Pelvic Floor Exercises: How to Strengthen Your Pelvic Floor

When Should You Train Your Pelvic Floor?

Everyone can benefit from pelvic floor control, which is a skill that can be trained. Pelvic floor exercises are especially important if you're pregnant or have given birth, experience prolapse symptoms, have urinary or fecal incontinence, or are preparing for pelvic surgery. The exercises are beneficial regardless of age or gender.

Everyone has the ability to control their pelvic floor muscles, and this is a skill that can be developed and strengthened over time. It's equally important to be able to both contract and relax these muscles. Contracting the pelvic floor helps you maintain continence, while relaxing helps you completely empty your bladder and bowels.

The pelvic floor muscles form the base of your pelvis, supporting your bladder, bowel, and uterus. These muscles control the openings for your urethra, rectum, and vagina. When functioning properly, they automatically tighten when you cough, sneeze, lift, or exercise, and relax when you need to empty your bladder or bowels.

Pelvic floor training is particularly beneficial in specific situations. If you're pregnant or have recently given birth, the muscles may have been stretched and weakened. The same applies before and after various surgeries in the pelvic area, including prostate surgery, hysterectomy, prolapse repair, or incontinence surgery. Training before these procedures makes recovery faster and more effective.

Training to Reduce Incontinence and Prolapse

Pelvic floor training strengthens the muscles and can prevent or reduce problems with urinary or fecal leakage. The training targets the muscles that support your internal organs and control the openings in your pelvic floor. When these muscles are strong and function well, they can better withstand the increased pressure that occurs during physical activity.

Many people experience improvement in mild prolapse symptoms with regular pelvic floor exercises. Prolapse occurs when the vaginal walls or uterus descend due to weakened support. While severe prolapse may require additional treatment, mild cases often respond well to muscle strengthening alone. The key is consistent training over several months to rebuild muscle strength and function.

Important for Those with Chronic Cough

If you have COPD or chronic cough, pelvic floor training is especially important. When you cough, pressure increases downward toward the pelvic floor. You need strong muscles that can counteract this pressure and close off the urethra and rectum. This is how you can prevent or reduce leakage problems when coughing.

The repeated stress of chronic coughing can gradually weaken the pelvic floor over time. By proactively training these muscles, you can maintain their strength and prevent incontinence from developing. This is particularly important because treatment becomes more difficult once significant weakness has occurred.

Using Muscles in Daily Life

The goal of training is for your pelvic floor to be strong enough and function well enough that you can be active in your daily life without problems. You may need to actively contract (squeeze) in certain situations if you have problems with leakage. But with regular training, the muscles can eventually start to tighten automatically when needed.

This automatic response is the ultimate goal of pelvic floor training. When your muscles are well-conditioned, they respond reflexively to increased abdominal pressure, protecting you from leakage without conscious effort. This allows you to exercise, play with children, and engage in all activities without worry or restriction.

Positive Effects on Sexual Function

The pelvic floor muscles play an important role during sexual activity. Pelvic floor training can therefore relieve certain sexual problems. Many people who experience pain during intercourse can benefit from learning to relax their pelvic floor. A well-functioning muscle should be able to contract when needed and relax in between.

Many people find that their sex life improves with pelvic floor training. For example, it may become easier to achieve orgasm or maintain an erection. The improved blood flow from regular exercise and the enhanced muscle tone both contribute to better sexual function. Additionally, the increased body awareness that comes from pelvic floor training can lead to more satisfying intimate experiences.

What Are the Best Positions for Pelvic Floor Exercises?

Start by finding a comfortable position lying down or sitting, as this makes it easier to feel the difference between contracting and relaxing. Try lying on your back with knees bent, lying on your side with a pillow between knees, sitting leaning forward, or kneeling on all fours. Once you've mastered the technique, progress to standing exercises.

Beginning in a comfortable, supported position is crucial for learning proper technique. When you're relaxed and stable, you can focus entirely on feeling the pelvic floor muscles without distraction from maintaining balance or position. This focused attention helps you identify the correct muscles and develop the mind-muscle connection essential for effective training.

