather than maximum intensity because sustaining a maximum contraction is not physiologically possible for extended periods. The moderate effort allows you to maintain the contraction long enough to build stamina in the muscle fibers responsible for sustained activity.

How Do I Train for Real-Life Situations?

Functional training means practicing pelvic floor contractions during the movements that cause you problems, such as standing up, walking, lifting, or jumping. Contract your pelvic floor before starting the movement, perform the movement, then relax. This trains your muscles to activate automatically when needed in daily life.

The ultimate goal of pelvic floor training is not just to be able to contract the muscles while lying still, but to have them function effectively during real-world activities. Functional training bridges this gap by practicing contractions during movements that challenge your pelvic floor.

How to Train Functionally

First, identify which activities cause you the most difficulty or leakage. Common challenging activities include standing up from sitting, walking, lifting objects from the floor, going up stairs, running, and jumping.

Once you've identified your challenging activities, practice incorporating pelvic floor contractions into these movements:

1. Contract your pelvic floor before beginning the movement.
2. Maintain the contraction while performing the movement (standing up, taking a few steps, lifting, etc.).
3. Relax your pelvic floor once the movement is complete.
4. Repeat the exercise several times.

With consistent practice, the pattern of contracting before and during challenging movements becomes automatic. Your brain learns to anticipate when pelvic floor support is needed and activates the muscles without conscious effort.

How Long Does It Take to See Results?

Expect to notice initial improvement after approximately 2 months of consistent training. Full training effect may take up to 6 months. Once you've achieved good strength, reduce to maintenance training 1-3 times per week to preserve your gains. Many people who stop training completely notice their symptoms return.

Patience is essential when embarking on pelvic floor training. Unlike some exercises where results are visible quickly, pelvic floor improvements develop gradually over weeks and months. Understanding this timeline helps set realistic expectations and maintain motivation.

During the first few weeks, you're primarily developing mind-muscle connection and technique rather than building significant strength. You may notice that finding and contracting the muscles becomes easier, even if your symptoms haven't improved yet. This neurological adaptation is an important foundation for the muscle building that follows.

Around the two-month mark, many people begin noticing symptomatic improvement. Leakage episodes may become less frequent or severe, urgency may be easier to control, and overall pelvic floor function may feel improved. These early benefits provide positive reinforcement to continue training.

Full training effect typically requires up to six months of consistent practice. The pelvic floor muscles, like all muscles, require time to adapt to training stimulus, increase in strength, and develop the endurance needed for all-day function.

Maintenance Training

Once you've achieved satisfactory strength and symptom control, you can reduce training frequency while maintaining your gains. Most people find that training 1-3 times per week is sufficient for maintenance. However, the specific frequency needed varies by individual; some people can maintain function with less frequent training while others need more.

It's important to note that many people who stop training completely experience return of their symptoms. The pelvic floor muscles, like all muscles, will gradually lose strength if not regularly challenged. Viewing pelvic floor exercises as a long-term lifestyle practice rather than a temporary treatment helps maintain benefits over time.

What Training Aids and Reminders Can Help?

Smartphone app reminders, visual cues like notes on mirrors, vaginal weights or cones, and electrical stimulation devices can all support pelvic floor training. Biofeedback devices provide real-time feedback on contraction quality. Consult a healthcare provider before using any device to ensure proper technique and appropriateness for your situation.

Consistency is the greatest challenge in pelvic floor training. Because the exercises can be done anywhere without special equipment, there's no external reminder to practice. Several tools and strategies can help maintain regular training.

Reminders and Habit Building

Setting daily reminders on your smartphone is one of the most effective ways to remember training. You might set three alarms at times that fit your routine, such as morning, midday, and evening. Another approach is to link exercises to existing habits, such as doing a set while waiting for your morning coffee to brew or while brushing your teeth.

Visual cues can also serve as reminders. A small note on your bathroom mirror, computer monitor, or refrigerator can prompt you to do a quick set of exercises whenever you see it.

