Home / For patients / Exercises
Pelvic floor muscle training
Pelvic floor exercises (also called Kegel exercises) are the most studied and safest way to treat and prevent stress incontinence. They need no equipment and can be done at home, at work or on the bus. What matters is correct technique and regularity.
Who they help
- women with stress and mixed incontinence — this is first-line treatment;
- women with urgency symptoms — as part of bladder training: quick squeezes help "switch off" a sudden urge;
- during pregnancy and after birth — for prevention;
- around menopause and with age — to keep the muscles strong.
According to a Cochrane review, women with stress incontinence who train their pelvic floor regularly are several times more likely to report cure or significant improvement than women who don't.
How to find the right muscles
The pelvic floor muscles surround the urethra, vagina and anus. To feel them:
- Imagine you're holding in wind and at the same time trying to stop the flow of urine. That "squeeze and lift inwards and upwards" feeling is them.
- Lie on your back with knees bent and place a hand on your perineum: with a correct contraction you'll feel a gentle lift.
Technique: two kinds of contraction
Slow (endurance)
Squeeze and lift, then hold while breathing calmly for as long as you can — up to 10 seconds. Then relax completely for the same time. Relaxing is as important as squeezing.
Fast (strength)
Squeeze hard and fast for 1 second, then let go immediately. These help you "close" reflexively when you cough, sneeze or jump.
Correct: tummy, buttocks and thighs relaxed, breathing freely, shoulders down. Incorrect: holding your breath, pulling in your tummy, clenching your buttocks or squeezing your thighs together, bearing down.
A 12-week plan
International guidelines recommend training for at least 3 months, with at least 8 contractions 3 times a day. A sample plan:
- Weeks 1–2: learn. Lying on your back, knees bent. 3 times a day: 8 slow contractions held for 3–5 seconds and 8 fast ones.
- Weeks 3–6: consolidate. Sitting. Hold slow contractions for 6–8 seconds, 8–10 repetitions, plus 10 fast. 3 times a day.
- Weeks 7–12: strengthen. Standing and moving. Hold for up to 10 seconds, 10–12 repetitions, plus 10 fast. Add "the knack": tighten your pelvic floor just before you cough, sneeze or lift something heavy.
- After 12 weeks: maintain. Keep going at least once a day — otherwise the benefit gradually fades.
Link the exercises to daily routines: your morning tea, a red traffic light, TV adverts, washing up. Phone reminders help too.
When to expect results
Many women notice the first changes after 4–6 weeks, but the effect should be judged after at least 3 months of regular training. Like any muscles, these need time to get stronger.
Common mistakes
- Too much, too hard in the first days — the muscles tire and ache. Better fewer, done correctly.
- Using the wrong muscles — tummy, buttocks, thighs.
- Not relaxing between contractions.
- Irregular practice — a couple of weeks, then a break.
- Stopping too early — before 3 months are up.
When to see a specialist
See a doctor or pelvic floor physiotherapist if you're not sure you're squeezing the right muscles, the exercises cause pain, you feel pressure or a "bulge" in the vagina, or there's no improvement after 3 months. A specialist can check your technique during an examination and add biofeedback or electrical stimulation if needed.
Sources
- NICE guideline NG123. 2019. nice.org.uk
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Cochrane Database Syst Rev. 2018;10:CD005654.
- Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012;30(4):437–443.