Each person may find different positions more effective for feeling the pelvic floor contraction. The key is to experiment and find what works best for you. Some positions make it easier to feel the muscles around the front of the pelvic floor (near the urethra), while others help you connect with the muscles around the back (near the rectum).

Lying on Your Back

Lie on your back with a pillow supporting your knees. This position allows complete relaxation of your trunk and legs, making it easier to isolate the pelvic floor muscles. The support under your knees also reduces any strain on your lower back, allowing you to focus entirely on the exercise without discomfort.

Lying on Your Side

Lie on your side with a pillow between your knees for support. This position is particularly comfortable for those who find lying on their back uncomfortable, such as during pregnancy. The pillow between the knees keeps the pelvis aligned and prevents strain on the hip muscles, allowing better focus on the pelvic floor.

Sitting Down

Sit on a chair and lean your upper body slightly forward. In this position, it may be easier to find the squeeze toward the front near the urethra. The forward lean shifts your weight slightly, which can help you better feel the anterior pelvic floor muscles that are particularly important for urinary control.

On All Fours

Kneel on all fours and rest your forearms and forehead on the floor. This position is often the easiest for finding the correct muscles if you have difficulty in other positions. Gravity works with you in this position, making it particularly helpful for those who experience a heavy feeling in the pelvic area.

Progressing to Standing

Once you've mastered the technique and become stronger, you can also train while standing. It's good to train the pelvic floor in different positions because it becomes easier to use the muscles in daily life when you need to squeeze. Stand with feet hip-width apart, toes pointing slightly inward, and knees slightly bent. Use the same technique as before, closing around the urethra and rectum and lifting upward and inward.

How Do You Perform Pelvic Floor Exercises Correctly?

The key to correct technique is imagining you're closing around the rectum, urethra, and vagina while lifting upward and inward, like stopping gas or urine. Keep your stomach, buttocks, and legs relaxed, breathe normally throughout, and rest at least as long as you squeezed between contractions.

The first step in training is finding the connection with your pelvic floor muscles. Think of closing around the rectum, urethra, and vagina while lifting your pelvic floor upward and inward. It can help to think about how you normally prevent passing gas or stop urine flow. Avoid straining or pushing downward, as this works against the muscles you're trying to strengthen.

You should be able to breathe normally while squeezing. This is an important indicator that you're using the correct muscles. If you find yourself holding your breath, you're likely recruiting your abdominal muscles instead of your pelvic floor. In the beginning, it may be difficult to feel the right muscles, but this usually becomes easier with practice.

Step-by-Step Instructions for Finding the Muscles

Follow these steps to locate and activate your pelvic floor muscles correctly:

1. Choose your position: Lie on your back or side with bent knees, sit on a chair leaning forward, or kneel with forearms on the floor
2. Relax surrounding muscles: Release tension in your back, stomach, buttocks, and legs
3. Check your stomach: Place a hand on your stomach and ensure it stays relaxed throughout the exercise
4. Breathe normally: Maintain natural breathing during the entire exercise
5. Contract around the rectum: Squeeze the muscle around your rectum as if stopping gas. Hold this contraction
6. Include the front muscles: Try to also squeeze forward around the vagina and urethra. It should feel like closing all openings and lifting upward and inward
7. Hold the contraction: Maintain the squeeze for a few seconds
8. Fully relax: Release completely and rest for at least as long as you held the contraction
9. Notice the difference: Pay attention to how tensed muscles feel compared to relaxed muscles
10. Repeat: Do this exercise 10 times. Complete 3 sets each day

When the exercise feels easy and you can clearly feel both the contraction and relaxation, you're ready for more challenging exercises targeting strength, speed, and endurance. It's beneficial to do all three types of exercises each time you train.

The Importance of Relaxation Between Contractions

For your muscles to function well, they need to be able to both contract and relax. When training your pelvic floor, it's essential to relax completely between each contraction. This gives you the best training effect and prevents muscle fatigue. It's also important to focus properly and train in clear sets rather than continuously squeezing.

