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

Maggie Abrams PT, DPT, WCS, NBC-HWC
Author:
September 27, 2024
Maggie Abrams PT, DPT, WCS, NBC-HWC
Physical therapist
By Maggie Abrams PT, DPT, WCS, NBC-HWC
Physical therapist
Maggie is a board-certified women’s health physical therapist, a health and wellness coach, and a visceral manipulation specialist.
Image by Valentina Barreto / Stocksy
September 27, 2024

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!"

Well, consider this your guide to dealing with pelvic floor issues before they become a problem, using exercises that are appropriate for you.

What are the pelvic floor muscles?

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

Let's start with the basics: The pelvic floor muscles are like a trampoline that lives at the base of your pelvis, with the bones of your pelvis serving as the trampoline frame. Everyone has pelvic floor muscles, but the exact shape of those muscles differs based on the shape of your genitalia.

Your pelvic floor muscles are just like any other striated muscles in the body: They can be strengthened with exercise.

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.

When they contract, they lift your organs toward your head. If you've heard of your "core muscles," the pelvic floor is the bottom of that group, with your abdominals providing the sides and your diaphragm serving as the top. They also share anatomy with the hip and do a lot during hip movements such as walking, running, and standing up from sitting. 

Who needs to strengthen their pelvic floor?

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.

People who experience any of the following may be candidates for exercising and strengthening their pubic floor:

Note: Pelvic floor strengthening is NOT for everyone

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.

Instead, I need to have you put down the bowling ball and learn how to relax first. It's the same for people who hold tension in their pelvic floor muscles. They have to learn how to relax and lengthen them first, before they can find relief.

The most effective exercises for strengthening your pelvic floor

The most effective exercises for your pelvic floor will be those given to you by a physical therapist who did an evaluation and prescribed exactly what you need. That said, this is one routine you can try to do at home to start strengthening your pelvic floor using proper form with the help of a mirror:

Step 1: Get to know your pelvic floor

To start, I often recommend that patients get up close and personal with their pelvic floor. Get comfortable in a private space, lying down on your back with lots of pillow support behind your head and shoulders. Use a mirror to look at your genitalia and anus. If you try to squeeze your pelvic floor muscles, do you see your anus (and vagina if you have one) squeeze closed and lift into your body? You can think about squeezing to hold in a fart in a crowded elevator (or about picking up a marble with your vagina). Then, if you try to relax your pelvic floor muscles, do you see your anus (and vagina if you have one) drop and open slightly? Imagine releasing a clenched fist or dropping a wrench into a hammock.

Step 2: Practice relaxing your pelvic muscles

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.

Then, use your mirror again to see if the pelvic floor is now moving with your breath. You want to see your anus drop and open a little with your deep inhalations.

Step 3: Squeeze and lift your muscles

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.

Bonus: Once three sets feel easy, progress them by doing them in a sitting position. Work to achieve the same level of squeeze and lift you had while lying down. Once that's easy, move to standing.

How to tell if your pelvic floor training is working

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.

If it feels like these exercises make any of your symptoms worse, stop and check in with a pelvic floor physical therapist. This can be a tricky area of the body to make sense of on your own. In fact, research shows that 24% of women do not perform Kegels correctly4, so know it's not your fault if you feel like you can't sense what I've described or you're not sure if you're doing them correctly.

The takeaway

The pelvic floor muscles can be tricky to train effectively because different types of dysfunctions can present the same way, with common symptoms of leakage and pain. And while those symptoms are common, they aren't normal—and you don't have to live with them forever. The good news is that pelvic floor muscles respond to training, and physical therapy is highly effective at eliminating these symptoms5.

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