Pelvic floor exercises: how to do them, how often and what to avoid

Pelvic floor exercises are small, repeated squeezes of the muscles that hold up your bladder, bowel and uterus. The standard plan, used in UK guidance, is to squeeze and lift at least eight times, three times a day, for at least three months, and it is the recommended first treatment for leaking when you cough, sneeze or jump.

This guide is education, not medical advice. If you have pain, heaviness, a bulge, bleeding, or leaking that is getting worse, see your doctor or a pelvic health physiotherapist before you start.

What the pelvic floor does

The pelvic floor is a hammock of muscle from your pubic bone at the front to your tailbone at the back. It supports your bladder, bowel and uterus, helps you stay continent, and works with your deep abdominal muscles, diaphragm and back muscles as a team. Pregnancy, childbirth, heavy lifting, constipation, menopause and a chronic cough can all load it. Our guide to deep core exercises shows how it fits with the rest of the team.

How do you find the right muscles?

1. Lie on your back with your knees bent and your feet flat.
2. Imagine stopping wind and, at the same time, stopping the flow of urine.
3. Feel the lift. You should feel a gentle squeeze and lift inside, around your back passage and vagina, as if lifting a blueberry.
4. Keep everything else soft. Buttocks, thighs and stomach stay relaxed, and you keep breathing.

Do not use stopping your urine mid-stream as a regular exercise. It can disturb normal emptying. Use it once, if at all, to find the muscles.

The daily routine

• Slow lifts: breathe out, squeeze and lift, hold while breathing normally for up to 10 seconds, then let go fully for as long as you held. Aim for eight.
• Quick flicks: squeeze and lift fast and strong, then release straight away. Aim for eight to ten.
• How often: three times a day. Pin it to something you already do, such as coffee, lunch and brushing your teeth.
• How long: UK guidance (NICE NG123) recommends at least three months, then many people keep a daily set for life.

If you can only hold for three seconds, hold for three. Add a second a week. Progress by changing position: lying down first, then sitting, then standing, then during everyday moves.

Common mistakes

• Holding your breath. Breathe out as you lift.
• Squeezing your buttocks, thighs or stomach instead of the pelvic floor.
• Pushing down, which loads the pelvic floor instead of lifting it.
• Skipping the release. A pelvic floor that can only hold on is tired, not strong.
• Training a pelvic floor that is already too tight. If you have pain with sex, tampons or examinations, or struggle to start a urine stream, a physiotherapist can tell you whether you need relaxation first.

Does it work?

A Cochrane review of pelvic floor muscle training found that women with stress urinary incontinence who did it were far more likely to report a cure, and more likely to report improvement, than women who did nothing. Results take weeks, and some women need supervised training from a pelvic health physiotherapist.

When to see someone

See your doctor or a pelvic health physiotherapist for heaviness or a bulge in the vagina, pain, bleeding, leaking that is getting worse, leaking of stool or wind, or if you cannot feel the muscles after two weeks of practice. In the US, ask for a referral to a pelvic floor physical therapist.

A full plan

If you want the whole eight weeks laid out, from lying down to carrying the shopping, with a daily five-minute set, a diastasis self-check and a bladder diary, that is what The Core Reset Edit is built for. The free preview shows the first pages. For the related questions, see our guides to Kegel exercises, the pelvic tilt and diastasis recti.

Sources: NICE NG123: urinary incontinence and pelvic organ prolapse in women · NHS: what are pelvic floor exercises?