The relaxation phase is just as important as the contraction phase. Muscles that cannot relax become chronically tense, which can actually cause problems rather than solve them. Tight pelvic floor muscles can contribute to pelvic pain, difficulty emptying the bladder, and painful intercourse. By emphasizing full relaxation, you maintain healthy muscle function.

Wait with Exercises if You Have Pain

Pelvic floor training increases blood circulation and speeds healing after, for example, childbirth or surgery in the pelvic area. Often it's good to start early with gentle, short squeezes, called circulation squeezes. But if you have pain in your pelvic area or pain when you squeeze, you should not train your pelvic floor muscles.

Follow the advice you've received from your midwife or doctor about how long to wait before starting exercises. Then begin training carefully and only use enough force that it doesn't cause pain. Forcing through pain can delay healing and potentially cause additional problems. Listen to your body and progress gradually.

How Can You Verify You're Using the Right Muscles?

There are several ways to check if you're exercising correctly. Place fingertips against the anal opening and feel the muscle tighten when you squeeze. Those with a vagina can insert one or two fingers and feel pressure on the sides. Those with a penis can watch for slight movement of the scrotum and penis during correct contraction.

Self-assessment is valuable because many people initially use the wrong muscles or use too many muscles together. Common mistakes include squeezing the buttocks, holding the breath and bearing down, or tightening the inner thighs. These compensatory movements indicate that you haven't yet isolated the pelvic floor muscles properly.

There are several methods to check that you're doing the exercises correctly:

• External touch: Place your fingertips against the anal opening (you can feel through your underwear). Squeeze and feel how the muscle around the opening contracts inward
• Internal check (vagina): Insert one or two fingers a few centimeters into the vagina and squeeze as if stopping gas or urine. You should feel pressure on the sides of your fingers, or a forward and inward movement
• Visual check (penis): Watch for slight movement of the scrotum and penis when you squeeze correctly. The base of the penis should lift slightly

Never Squeeze to Stop Urine Flow

You should never practice squeezing while urinating. When you urinate or have a bowel movement, it's important to relax completely so your bladder and bowels can empty properly. Interrupting the urine stream, while sometimes suggested as a test to identify the muscles, should not be done regularly as it can lead to incomplete emptying and may increase infection risk.

Using the urine stream as a test once or twice to confirm you've found the right muscles is acceptable, but this should never become a regular practice. During normal urination and bowel movements, focus on complete relaxation rather than control. This distinction is important for maintaining healthy elimination patterns.

How Do You Train Pelvic Floor Strength?

Strength training involves squeezing as hard as you can around the rectum, vagina, and urethra, then lifting upward and inward with maximum force. Hold for 5-6 seconds with full intensity, then rest equally long. Aim for 10 repetitions, training 1-3 times daily initially, then 3-4 times weekly once you're stronger.

The pelvic floor muscles must be strong enough to maintain continence even when you're physically active. The downward pressure into the pelvis increases when you move, and the pelvic floor must be able to resist this pressure. The pressure becomes greater the more you exert yourself, such as when coughing, lifting heavy objects, or running. Therefore, you need to build up strength in the pelvic floor if you have problems during certain activities.

Strength training requires maximum effort during each contraction. Unlike the beginner exercises where you're learning technique, strength training pushes your muscles to their limit. This overload is what stimulates the muscles to grow stronger over time. Be careful to maintain proper technique even as you increase intensity.

How to Train Strength

Choose your preferred position (see instructions above for finding the right muscles). Eventually, also train while standing.

Follow these steps to train strength contractions:

1. Relax your back, stomach, buttocks, and legs
2. Breathe normally throughout the exercise
3. Squeeze as hard as you can around the rectum, vagina, and urethra
4. Lift upward and inward as high as you can without engaging other muscles
5. Hold the squeeze with the same intensity, aiming for 5-6 seconds
6. If you can't hold that long, start with shorter squeezes and gradually increase the time as you become stronger
7. Relax completely and rest at least as long as you squeezed

Give maximum effort in each squeeze—this is how muscles become stronger. Be careful with your technique so you don't start engaging other muscles. This is especially important when you begin to tire in your pelvic floor. Squeeze as many times as you can manage, with 10 contractions as the goal. Start with 1-3 sessions per day. When you feel stronger and confident in your technique, 3-4 times per week may be sufficient if you train to fatigue each session.

