Pelvic floor exercises: A complete guide beyond Kegels

Pelvic floor exercises are not limited to repeated Kegel squeezes. A balanced program may include slow holds for endurance, quick contractions for power, functional bracing, breathing and coordination, as well as relaxation or ‘down-training’. The right exercises depend on whether your pelvic floor muscles are weak, overactive, poorly coordinated or a combination of these.

If you’d like a little more background before getting started, read our guide to what the pelvic floor is and how it works.

Key takeaways

• Kegels are one type of pelvic floor exercise, not the whole picture.
• A healthy pelvic floor needs to contract, hold, respond quickly and fully relax.
• Slow holds build endurance, while quick contractions train speed and power.
• ‘The Knack’ teaches the pelvic floor to respond before a cough, sneeze or lift.
• More squeezing is not always better. Pain, difficulty emptying your bladder or bowel and painful penetration can be signs that relaxation and professional assessment should come first.
• Technique matters more than doing a high number of repetitions.

Are Kegels and pelvic floor exercises the same thing?

Not quite. A Kegel is a voluntary squeeze and lift of the pelvic floor muscles, followed by a full release. Pelvic floor muscle training is broader. It may be used to improve strength, endurance, speed, coordination or relaxation, depending on what your muscles need.

The pelvic floor is part of a coordinated system that also includes your diaphragm, abdominal muscles and back muscles. It needs to respond to changes in pressure when you cough, laugh, run, lift, use the toilet or breathe. Constantly clenching it is not the goal.

Do you need to strengthen or relax your pelvic floor?

This is the most important question to consider before starting pelvic floor exercises.

Symptoms such as leaking urine when you cough, sneeze or exercise, difficulty controlling wind and a feeling of pelvic heaviness may be associated with weakness or poor coordination. Strengthening exercises may help some people with these symptoms.

However, pelvic floor muscles can also be tight or overactive. Possible signs include:

• pelvic, vulval or genital pain
• pain during or after penetration
• difficulty starting urination or fully emptying the bladder
• constipation or difficulty emptying the bowel
• urinary urgency, frequency or pain
• pain during or after Kegel exercises
• difficulty feeling the muscles let go after a contraction.

Weakness and overactivity can also occur together, so symptoms alone cannot tell you exactly what is happening. If you have pain, difficulty emptying your bladder or bowel, a vaginal bulge, symptoms after surgery or symptoms that worsen with Kegels, see a pelvic health physiotherapist, continence nurse or GP before beginning a strengthening program.

How to find and contract your pelvic floor muscles

Start lying down or sitting in a supported position. Relax your jaw, shoulders, abdomen, buttocks and thighs, then breathe normally.

Gently imagine:

• stopping yourself from passing wind
• closing the openings around the anus and urethra, then drawing them inward and upward
• if you have a vagina, gently closing and lifting around the vaginal opening
• if you have a penis, shortening the penis slightly and lifting the testicles.

You are looking for an internal closing and lifting sensation, not a downward push. Your buttocks and thighs should remain relaxed and you should be able to breathe throughout.

After each contraction, let the muscles completely soften. The release is part of the exercise, not simply the pause before the next squeeze.

You may have heard that stopping your urine stream is a way to identify the pelvic floor. It can be used once or twice as a check, but do not regularly perform Kegels while urinating. Repeatedly interrupting the stream can interfere with normal bladder emptying.

The different types of pelvic floor exercises

Different exercises train different functions. A personalised program may use several of the following.

1. Slow holds for strength and endurance

Slow contractions help your pelvic floor sustain support over time. This endurance is useful during standing, walking, exercise and other everyday activities.

To practise:

1. Gently squeeze and lift your pelvic floor muscles.
2. Keep breathing and avoid tightening your buttocks, thighs or upper abdomen.
3. Hold for 3 seconds.
4. Release completely and rest for at least 3 seconds.
5. Repeat 3–5 times.

As your control improves, gradually build towards 5–8 second holds and 8–10 repetitions. The quality of each contraction matters more than reaching a particular number. Stop when the muscles become tired or you can no longer fully lift and release.

2. Quick contractions for speed and power

Quick contractions, sometimes called ‘quick flicks’, train the muscles to respond rapidly. This can be useful when pressure rises suddenly, such as during a cough or sneeze.

To practise:

1. Squeeze and lift the pelvic floor quickly.
2. Let go completely.
3. Begin with 3–5 repetitions, allowing a clear release between each one.
4. Build towards 8–10 good-quality repetitions.

A quick contraction is not a small partial clench. Aim for a clear lift followed by a clear release.

3. Functional bracing: ‘The Knack’

The Knack is a practical pelvic floor technique rather than a traditional exercise set. It involves gently contracting your pelvic floor just before and during an activity that increases pressure inside your abdomen.

Try a gentle squeeze and lift immediately before you:

• cough or sneeze
• laugh
• lift a child, shopping bag or gym weight
• stand up from a chair
• jump or land.

Keep breathing rather than holding your breath and release the contraction once the effort has passed. The aim is a well-timed response, not to keep your pelvic floor clenched throughout the day.