Training Devices

Various devices can assist with pelvic floor training, particularly for those who have difficulty locating the correct muscles or want additional feedback on their technique.

Vaginal weights or cones are inserted into the vagina while standing. The weight naturally wants to fall out, requiring you to actively contract your pelvic floor to keep it in place. Some come in graduated sets, allowing you to progress to heavier weights as you get stronger.

Biofeedback devices use sensors to detect pelvic floor contractions and display real-time feedback on a screen or smartphone app. This visual feedback helps ensure you're contracting the right muscles and can track progress over time.

Electrical stimulation devices use mild electrical currents delivered through a vaginal or rectal probe to stimulate pelvic floor muscle contractions. These can be helpful for people who have difficulty voluntarily contracting their muscles, as the stimulation causes the muscles to contract without conscious effort, helping build the mind-muscle connection.

What Else Can I Do to Support My Pelvic Floor?

Beyond exercises, you can protect your pelvic floor by maintaining a healthy weight, avoiding or treating chronic constipation, managing persistent coughs, not smoking, and using vaginal estrogen if recommended for menopausal vaginal dryness. Avoiding unnecessary straining during bowel movements and staying physically active also support pelvic floor health.

While pelvic floor exercises are central to improving muscle function, other lifestyle factors can either support or undermine your efforts. Addressing these factors creates an environment where your training is most effective.

Maintain a Healthy Weight

Excess body weight increases the pressure on your pelvic floor throughout the day. Every extra pound of abdominal weight pushes down on the pelvic organs and stresses the supportive muscles. Weight loss, when appropriate, can significantly reduce pelvic floor strain and improve symptoms of incontinence and prolapse.

Prevent and Treat Constipation

Chronic constipation leads to repeated straining during bowel movements, which puts significant stress on the pelvic floor. Over time, this straining can weaken the muscles and contribute to prolapse. Maintaining soft, easy-to-pass stools through adequate fiber intake, hydration, and regular physical activity protects the pelvic floor from this strain.

Manage Chronic Coughs

Each cough creates a sudden surge of abdominal pressure that the pelvic floor must resist. Chronic respiratory conditions, smoking-related coughs, or untreated allergies can subject the pelvic floor to thousands of these pressure surges daily. Treating the underlying cause of a chronic cough reduces this repeated stress.

Don't Smoke

Smoking damages tissue throughout the body, including the connective tissue that supports pelvic organs. Smokers also tend to cough more frequently. Quitting smoking benefits pelvic floor health along with countless other aspects of health.

Consider Vaginal Estrogen

After menopause, declining estrogen levels cause vaginal and urethral tissues to become thinner and drier. This can contribute to incontinence symptoms. Topical vaginal estrogen, available by prescription, can help restore tissue health and improve symptoms. Discuss with your healthcare provider whether this option is appropriate for you.

When Should I See a Healthcare Provider?

Seek help if you need guidance with pelvic floor exercises, if your symptoms haven't improved adequately after consistent training, if you're avoiding activities or relationships due to pelvic floor problems, or if you experience significant changes in bladder or bowel function. A physiotherapist, urologist, or urogynecologist can provide specialized assessment and treatment.

While pelvic floor exercises are an effective self-treatment for many people, there are situations where professional guidance is valuable or necessary.

If you're having difficulty identifying the correct muscles or aren't sure whether you're using proper technique, a pelvic floor physiotherapist can provide hands-on assessment and instruction. They may use biofeedback to show you exactly which muscles are contracting and how strongly.

If you've been consistently training according to recommendations but haven't seen adequate improvement after several months, it's worth seeking evaluation. Your symptoms may require additional treatment beyond exercises, such as medication, pessaries, or surgery, or there may be an underlying condition that needs to be addressed.

If pelvic floor problems are significantly affecting your quality of life, causing you to avoid exercise, social activities, or intimate relationships, don't hesitate to seek help. These problems are extremely common and treatable, and healthcare providers who specialize in pelvic health deal with them daily without judgment.