To use the strength you build in your pelvic floor, try actively squeezing in daily situations, such as when you sneeze, cough, or lift something heavy.

How Do You Train Pelvic Floor Speed?

Speed training prepares your pelvic floor for sudden pressure increases like sneezing or quick movements. Contract as quickly and forcefully as possible, hold for 2 seconds, relax for 2 seconds, and repeat 10 times. Train 1-3 times daily initially, reducing to 3-4 times weekly when stronger.

Sometimes the pelvic floor muscles must contract quickly. This is needed when you sneeze or make a sudden movement. To handle fast, unplanned exertion, you need to train speed. The ability to quickly generate force is different from sustained strength and requires specific training.

Speed contractions develop the fast-twitch muscle fibers in your pelvic floor. These fibers are designed for quick, powerful movements rather than sustained effort. By training them specifically, you improve your ability to respond instantly when sudden pressure is applied to your pelvic floor.

How to Train Speed

Choose your preferred position and eventually also train while standing.

Follow these steps for speed training:

1. Relax your back, stomach, buttocks, and legs
2. Breathe normally throughout the exercise
3. Contract around rectum, vagina, and urethra as quickly and forcefully as possible, lifting upward and inward
4. Hold the contraction for 2 seconds
5. Relax for 2 seconds
6. Repeat 10 times

Start with 1-3 sessions per day. When you feel stronger and confident in your technique, 3-4 times per week may be sufficient, training to fatigue each session.

How Do You Train Pelvic Floor Endurance?

Endurance training involves holding a moderate-intensity contraction for as long as possible, with a goal of one minute. This trains your muscles to support organs and maintain continence throughout the day and during extended activities like walking or running. Perform one long hold at the end of each training session.

The pelvic floor muscles must be enduring enough to support your internal organs and maintain continence around the urethra and bowel all day, as well as during walking or running. You also need to be able to hold tight and make it all the way to the bathroom, even when you urgently need to urinate. Therefore, endurance training is essential.

Endurance training develops the slow-twitch muscle fibers that are designed for sustained effort. These fibers don't fatigue as quickly as fast-twitch fibers and provide the constant background support your pelvic organs need. Without adequate endurance, you may experience problems later in the day as muscles tire.

How to Train Endurance

Endurance training means holding your squeeze for a long time. Do this long hold at the end of each training session, after your strength and speed exercises.

Follow these steps for endurance training:

1. Relax your back, stomach, buttocks, and legs
2. Breathe normally throughout the exercise
3. Contract around rectum, vagina, and urethra, lifting upward and inward with moderate force
4. Hold the squeeze as long as you can, with a goal of one minute
5. If you lose the contraction, try to quickly re-engage and continue holding
6. Relax completely and rest at least as long as you just held the contraction

How Do You Use Pelvic Floor Exercises in Daily Activities?

Functional training means practicing pelvic floor contractions during real-life movements. Contract before standing up, walking, lifting, or jumping. This trains your muscles to respond automatically during activities that challenge continence. Always tighten before the movement, maintain during, and relax after.

When you've mastered the correct technique and trained for a while, you can exercise your pelvic floor while standing. Once you've achieved good strength, the goal is to use your muscles in everyday life. Training in connection with everyday movements is called functional training.

Functional training bridges the gap between isolated exercises and real-life performance. Your ultimate goal is for the pelvic floor to respond automatically during challenging activities. By consciously practicing during various movements, you train this automatic response to become ingrained.

Try contracting your pelvic floor muscles in situations where you notice more problems. For example, when standing up, walking, lifting something from the floor, or jumping.

Here's how to train functionally:

1. Contract your pelvic floor before you make the movement
2. Stand up, walk a few meters, lift, or jump
3. Relax your pelvic floor again
4. Repeat the exercise several times

How Long Does It Take to See Results?