4. Urge-control contractions

Pelvic floor contractions may also be used as part of bladder training to help settle a sudden urinary urge.

If urgency strikes, stop moving, breathe slowly and avoid rushing to the toilet. A small number of quick, controlled pelvic floor contractions may help the bladder settle. Once the urge eases, walk to the toilet at a normal pace.

Frequent or severe urgency can have several causes. If it is new, painful, accompanied by other symptoms or affecting daily life, seek advice rather than relying only on exercises.

5. Pelvic floor relaxation and down-training

Some pelvic floors need help letting go before they need more strengthening. Pelvic floor down-training aims to reduce unnecessary tension and improve the ability to lengthen and relax. You may also hear this described as a ‘reverse Kegel’, although it should be a gentle release rather than a forceful push.

To practise:

1. Lie or sit in a comfortable, supported position.
2. Place your hands around your lower ribs or lower abdomen.
3. Breathe in slowly and allow your ribs and abdomen to expand.
4. Imagine the sit bones widening and the muscles around the urethra, vagina or penis and anus softening.
5. Breathe out easily without automatically squeezing.
6. Continue for 5–10 relaxed breaths.

Do not bear down or strain. The movement may feel very subtle. Supported positions such as lying with your knees bent, child’s pose or a supported butterfly stretch may make it easier to let go, provided they are comfortable for your body.

If you have pelvic pain, vaginismus, painful penetration or persistent difficulty relaxing, individual guidance from a pelvic health physiotherapist is preferable to trying to stretch or release the muscles forcefully.

6. Breathing, core coordination and movement

Your pelvic floor, diaphragm and deep abdominal muscles normally work together. As you breathe in, the diaphragm moves down and the pelvic floor can gently lengthen. As you breathe out or perform an effort, the pelvic floor can recoil and contribute to support.

Once you can contract and relax the muscles in a supported position, practise that control while sitting, standing and moving. A physiotherapist may progress pelvic floor training into walking, squats, lifting, jumping or sport according to your needs.

Exercises such as yoga, Pilates, bridges and squats can support general mobility, strength and breathing. However, they are not automatically pelvic floor exercises and they do not replace specific pelvic floor muscle training when that has been recommended.

A general beginner pelvic floor strengthening routine

If you do not have pelvic pain, difficulty emptying your bladder or bowel or symptoms that worsen when you squeeze, this general routine may be a useful starting point:

1. Begin with 3–5 slow contractions, holding each for 3 seconds.
2. Rest for at least the same length of time and fully release between repetitions.
3. Add 3–5 quick contractions, again releasing each time completely.
4. Practise up to 3 sets across the day.
5. Gradually build towards 8–10 slow holds of 5–8 seconds and 8–10 quick contractions.
6. Progress from lying to sitting, then standing as the exercises become easier.

This is general guidance, not a prescription. Your ideal number of repetitions, contraction strength, position and progression may be different. A smaller number of correctly performed contractions is more useful than many repetitions with poor technique.

How can you tell if you are doing pelvic floor exercises correctly?

During a correct contraction:

• you feel an inward and upward lift
• you continue breathing
• your buttocks and thighs remain mostly relaxed
• you do not push or bear down
• you can fully release after the contraction
• the exercise does not cause pain.

It is normal for the lower abdominal muscles to respond gently because the pelvic floor and deep core work together. However, a forceful abdominal brace, breath hold or visible squeezing of the buttocks can take the focus away from the pelvic floor.

Because these muscles are hidden, technique can be difficult to judge. A pelvic health physiotherapist or continence nurse can assess both contraction and relaxation and tailor a program to your symptoms.

Common pelvic floor exercise mistakes

Doing Kegels without knowing what your muscles need

Repeated strengthening can aggravate symptoms if the muscles are already overactive or unable to release.

Holding your breath

Breath-holding increases pressure through the abdomen and makes coordination more difficult. Keep your breathing easy throughout each exercise.

Pushing down instead of lifting

Straining or bearing down is the opposite of the movement intended during a strengthening contraction. If you cannot feel an upward lift, seek help with your technique.

Skipping the relaxation phase

The pelvic floor must return to rest between contractions. If the release becomes smaller as the set continues, stop and rest.

Doing too many repetitions

Pelvic floor muscles can fatigue. More is not necessarily better, particularly if contractions become weaker or other muscles begin taking over.

Only exercising while lying down

Lying down is often the easiest place to learn, but the pelvic floor also needs to work when you are upright and moving. Progress gradually to sitting, standing and relevant daily activities.

Expecting an instant change

Coordination may improve before strength does. Some people notice changes within several weeks, but a structured strengthening program is often continued for at least 3 months. Persistent symptoms deserve assessment rather than simply adding more Kegels.

Do pelvic floor exercises work?

Pelvic floor muscle training has the strongest evidence as a conservative treatment for urinary incontinence. A Cochrane review found that women completing pelvic floor muscle training were more likely to report improvement or cure than those receiving no treatment or inactive treatment.

