How to Perform Pelvic Floor Strengthening Exercises
Pelvic floor muscle training (PFMT) should be performed as a program of repeated voluntary pelvic floor muscle contractions, ideally taught and supervised by a healthcare professional, as this approach has been proven to improve symptoms and quality of life in patients with pelvic floor dysfunction. 1
Basic Technique
The fundamental exercise involves voluntary contraction of the pelvic floor muscles (levator ani muscles including puborectalis, pubococcygeus, iliococcygeus, and coccygeus muscles) to strengthen these muscles and provide urethral support. 2
Key Steps for Proper Execution:
Identify the correct muscles: Contract the muscles you would use to stop urination midstream or prevent passing gas, without tightening your abdomen, buttocks, or thigh muscles 2, 3
Perform the contractions: Squeeze and lift the pelvic floor muscles inward and upward, holding each contraction 3
Apply exercise physiology principles: Training should focus on improving muscle strength, power, endurance, and relaxation through progressive overload 3
Training Protocol
A structured program supervised by a trained healthcare professional is essential for effectiveness. 1 The evidence shows that women who received supervised pelvic floor muscle training were more likely than control participants to report cure or symptom improvement with better satisfaction and quality of life. 1
Recommended Approach:
Frequency: Perform exercises daily, as recommended by the WHO for pregnant and postpartum women to reduce urinary incontinence risk 1
Specificity: Training must be specific to the type of pelvic floor dysfunction—pelvic floor muscle contraction is an acquired skill, not innate, requiring dedicated practice 4
Professional guidance: Work with a physical therapist or healthcare provider trained in pelvic floor rehabilitation to ensure proper technique 1, 5, 6
Critical Distinction: When NOT to Do Strengthening Exercises
Pelvic floor strengthening exercises (Kegel exercises) should be AVOIDED in patients with pelvic floor tenderness or hypertonic pelvic floor disorders. 1 In these cases, manual physical therapy techniques that resolve trigger points, lengthen muscle contractures, and release connective tissue restrictions are appropriate instead. 1
Assessment Before Starting:
Check for pelvic floor tenderness: If present, manual physical therapy rather than strengthening is indicated 1
Evaluate for hypertonicity: Patients with tight, overactive pelvic floor muscles need relaxation techniques, not strengthening 6
Important Considerations
Other exercise regimens (Pilates, Paula method, hypopressive exercises) performed alone do not increase pelvic floor muscle strength and should not be substituted for specific pelvic floor muscle training. 7 These may be used as adjuncts but only when combined with proper PFMT. 7
Safety Profile:
No harms have been identified with behavioral interventions like pelvic floor muscle training when performed correctly 1
Proper technique is essential: Incorrect performance (such as bearing down instead of lifting) can worsen symptoms, emphasizing the need for professional instruction 4, 6
Expected Outcomes:
Effectiveness varies by condition: PFMT is particularly effective for stress urinary incontinence and has evidence supporting its use for urge incontinence, pelvic organ prolapse, and fecal incontinence 5, 6
Time commitment required: Strengthening pelvic floor muscles requires specificity training and dedication to an exercise program over weeks to months 4