Expect to train for approximately 2 months before noticing improvement. Full training effect can take up to 6 months. Once you've built adequate strength, speed, and endurance, you can reduce training to 1-3 times per week for maintenance. Many people who stop training completely experience a decline in function.

Building pelvic floor strength takes time and consistent effort. Like any muscle training, results don't happen overnight. The muscles need time to adapt, grow stronger, and develop the neural connections that allow efficient activation. This process cannot be rushed, but steady progress is reliably achieved with regular training.

The timeline for improvement varies somewhat between individuals based on factors like starting strength, consistency of training, and the nature of the problem being addressed. However, most people following a proper program will notice meaningful improvement within the expected timeframe.

When you've trained up strength, speed, and endurance and are satisfied with your progress, you can reduce training. Continuing 1-3 times per week is usually sufficient to maintain muscle function. Many people who stop training entirely notice a decline, so some ongoing maintenance is recommended for lasting results.

What Training Aids and Reminders Can Help?

Consistency is key, so set daily reminders on your phone or place notes where you'll see them. Apps specifically for pelvic floor training can guide your exercises. Training aids like vaginal cones/weights or electrical stimulators can help you find and activate the correct muscles. Always get proper instruction before using training devices.

Creating a new habit takes time, and fitting training into your daily routines requires strategy. Having reliable reminders helps ensure you don't forget to train during your busy day. The most effective approach is linking your exercises to an existing daily habit, like brushing your teeth or having your morning coffee.

Set a Daily Reminder

For training to be effective, you must do it regularly. Having a good strategy helps you include training every day and not forget. You can, for example, set reminders on your mobile phone that notify when it's time to squeeze, or put a note on the bathroom mirror, computer, or coffee maker.

Apps for Support

There are mobile apps and websites with more information about pelvic floor training. Many apps offer guided exercise programs, reminder functions, and progress tracking. Ask your physiotherapist, urotherapist, or midwife for recommendations on reliable apps in your region.

Aids for Finding the Right Muscles

Various training aids can help you find the right muscles when exercising your pelvic floor. It's important to use these aids correctly to achieve the desired effect. It's best to get instructions from your physiotherapist, urotherapist, or midwife.

Vaginal Weights and Cones

Weights in the form of cones or balls in plastic can be inserted into the vagina when standing. These work because you need to actively squeeze to prevent the weight from falling out. Some weights have an extension in the form of a stick. These should be inserted while lying down and work by moving downward if you squeeze correctly.

Electrical Stimulators

A device that stimulates via an electrode in the vagina or rectum can help both women and men find the pelvic floor muscles. They work by sending a weak current that contracts the muscles, helping you feel how it should feel when you squeeze correctly and activating your muscles.

Do not use a stimulation device if you have a pacemaker, are pregnant, or have a urinary tract or vaginal infection.

Vaginal weights and stimulation devices are available at pharmacies or from companies that work with pelvic floor health products.

How Does Physical Activity Affect the Pelvic Floor?

If you leak during exercise, temporarily avoid the specific activities that cause problems. Once you've built adequate pelvic floor strength through training, you can gradually return to those exercises. High-intensity training may cause leakage even in people with normally strong pelvic floors, so modifications may be needed.

Physical activity and pelvic floor health have a complex relationship. While general fitness is important for overall health, some high-impact activities can stress the pelvic floor significantly. Understanding this relationship helps you make informed decisions about your exercise routine.

If you leak urine or stool when exercising, it's good to avoid those exercises that cause problems. When you've trained up strength in your pelvic floor, you can do those exercises again. The key is to build sufficient pelvic floor strength before returning to challenging activities.

For Those Who Train Intensely

It's common for leakage to occur if you are a woman and train very hard, even if you have a strong pelvic floor in daily life. This is because extremely high-impact activities generate forces that can exceed even a well-trained pelvic floor's capacity. In such cases, it may be better to avoid the heaviest exercises or modify them. Ask a physiotherapist for advice on appropriate modifications.

What Else Can You Do for Your Pelvic Floor?

Support your pelvic floor by quitting smoking, treating chronic cough, maintaining a healthy weight, and avoiding constipation with hard straining. Topical estrogen can help if vaginal tissues are dry. These lifestyle factors significantly impact pelvic floor function and can enhance the effects of exercise.

