Why do we need pelvic floor muscles and how to wake them up?

Everyone has pelvic floor muscles, but most of us only notice them when something goes wrong — such as leaking a little urine when we cough. Here is what these muscles do, what the evidence says about training them, and how to start noticing them.

Where the pelvic floor is and what it does

The pelvic floor muscles form a sling across the base of the pelvis. They support the bladder and bowel and, in women, the uterus and vagina. The urethra and the back passage pass through them, so these muscles help you hold in urine, wind and stools (CUH; NIDDK). The overall layout is similar in men and women, but the anatomy differs.

The pelvic floor also plays a part in sexual function; in men, for example, these muscles are active during normal erections (Dorey et al., 2004).

These muscles need to relax fully as well as contract — without relaxation, emptying the bladder and bowel becomes harder.

What can weaken the pelvic floor

• pregnancy and childbirth, surgery and ageing (NIDDK);
• in men, prostate surgery (CUH);
• a long-term cough, constipation and straining, excess weight and heavy lifting (NHS).

The opposite problem also happens: muscles that do not relax well. In that case, simply doing more squeezes may not help; NIDDK warns that overdoing the exercises can lead to straining when you urinate or move your bowels (NIDDK).

What the evidence supports

• Stress urinary incontinence in women. In a Cochrane review, women who did pelvic floor muscle training were about eight times more likely to report a cure than women who had no treatment (56% vs 6%) (Dumoulin et al., 2018). NICE recommends at least 3 months of supervised training as the first treatment (NICE NG123).
• Stage 1–2 pelvic organ prolapse with symptoms. NICE suggests considering a supervised training programme of at least 16 weeks (NICE NG123).
• Men and prostate surgery. Exercising before the operation helps reduce how much, and for how long, urine leaks afterwards (CUH). For stress incontinence after prostatectomy, NICE recommends supervised training for at least 3 months before other options are considered (NICE CG97).
• Sexual function. Training may improve it (NIDDK), but the studies are few and small.

What the exercises do not do: there is no evidence that they treat haemorrhoids, regulate periods or delay the menopause.

How to find the muscles

1. Sit or lie down. Relax your stomach, thighs and buttocks.
2. Imagine you are holding in wind: notice a squeeze and a gentle lift upwards and inwards. Then let go completely.
3. Men can use a mirror: when the muscles contract, the penis and testicles lift slightly (CUH).
4. Use stopping your urine flow only as an occasional check — no more than once a week — never as an exercise, because it can stop your bladder from emptying fully (CUH; NIDDK).

Keep breathing normally. When you breathe and move, the pelvic floor works together with the abdominal muscles and the diaphragm, but during Kegel exercises your stomach and thighs should stay relaxed (NIDDK).

Written or spoken instructions are not always enough. In a small study, only 49% of women performed an ideal contraction after brief verbal instruction (Bump et al., 1991). If you are unsure, a doctor or pelvic health physiotherapist can check your technique.

How long before you notice a difference

According to NIDDK, you may not feel your bladder control improve until after 3 to 6 weeks of regular practice (NIDDK). The NHS says it can take a few months (NHS). The time it takes depends on the cause of your symptoms and on your technique.

When to see a professional

• the exercises are painful, or sex is painful;
• you cannot find the right muscles;
• leaking of urine, wind or stools continues;
• you feel heaviness or bulging in the vagina;
• you are pregnant or have recently had pelvic surgery — agree a plan with your doctor before you start.

KegelFit offers a Kegel exercise timer and video workouts for the pelvic floor and the whole body. It helps you keep a routine, but it does not measure muscle strength or check your technique. Free to download, with in-app purchases: Google Play · App Store.

Sources

1. NIDDK. Kegel Exercises (last reviewed November 2021). https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises
2. Cambridge University Hospitals NHS. Pelvic floor exercises in men: frequently asked questions (version 11, 13 September 2024). https://www.cuh.nhs.uk/patient-information/pelvic-floor-exercises-in-men-frequently-asked-questions/
3. NHS. 10 ways to stop leaks (reviewed 15 June 2023). https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/
4. NICE. Urinary incontinence and pelvic organ prolapse in women: management (NG123), 2019. https://www.nice.org.uk/guidance/ng123
5. NICE. Lower urinary tract symptoms in men: management (CG97). https://www.nice.org.uk/guidance/cg97
6. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654. https://doi.org/10.1002/14651858.CD005654.pub4
7. Bump RC, et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165(2):322–327. https://doi.org/10.1016/0002-9378%2891%2990085-6
8. Dorey G, et al. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004;54(508):819–825. https://pubmed.ncbi.nlm.nih.gov/15527607/