Pelvic floor muscle training may also improve symptoms for some people with pelvic organ prolapse, particularly when the program is supervised and continued for several months. It does not guarantee that prolapse will be prevented or reverse an existing prolapse.

Outcomes vary according to the cause of the symptoms, technique, consistency and whether the program matches the person’s actual needs. Pelvic floor exercises are not a universal treatment for pelvic pain, sexual difficulties, bladder symptoms or bowel symptoms.

Can pelvic floor trainers help?

Pelvic floor trainers are optional tools, not a requirement for effective exercise. Different products work in different ways:

• Biofeedback trainers provide information about your contraction and may help with technique, motivation or progress tracking.
• Weighted cones or balls add resistance and may help some people train strength and endurance.
• Electrical stimulation devices activate muscles using a gentle electrical current and may be recommended when someone has difficulty producing a contraction independently.

These devices are not interchangeable and an internal trainer is not suitable for every body or every pelvic floor condition. Follow the instructions for the specific product and seek professional advice if you are pregnant, have recently given birth or had pelvic surgery, have pelvic pain, unexplained bleeding or difficulty inserting a device.

Our guide to choosing pelvic floor trainers and exercisers explains the different device types. You can also explore Period Shop’s pelvic floor trainers.

When should you see a pelvic health professional?

Speak with a pelvic health physiotherapist, continence nurse or GP if:

• you cannot feel your pelvic floor contract or relax
• you have pelvic, genital or lower abdominal pain
• Kegels cause pain or make your symptoms worse
• you have difficulty urinating or emptying your bowel
• you notice a vaginal bulge, heaviness or dragging sensation
• you have persistent bladder or bowel leakage
• you have recently given birth or had pelvic, gynaecological, urological or colorectal surgery
• you are unsure whether strengthening or relaxation is appropriate
• your symptoms are not improving despite consistent, correctly performed exercises.

In Australia, the National Continence Helpline provides free, confidential advice on 1800 33 00 66.

Frequently asked questions

Should you do pelvic floor exercises every day?

Many strengthening programs involve daily practice, but the right frequency depends on your muscle function and symptoms. Rest and full relaxation between contractions are essential. If exercise causes pain or worsens urgency, constipation or emptying difficulties, stop and seek individual advice.

Can Kegel exercises make pelvic floor problems worse?

Yes, they can worsen symptoms when the pelvic floor is already overactive or the exercises are performed by pushing down, holding the breath or never fully releasing. Kegels should feel controlled and pain-free.

Should you practise Kegels while urinating?

No. Briefly stopping the stream once or twice can help identify the muscles, but it should not become an exercise. Regularly interrupting urination may affect normal bladder emptying.

What is the best position for pelvic floor exercises?

The best starting position is one in which you can clearly feel the muscles lift and release without using your buttocks or thighs. Lying down is often easiest for beginners. Progress to sitting and standing as your control improves.

Can men do pelvic floor exercises?

Yes. Everyone has a pelvic floor. Training may be used to support bladder and bowel control, sexual function and recovery after prostate treatment. The correct program still depends on whether the muscles need strength, coordination or relaxation.

Can you do pelvic floor exercises during pregnancy or after birth?

Pelvic floor muscle training is commonly used during pregnancy and after birth, but the program should suit your pregnancy, birth experience, symptoms and healing. Ask your midwife, obstetrician, GP or pelvic health physiotherapist when and how to begin, particularly after a complicated birth, significant tearing or surgery.

Can pelvic floor exercises fix prolapse?

Pelvic floor muscle training may reduce symptoms and improve support for some people with pelvic organ prolapse, but it does not guarantee that the prolapse will disappear. A pelvic health assessment can guide exercise and discuss other options where needed.

How long do pelvic floor exercises take to work?

Some people notice better awareness or control within a few weeks. Building strength and changing symptoms often takes 3 months or longer. Progress depends on correct technique, consistency and whether the exercises address the underlying issue.

A balanced pelvic floor can both work and let go

Pelvic floor health is not simply about achieving the strongest possible squeeze. These muscles need endurance, speed, coordination and the ability to relax fully. Slow holds, quick contractions, functional techniques and down-training each have a different purpose.

Start with technique, match the exercise to your symptoms and ask for help if you are unsure. The most effective program is one designed for what your pelvic floor actually needs.

Disclaimer: This article provides general information and is not a substitute for individual medical advice, diagnosis or treatment. Speak with a qualified healthcare professional about symptoms or exercises that are appropriate for you.

References

• Continence Health Australia: Pelvic floor exercises for women
• Continence Health Australia: Pelvic floor exercises for men
• Better Health Channel: Pelvic floor
• Pelvic Floor First: Activating your pelvic floor
• Cochrane: Pelvic floor muscle training for urinary incontinence in women
• Cochrane: Conservative management of pelvic organ prolapse
• NICE: Urinary incontinence and pelvic organ prolapse in women
• Torbay and South Devon NHS Foundation Trust: Exercises for breathing and pelvic floor relaxation