Pelvic floor exercises for women

What are pelvic floor muscles?

They are layers of muscles stretching like a hammock from the pubic joint at the front of the pelvis to the coccyx and sacrum at the back of the pelvis. They are firm and supportive, helping to hold the bowel, bladder and uterus in place and closing the outlets of the bladder and bowel. When you pass urine or have a bowel motion, the pelvic floor muscles relax.

After emptying, they tighten again to restore control.

Why do pelvic floor exercises?

Weakness of the pelvic floor muscles can be a common problem affecting 1 in 3 women by middle age, resulting in incontinence and prolapse.

This may be due to the effects of pregnancy, childbirth, pelvic surgery or simply getting older; being overweight or constipated may add to strain on the muscles. Incontinence can affect your bladder and/or bowel.

These exercises are important for all women, particularly if you:

  • leak on coughing, sneezing, laughing or physical exertion
  • have difficulty controlling wind
  • leak before reaching the toilet
  • are pregnant or have recently had a baby
  • are menopausal or post-menopausal

Finding the pelvic floor muscles

  • Sit comfortably on a firm chair with your knees slightly apart or lie down.
  • Tighten your back passage – as if you are stopping yourself passing wind. Do not squeeze your buttocks or leg muscles. Do not hold your breath, continue to breathe normally.
  • Tighten your vagina and front passage – as if you are trying to stop the flow of urine. Try to feel the muscles lifting upwards and forwards towards the pubic bone.
  • Feel the muscles working together, then relax.
  • Tighten the pelvic floor muscles as above and hold this. How many seconds can you hold? Aim for 5 seconds – when you let go, can you feel the muscles relax? If not, you have held too long – try again with a shorter hold. Some women may be able to hold for only 1-2 seconds and others as many as 8-10 seconds. It is important to discover your hold time.

Pelvic floor exercises

In sitting – as before:

Exercise 1- slow pull-ups

Tighten the pelvic floor muscles slowly. Continue to tighten for your length of hold, relax, and feel the muscle let go. Rest for the same number of seconds. Repeat this 5 times. As it gets easier, gradually increase length of hold and number of repetitions, aiming for 10 seconds.

Exercise 2 - fast pull-ups

Tighten the pelvic floor muscles quickly. Let go straight away. Repeat this 10 times – approximately 1 contraction per second.

Pelvic floor exercise routine

Do exercise 1 and 2 at each session. As soon as you can, increase to 10 slow and 10 fast pull-ups. Aim to repeat each session at least 3 times each day.

As your muscles get stronger you may progress to doing the exercises in standing as well as in sitting or lying.

Do not expect immediate improvement – so do not give up. You need to continue this routine for at least 6 months. As the muscles get stronger you will be able to increase your hold time and number of repetitions at each session.

Do not practice stopping the flow of urine midstream as this may interfere with the normal process of emptying your bladder.

Exercise for life

  • Continue pelvic floor exercises several times per day for the rest of your life in order to keep these muscles fit and healthy. If symptoms return increase your daily input again.
  • Try to get in the habit of tightening your pelvic floor muscles before you cough, sneeze or lift anything.
  • If your problem is ‘urgency’ (needing to get to the toilet quickly), tighten your pelvic floor muscles when you get the desire to empty your bladder; wait until the desire passes before moving.

Additional tips

Being constipated or overweight can strain the pelvic floor muscles so eat a balanced diet including fruit and vegetables and drink between 6 and 8 cups of fluid a day. Avoid tea, coffee or coca-cola if you suffer from urgency or frequency (the need to pass urine more often than normal).

Specialist referral

If you have difficulty in identifying your pelvic floor muscles and have symptoms of incontinence discuss this with your consultant or GP who can refer you to a physiotherapist who specialises in pelvic floor problems.

References

Laycock, J and Haslam, J (2008) Therapeutic management of incontinence and pelvic pain. Springer Verlag. (2nd ed)
NICE Clinical Guideline 40: Urinary incontinence. The management of urinary incontinence in women (2013)

NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

North Bristol NHS Trust,
Southmead Hospital Bristol
BS10 5NB

See your appointment letter for the number to phone with any queries you may have

© North Bristol NHS Trust. This edition published September 2019. Review due September 2021. NBT002529