Pelvic floor exercises: a clear guide to doing them right

Pelvic floor exercises (often called kegels) are repeated, controlled squeezes and releases of the muscles that support your bladder, bowel and uterus. Done correctly and consistently for at least three months, they reduce leaking for many women and can improve prolapse symptoms and sexual response. They are not the right starting point for everyone, though: if your pelvic floor is already tight, relaxation comes first.

What the pelvic floor does

The pelvic floor is a layer of muscles that stretches like a sling from the pubic bone at the front to the tailbone at the back. It does several jobs at once:

• keeps the bladder and bowel closed until you choose to empty them
• supports the pelvic organs against the pressure of coughing, lifting and jumping
• contracts rhythmically during orgasm and contributes to arousal
• relaxes to allow peeing, bowel movements, penetration and birth

That last point is often forgotten. A healthy pelvic floor is not simply strong. It can contract when needed and let go fully afterwards.

How to find the right muscles

Sit comfortably with your thighs and buttocks relaxed. Imagine you are trying to stop yourself passing wind and, at the same time, trying to stop the flow of urine. The feeling is a squeeze and a gentle lift inward and upward. Your belly, buttocks and inner thighs should stay soft.

If you are unsure, a few other cues can help:

• Place a clean finger just inside the vagina and squeeze. You should feel a gentle tightening and lift around the finger.
• Watch with a hand mirror. The area between the vagina and anus (the perineum) should draw slightly inward, not bulge outward.
• Try the exercise lying down first, where gravity makes the muscles easier to feel.

Avoid practicing by stopping your stream on the toilet. Doing it once to identify the muscles is fine, but making it a habit can disturb normal bladder emptying.

How to do the exercises

The NHS and most hospital physiotherapy teams teach two types of squeeze.

Slow squeezes (endurance)

1. Breathe in and let your belly relax.
2. As you breathe out, squeeze and lift the pelvic floor.
3. Hold for as long as you can, up to 10 seconds, while breathing normally.
4. Let go fully and rest for about the same length of time.
5. Repeat up to 10 times.

Quick squeezes (power)

Squeeze and lift firmly, then release straight away. Repeat until the muscles tire, up to 10 times. Quick squeezes train the reflex you need when you cough, sneeze or laugh.

Aim for a set of each, about three times a day. If you can only hold for two or three seconds at first, start there and build up gradually.

The release matters as much as the squeeze

Many women rush the relaxation phase. After each contraction, pause and feel the muscles drop back to their resting position. If you notice that you cannot quite let go, or that the area feels tired and achy after a session, that is useful information. It may point to a pelvic floor that holds too much tension, which is covered in detail in our guide to the hypertonic pelvic floor. Practicing reverse kegels alongside your squeezes trains this release deliberately.

Common mistakes

Who benefits most

The evidence for pelvic floor muscle training is strongest for stress urinary incontinence, the kind of leaking that happens with coughing, sneezing or exercise. National guidance in the UK recommends at least three months of supervised training as a first treatment. It also helps with:

• mild to moderate pelvic organ prolapse symptoms
• leaking or urgency during pregnancy and after birth (see the pelvic floor after childbirth)
• some types of bowel control problems
• sexual response, for women whose muscles are weak rather than tense

When strengthening is not the answer

Pain during sex, a feeling that penetration hits a wall, burning, pelvic aching, constipation with straining, or a slow or hesitant urine stream can all be signs that the muscles are overactive rather than weak. Adding more kegels to an already tight pelvic floor can increase pain.

This is one of the main reasons the editorial team recommends an assessment before you start a long program, especially if pain is part of the picture. A pelvic floor physical therapist can check both strength and the ability to relax, and design a plan that may begin with release work rather than strengthening. If painful sex is your main concern, our overview of dyspareunia explains the wider range of causes.

Making it a habit

Consistency is where most programs fail. A few practical approaches help:

• Link your exercises to something you already do daily, such as brushing your teeth or waiting for the kettle.
• Use a reminder on your phone, or a free pelvic floor app that times holds and rests.
• Track how often you leak, so you can see change over weeks rather than days.
• Once the basic squeeze feels easy, practice it in real situations: tighten just before you cough, sneeze or lift.

Some women like feedback from a device. Our guide to kegel trainers explains what they do and who should avoid them.

When to get help

See a GP, gynecologist or pelvic floor physical therapist if you cannot feel the muscles working, if leaking is not improving after three months of regular practice, if you notice a bulge or dragging sensation in the vagina, or if exercises cause pain. Guidance from national bodies favors supervised training for this reason: many women who think they are doing kegels correctly turn out to be bearing down instead.