Pelvic floor exercises: complete guide
Learn what the pelvic floor is, which symptoms suggest dysfunction, and how to train it with evidence-based exercises.
The pelvic floor is the group of muscles, fascia and ligaments that close the base of the pelvis: they control urinary and faecal continence, support the pelvic organs, and contribute to sexual function and lumbar stability. Pelvic floor muscle training (PFMT) is the first-line conservative intervention recommended by guidelines such as NICE NG123 and the Cochrane review CD005654 for stress incontinence and prolapse. A complete programme is not limited to Kegel exercises: it combines body awareness, correct contraction, active relaxation and functional progression.
The pelvic floor is one of the most ignored muscle groups in the body, but one of the most important for quality of life. It controls urinary and faecal continence, supports the pelvic organs, contributes to sexual function and works together with breathing, abdominal pressure and lumbar stability.
When it works well, you simply do not notice it. When it fails, symptoms can range from uncomfortable to limiting.
What the pelvic floor is and where it is
The pelvic floor is a set of muscles, fascia and ligaments forming the base of the pelvic cavity. Imagine it as a muscular hammock stretching from the pubic bone to the coccyx and from one sitting bone to the other.
In women it has three openings —urethra, vagina and rectum— and in men two —urethra and rectum. Its muscles work in constant coordination with the breathing diaphragm, deep abdominal muscles and spinal stabilisers.
Why it matters
Continence: it controls urethral and anal closure, preventing urine, gas or stool leakage during pressure or urgency.
Organ support: it supports the bladder, uterus and rectum. When support weakens, pelvic organ prolapse can appear.
Sexual function: tone, contraction and especially relaxation influence penetration, orgasm and satisfaction.
Lumbar and pelvic stability: it forms part of the trunk stabilising system. Dysfunction may contribute to chronic low back pain.
Symptoms that may suggest a problem
Urinary incontinence
- Stress incontinence: leakage when coughing, sneezing, jumping or running.
- Urgency incontinence: a sudden, hard-to-control need to urinate.
- Mixed incontinence: a combination of both.
Pelvic organ prolapse
A feeling of heaviness or pressure, as if “something is coming down”. It can worsen with effort, prolonged standing and constipation.
Read our guide to pelvic organ prolapse →
Pelvic pain and dyspareunia
Chronic pelvic pain, pain during sex and vaginismus are often associated with pelvic floor overactivity: muscles with too much tension that cannot relax. In this case, treatment is not more contraction but learning to release. Pelvisana is not designed to treat these dysfunctions, although it considers them in its assessment.
PFMT: evidence and principles
PFMT is the first-line conservative intervention recommended by major clinical guidelines for stress and mixed urinary incontinence and pelvic organ prolapse.
NICE NG123 recommends supervised PFMT as the first therapeutic option for stress incontinence. Cochrane CD005654 observes better outcomes in women who perform PFMT compared with no treatment. The International Continence Society (ICS) includes PFMT in conservative management.
Explore the evidence sources in detail →
PFMT is not simply “doing Kegels”. A complete programme includes body awareness, correct contraction technique, active relaxation, functional progression and long-term adherence.
How to train correctly
Before training, you need to know what you want to move. The most common cue is imagining that you want to stop urine flow or hold back gas: that internal contraction is the pelvic floor.
Important: do not use stopping urine flow as an exercise. It can be a one-off check, but doing it repeatedly may disrupt bladder emptying.
The starting point depends on your capacity: sustained contractions, quick contractions and enough rest for true relaxation. As strength and endurance improve, duration, repetitions and position difficulty progress.
Read the Kegel exercises guide →
The pelvic floor across life
Pregnancy and postpartum
Pregnancy places a major load on the pelvic floor. PFMT during pregnancy can be useful and is often recommended in low-risk situations. With complications, pain or clinical doubts, consult your obstetric team first.
Read the postpartum recovery guide →
Menopause
Falling oestrogen levels reduce the strength and elasticity of pelvic floor tissues. PFMT in menopause has evidence for improving continence and sexual quality of life.
Read the menopause and pelvic floor guide →
Prostate surgery
Radical prostatectomy is one of the most common causes of urinary incontinence in men. Pre- and post-operative PFMT has strong evidence for reducing the duration of incontinence.
When to seek professional help
- Pelvic, perineal or lumbar pain that does not improve or worsens with exercise
- Prolapse symptoms: pressure, heaviness or visible tissue in the vagina
- Severe or chronic incontinence that does not improve after 8–12 weeks of training
- Sexual dysfunction with pain
- Postpartum recovery after third- or fourth-degree tear, forceps or vacuum birth
- Overactivity: difficulty relaxing, pain during sex or persistent perineal tension
FAQ
How long does it take to notice improvements with PFMT?
Most clinical studies observe measurable changes between 6 and 12 weeks of consistent training. Regularity is key: short sessions every day beat one long session done occasionally.
What is the difference between doing Kegels alone and using an app like Pelvisana?
Kegel exercises alone mainly train contraction. A structured programme like Pelvisana adds progressions, relaxation timing, progress tracking and educational content adapted to your situation, helping you train with more clinical criteria and consistency.
Can everyone do pelvic floor exercises?
Many people can start with gentle exercises, but if there is pain, overactivity or difficulty relaxing, relaxation and assessment by a specialist pelvic floor physiotherapist should come before insisting on contractions.
Does the pelvic floor affect men?
Yes. Although incontinence and prolapse mostly affect women, men can also experience incontinence, especially after prostate surgery, and pelvic floor dysfunction. Training has evidence in both sexes.
Can I do pelvic floor exercises during pregnancy?
In many pregnancies, pelvic floor training is considered safe and can be part of preparation. If there are complications, pain, bleeding or a high-risk pregnancy, consult your obstetric team first.
Related articles
Learn how to locate, contract and relax the pelvic floor without compensating with the abdomen, glutes or breath holding.
Learn correct Kegel exercise technique, avoid frequent mistakes and progress safely to improve the pelvic floor.
Avoid the most common mistakes: squeezing too hard, forgetting relaxation, holding your breath or training with pain.
Understand stress, urgency and mixed incontinence, their main causes, and why PFMT is first-line conservative treatment.
Try Pelvisana: the guide in practice
Pelvisana turns this guide into structured routines, progress tracking, and clinically grounded content.
