>Continence Information > Living with incontinence > Pelvic Floor Muscle Exercise

Exercise plays a large part in maintaining a healthy body weight. Carrying excess body weight applies pressure to the pelvic floor muscles which supports the bladder and bowel to function properly. It is recommended to exercise daily as exercise stimulates movement of the bowel which help ease constipation.

Though a general fitness regime is good for you, one form of exercise is particularly beneficial in helping to strengthen your pelvic floor muscles. That is pelvic floor muscle exercises! Strengthening your pelvic floor muscles will help you actively support your bladder and bowel. This improves bladder control and can reduce or stop leakage of urine and faeces. Like other muscles, the pelvic floor muscles become stronger with a regular exercise program.

If you do have symptoms relating to urinary or faecal incontinence seek help as the symptoms won't go away on their own and may worsen over time. For further information and advice ring the National Continence Helpline on 1800 33 00 66.

On this Page...

• Pelvic floor muscles
• Common Myths about Pelvic Floor Exercise
• The benefits of pelvic floor muscles exercises
• Identifying your pelvic floor muscles
• Exercising your pelvic floor muscles
• When to seek professional help

Pelvic floor muscles

Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic organs are the bladder and bowel in men, and bladder, bowel and uterus in women.

Pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and sitting bone to sitting bone (side to side). These muscles are normally firm and thick.

Imagine the pelvic floor muscles as a round mini-trampoline made of firm muscle. As with the mat of a trampoline, the pelvic floor has the potential to move down and up. The bladder, uterus and bowel lie on the pelvic floor muscle layer.

Now imagine a hole in the trampoline for the passages to pass through. There are two passages in men (the urethra and anus) and three passages in women (the urethra, vagina and anus). The pelvic floor muscles normally wrap quite firmly around the hole in the trampoline to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter).

All these muscles are part of the complex layer called the pelvic floor. Although it is hidden from view, it can be consciously controlled and therefore trained, much like the arm, leg or abdominal muscles.

Anatomy of urinary bladder and pelvis with pelvic floor muscles 

Male	Female

What do pelvic floor muscles do?

Pelvic floor muscles provide support to the organs that lie on it. The sphincters give us conscious control over the bladder and bowel, to maintain control of urine, faeces and flatus (wind) and to allow us to delay emptying until it is convenient.

Pelvic floor muscles are important for sexual function in both men and women. In men, it is important for erectile function and ejaculation. In women, voluntary contractions of the pelvic floor contribute to sexual sensation and arousal. The pelvic floor muscles also provide women support for the baby during pregnancy and assist in the birthing process.

The muscles of the pelvic floor work with the abdominal and back muscles to stabilise and support the spine.

What can happen to these muscles?

• They can get too loose and weak This is a common problem for women because of pregnancy and childbirth. However, they can be successfully strengthened with pelvic floor muscle training.
• They can get too tight This is less common but very distressing problem for both men and women. The causes are often complex and professional help is required to resolve the problem.

In almost all cases it is possible to gain control over the pelvic floor muscles and to rain them to do their job well.

What can make these muscles too loose?

• Pregnancy and childbirth Evidence suggests that problems can start during pregnancy and not just after birth. Women who have had multiple births, instrumental births (with forceps or ventouse), severe perineal tearing or large babies (birth weight over 4kg) are at greater risk of pelvic floor muscle damage.
• Straining on the toilet (constipation) Chronic or repeated straining on the toilet (associated with constipation) can lead to pelvic floor weakness and/or prolapse of the organs into the vagina or to a rectal prolapse (the rectal lining protrudes from the anus). It is important to teach the underlying bowel problem and good toileting habits.
• Chronic coughing Chronic coughing for any reason (for example, asthma, bronchitis or a smoker's cough) increases the risk of urinary incontinence and prolapse.
• Heavy lifting Heavy lifting can create pressure on the pelvic floor and ultimately lead to prolapse. Women in certain professions such as nursing or courier services are at particular risk. Women performing heavy weight training at a gym can also be at risk of straining the pelvic floor.
• High impact exercise Women involved in high impact sports such as basketball, netball or running are at increased risk of leaking urine. This applies to elite athletes as well.
• Age Pelvic floor muscles tend to get weaker with increasing age. Pelvic floor muscle exercises can help strengthen them at any age.
• Obesity Being overweight increases the risk of leaking urine and may place greater strain on the pelvic floor.