While exercises are the cornerstone of pelvic floor rehabilitation, several lifestyle factors significantly affect pelvic floor health. Addressing these factors alongside your exercise program can enhance results and prevent recurrence of problems. Think of these as the foundation that supports your training efforts.

It's good to avoid things that unnecessarily stress your pelvic floor and can cause more problems. Here's what you can do for your pelvic floor to function well:

• Stop smoking or don't start: Smoking causes chronic cough that stresses the pelvic floor and affects tissue health
• Treat chronic cough: Persistent coughing repeatedly strains pelvic floor muscles
• Maintain a healthy weight: Excess weight increases constant pressure on the pelvic floor
• Avoid constipation: Hard straining during bowel movements damages pelvic floor structures
• Consider topical estrogen: If vaginal tissues feel dry, this can help. Ask your midwife or doctor if it's appropriate for you

How Does the Pelvic Floor Work?

The pelvic floor consists of multiple layers of muscles and connective tissue forming the base of your pelvis. These structures support the bladder, bowel, and uterus while controlling the openings for the urethra, rectum, and vagina. The muscles work continuously when you're upright and increase activity during physical exertion.

Understanding the anatomy of the pelvic floor can help you better visualize and connect with these muscles during exercise. The pelvic floor is not a single muscle but a complex system of muscles, ligaments, and connective tissue that work together to provide support and control.

At the bottom of your pelvis are several layers of supporting muscles and connective tissue that together form the pelvic floor. The pelvic floor supports the organs in the pelvis: the bowel, bladder, and uterus.

In the pelvic floor there are openings for the urethra, bowel, and vagina. The pelvic floor muscles have the task of closing these openings so you can maintain continence. When you urinate or have a bowel movement, it's important that the muscles relax completely so your bladder and bowel can empty as well as possible.

The Pelvic Floor Provides Support for the Bowel and Urethra

The pelvic floor muscles never rest completely but are most active when you move. If you cough, sneeze, lift, jump, or run, pressure is created downward toward the organs in the pelvis. Then the pelvic floor muscles tighten to provide support and prevent you from leaking urine or stool. The greater the exertion, the more the muscles must work to provide sufficient support so you can stay continent.

The Pelvic Floor Is Affected by Various Changes and Problems

Throughout life, the pelvic floor is affected by physical and hormonal changes. After pregnancy and childbirth, the pelvic floor loses both strength and baseline tension. It's common to feel tired and heavy in the pelvic area during the first year after childbirth, regardless of delivery method. Leakage may also occur before the area has recovered. If you have significant problems, you should seek care.

Menopause can also affect the pelvic floor muscles. The mucous membranes are also affected, which can make leakage more likely. The muscles can also be affected by other problems, including chronic cough, chronic constipation, significant obesity, and cancer treatment in the pelvis.

When Should You Seek Medical Care?

Contact a healthcare provider if you need help with pelvic floor training technique, if you've trained according to recommendations but problems haven't improved sufficiently, or if incontinence prevents you from physical activity, socializing, or sexual activity. Pelvic floor training is part of treatment for incontinence and prolapse, but sometimes additional treatment is needed.

While pelvic floor exercises are effective for many people, some situations require professional guidance or additional treatment. Knowing when to seek help ensures you receive appropriate care and don't continue struggling with a problem that could be resolved more effectively with medical intervention.

Contact a healthcare center if any of the following applies to you:

• You need help with pelvic floor training technique
• You've trained your pelvic floor according to recommendations but your problems haven't improved sufficiently
• You avoid physical activity, meeting friends, or having sexual intercourse because of your problems

Pelvic floor training is an important part of treatment for urinary incontinence and fecal incontinence, but sometimes training alone isn't enough. Then your problems may need to be investigated further. Pelvic floor training can also help if you have prolapse. If problems don't improve with training, you should contact healthcare.

You may also contact a physiotherapist directly, as many specialize in pelvic floor rehabilitation and can provide personalized guidance and treatment.