Pelvic floor exercises

Done properly, pelvic floor training is the first line treatment for stress urinary incontinence and helps a good proportion of mild prolapse. Done the way most people do it, it achieves very little.

Finding the right muscles

Sit or lie comfortably with the legs slightly apart and the abdomen relaxed. Imagine stopping the flow of urine and, at the same time, stopping yourself from passing wind. Draw both of those areas inward and upward. That combined action is the pelvic floor contraction. It should feel like a gentle internal lift, not like tightening the surface.

Three checks tell you whether you have it. The buttocks should stay soft. The thighs should stay soft. The breath should keep moving. If the belly hardens sharply, the chest rises, or the body lifts slightly off the chair, something else is doing the work.

A hand placed flat on the lower abdomen is a useful monitor. A slight, gentle drawing in underneath the hand is normal and correct, because the deep abdominal muscles work together with the pelvic floor. A firm bracing or a bulge outward is not.

Do not practise by stopping the flow of urine repeatedly. It is a reasonable one time check that the right muscles have been found, and a poor habit, because interrupting the stream regularly interferes with normal bladder emptying.

The two kinds of contraction

The pelvic floor has both slow endurance fibres, which maintain support all day, and fast fibres, which produce the split second squeeze that prevents a leak during a cough. Training only one leaves half the job undone.

Long holds train endurance. Contract, hold at a steady effort, then release fully and rest. Start with whatever can be held cleanly, which for many people is three or four seconds, and build towards ten. The hold must be honest: a contraction that fades halfway through is a shorter hold, not a longer one.

Short contractions train speed. Squeeze quickly and firmly, release immediately, and repeat. Quality drops fast, so a small number of clean repetitions beats a long ragged set.

Rest, and why it matters

Full release between contractions is not optional. A muscle that is never allowed to lengthen becomes short, tired and less able to contract, which is exactly the state that produces an overactive pelvic floor. Rest for at least as long as the hold, and preferably longer. If the release is not felt as a distinct letting go, the rest is too short.

How much, and for how long

A structured plan is more effective than an intention to squeeze whenever you remember. Three sessions on most days, each combining a set of long holds and a set of short contractions, is a reasonable shape. The eight week programme sets out sets, hold times, rest and progression rules week by week.

Expect the first changes at around six to eight weeks and a fair judgement of the result at three months. Muscle adaptation is slow, and pelvic floor muscles are no exception. The gains also behave like any other training effect: they fade if training stops, so most people who have had symptoms keep a reduced maintenance routine indefinitely.

The knack

One technique is worth learning immediately, because it works before any strength has been gained. Contract the pelvic floor deliberately just before and during a cough, sneeze, lift or jump. This restores the timing of the reflex and often reduces leaking straight away. It is a skill rather than a strength gain, which is why it works so quickly.

Devices and feedback

Some people cannot tell whether they are contracting correctly, and for them feedback helps more than instruction does. A clinician can confirm the contraction on examination, which is the most reliable method. Devices that register a contraction and display it also exist, and independent retailers such as inWonderstate group these pelvic trainers as a category of their own, separate from anything else they sell. The evidence that any device outperforms correctly taught exercises alone is limited, so the sensible way to think about them is as an aid to doing the right thing consistently rather than as a treatment in themselves.

Weighted cones work on a similar principle. They suit some people and irritate others, and they are unsuitable for anyone whose floor is overactive.

Common mistakes

• Bearing down instead of lifting. This is the most common error and it increases pressure on the pelvic floor rather than supporting it.
• Holding the breath throughout. Breathing should continue normally.
• Squeezing the buttocks and inner thighs. Both are easier to feel than the pelvic floor, which is why they get recruited.
• Doing far too many, far too quickly, with no rest.
• Practising only while lying down. Progress to sitting and standing, because symptoms happen upright.
• Giving up at four weeks. That is roughly the point at which nothing has visibly changed yet.

When exercises are the wrong answer

If several weeks of correct practice make symptoms worse, if there is pain during or after the exercises, or if penetration is painful, stop and be assessed. Those are typical signs of an overactive pelvic floor, which needs release work rather than strengthening. A pelvic health physiotherapist can tell the difference in a single appointment, which is worth far more than months of guessing.

Last reviewed: September 2026