The Best Exercises To Strengthen Your Pelvic Floor, From A PT

As a pelvic floor physical therapist, I often see patients who have dealt with pelvic symptoms for years without realizing that treatment is available. By the time they come to see me, they tell me, "I wish I had known about this sooner!"

Strengthening the pelvic floor muscles is one way to deal with pelvic issues, but it's not the right treatment for everyone.

The pelvic floor muscles do a lot for us. They squeeze to close the opening from the bladder and the anus (and vagina if you have one), supporting continence, but they also relax and lengthen to allow you to pee and poop (and have penetrative intercourse and birth babies). They contribute to erections (both clitoris and penis) and the contractions of orgasm too.

Let's talk about what a "strong" pelvic floor can do.

A strong pelvic floor can keep you continent even against the pressure from a sneeze (aka a "jump" on a trampoline). A strong pelvic floor also helps you have a full and pleasurable sexual response. It can lift against the pressure your body creates when you carry something and helps you stabilize your trunk and hips while going upstairs, getting out of the car, or during exercise. If your pelvic floor doesn't have the strength to do those things, you might experience leakage or pain with those activities.

The good news is that your pelvic floor muscles are just like any other striated muscles in the body: They can be strengthened with exercise.

Other types of pelvic floor dysfunction can also lead to these symptoms and won't respond positively to pelvic floor strengthening.

For example, some people hold a lot of tension in their pelvic floor muscles, which makes the muscles very tight. You might then ask, "How do they have leakage if their muscles are tight?!" To answer that question, I'll offer you a metaphor: If I asked you to walk around all day carrying a bowling ball in your hands and then suddenly I tossed you a tennis ball to catch, would you be able to catch it? No. Your arms would be too exhausted and tight to react.

That's what it's like when someone holds tension in their pelvic floor all day, and then they sneeze. Their pelvic floor is too exhausted and tight to react, so a leak can happen.

This demonstrates why it's not a good idea for someone with a tight pelvic floor to do strengthening exercises. In the bowling ball scenario, would it make sense for me to have you strengthen your arms to help you catch that tennis ball? No.

Still lying down on your back, place one hand on the lowest part of your belly and one hand on your chest. Trying not to move your chest hand, breathe in deeply all the way to your belly hand, feeling it rise. Breathe out slowly, feeling your belly hand drop back down. Continue to breathe like this, into your belly, keeping a slow pace for five minutes.

Breathe in deeply and feel the pelvic floor muscles relax and lengthen. Then, as you exhale, squeeze and lift the pelvic floor. If you aren't sure if you are doing it, use your mirror to watch for the anus squeezing closed and lifting into the body. See if you can match how long you hold your squeeze with the length of your exhalation.

When you've blown out all your air, breathe in again and relax the pelvic floor muscles. Repeat this until you've done 8-12 squeezes, completing three sets per day3, but stop if you notice you're having trouble relaxing all the way between squeezes.

When you first start to train your pelvic floor muscles, you may notice some immediate symptom relief. This tends to happen because the brain is improving its ability to talk to the pelvic floor muscles.

Then, most people will experience a slowdown as they continue to strengthen their muscles, which can last up to six to eight weeks. After that, finally, most people will notice bigger changes that might look like a decrease in leakage (urine or stool), increased sexual response, feeling stronger in their hips and core, and/or a reduction of pain in their hips, back, and pelvis.