Not just Kegels: combining pelvic floor exercises with whole-body training

Kegel exercises train one specific group of muscles. But your pelvic floor works all day — when you cough, carry shopping, run or jump. So it helps not only to train these muscles, but also to choose general exercise that does not work against them.

Who should pay closer attention to the pelvic floor

For women, NICE lists these risk factors for pelvic floor dysfunction (NICE NG210):

• modifiable: a body mass index over 25, smoking, lack of exercise, constipation, diabetes;
• non-modifiable: age, a family history of incontinence, gynaecological surgery, gynaecological cancer and its treatment, a chronic cough or lung disease, and factors related to pregnancy and birth.

For men, the pelvic floor needs particular attention before and after prostate surgery (CUH). People with neurological conditions — such as stroke, spinal injury, multiple sclerosis or diabetes — should plan exercise with a healthcare professional (CUH). Running, jumping and sit-ups put pressure on the pelvic floor and can make leaks worse (NHS).

Learning about the pelvic floor can start early: NICE recommends teaching young women aged 12 to 17 about pelvic floor anatomy and exercises in education settings (NICE NG210).

Why add general exercise

Pelvic floor exercises do not replace everyday physical activity. WHO recommends that adults do 150–300 minutes of moderate aerobic activity a week, plus muscle-strengthening activities on at least two days a week (WHO; Bull et al., 2020). NICE advises women that physical activity and a healthy diet can help prevent pelvic floor dysfunction, and that for people with a BMI over 30, weight loss can help with urinary incontinence and prolapse symptoms (NICE NG210).

KegelFit's sessions combine Kegel exercises with movements for the abdominal, gluteal and thigh muscles. This is a convenient way to do both, but there is no evidence that the combination is several times more effective than doing them separately.

Signs the load is too much

Stop, or switch to an easier version, if:

• you leak urine during the exercise;
• you feel heaviness, pressure or bulging in the vagina or perineum;
• you hold your breath, strain, shake or tense other muscles, such as shrugging your shoulders (Pelvic Floor First);
• you cannot contract and then relax your pelvic floor while moving.

What you can change: use a lighter weight or a smaller range of movement, do fewer repetitions, or swap high-impact moves for low-impact strengthening such as pilates (NHS). Before you lift something heavy, gently tighten your pelvic floor and hold it during the lift (NHS; CUH).

How to build your routine

• Start small — for example, one short session a day.
• Add repetitions or sets only when you can keep your technique to the end of a set (Pelvic Floor First).
• Relax the muscles fully between contractions. Overdoing it can lead to straining when you urinate or open your bowels (NIDDK).
• Consistency matters more than the length of any single session. Changes in bladder control usually take at least a few weeks to appear (NIDDK).

What about medicines?

Medicines for urinary incontinence are chosen by a doctor after an assessment, depending on the type of incontinence, your age and any other conditions. For stress urinary incontinence in women, NICE recommends starting with at least 3 months of pelvic floor muscle training supervised by a professional (NICE NG123). App-based sessions do not replace such a programme, or an assessment.

When to get professional help

• leaking continues or gets worse;
• you have pelvic pain or pain during sex;
• you notice heaviness or bulging;
• you have recently given birth or had pelvic or prostate surgery — agree the timing and intensity of exercise with your doctor.

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. NICE. Pelvic floor dysfunction: prevention and non-surgical management (NG210), 2021. https://www.nice.org.uk/guidance/ng210
2. NICE. Urinary incontinence and pelvic organ prolapse in women: management (NG123), 2019. https://www.nice.org.uk/guidance/ng123
3. 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/
4. NHS. 10 ways to stop leaks (reviewed 15 June 2023). https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/
5. NIDDK. Kegel Exercises (last reviewed November 2021). https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises
6. Continence Health Australia (formerly Continence Foundation of Australia). Pelvic Floor First: Pelvic Floor Safe Exercises. https://www.pelvicfloorfirst.org.au/pages/pelvic-floor-safe-exercises.html
7. WHO. Physical activity. Fact sheet, 26 June 2024. https://www.who.int/news-room/fact-sheets/detail/physical-activity
8. Bull FC, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–1462. https://doi.org/10.1136/bjsports-2020-102955