What can make these muscles too tight?

This is a complex issue. Sometimes pelvic floor muscles can fail to relax properly, which causes the bladder and bowel not to empty properly. Sometimes pelvic floor muscles can be very tight in women so that intercourse is difficult or impossible. Pain is often the culprit causing the pelvic floor muscles to tighten up protectively. Because the pelvic floor is hidden from view, the problem can often go undiagnosed for a long time. However, seeking help from a pelvic floor physiotherapist can effectively treat it.

Common myths

• Pelvic floor muscles exercises are easy to do Everyone seems to think that women should intuitively know how to pelvic floor muscles exercises, but they are quite complicated muscles which are hard to isolate.
• Pelvic floor muscle exercises can be learned from a pamphlet Research shows that up to 50% of women trying to do pelvic floor muscle exercises from a pamphlet get the technique wrong. Practicing the wrong technique will not help and could even make the problem worse.
• Pelvic floor muscle exercises don't work, I've tried them and they made no difference Research shows that pelvic floor muscle exercises are effective for some types of incontinence such as stress incontinence and/or overactive bladder causing urge incontinence. They can also help faecal incontinence when the cause of the problem is a weak pelvic floor. However, they will not work if there are other causes of urine or faecal loss (for example, infection, inflammation or underlying bowel disease). There is amply evidence to show that pelvic floor muscle exercise is effective when the exercises are done correctly and when they are adequately training and supervised by a continence and women's health or pelvic floor physiotherapist, or continence nurse advisor. If your 'do-it-yourself' pelvic floor muscle exercise program did not work, then chances are they were not done the right way. Get help from a health professional to confirm that your technique is correct and have an individualised training program specifically developed for your problem and the condition of your pelvic floor muscles.
• Pelvic floor muscle exercises are done by stopping the flow of urine over the toilet This is a common misconception. Stopping the flow of urine on the toilet is not an exercise but a way of identifying the pelvic floor muscles.
• Pelvic floor muscle exercises won't work for me, I'm too old Age is no barrier to the benefits of pelvic floor muscle exercises. There is evidence to suggest that older people are just as likely to benefit from pelvic floor muscle exercises for incontinence as younger people.
• I've had a baby, the damage is done, pelvic floor muscle exercises won't help Postnatal pelvic floor muscle exercises have been shown to assist in the recovery of pelvic floor muscle function and to reduce or cure the likelihood of urinary incontinence I women who have had instrumental births or big babies.
• There's no need to do pelvic floor muscle exercises until you have a baby Pelvic floor muscle training is important to control incontinence which may start during pregnancy. Pelvic floor muscle exercises done during pregnancy will help the recovering of pelvic floor muscle function and bladder control after the birth of the child. New research shows that strong pelvic floor muscles will not make birthing more difficult.
• I can't do pelvic floor muscle exercises because I find it hard to get down on the floor Some people think that pelvic floor muscle exercises are done on the floor. In reality however, these exercises can be done in any position. The word 'floor' merely refers to their position at the bottom (or floor) of the pelvis. In fact, they should especially be done standing up as control of urine leakage is usually most necessary when upright.
• Men don't have a pelvic floor Men do have pelvic floor muscles. They can even be trained to improve bladder control after prostate surgery.

The benefits of pelvic floor muscles exercises

• improved control over bladder and bowel function;
• reduced risk of prolapse (i.e. 'sagging' of internal organs);
• better recovery from childbirth and surgery;
• increased sexual sensation and orgasmic potential; and
• increased social confidence and quality of life.

How to improve your muscle control

• Become proactive and take control of your pelvic floor muscles There are many ways that you can learn more about your pelvic floor muscles. These include visiting a continence and women's health or pelvic floor physiotherapist; or continence nurse advisor; or contacting the National Continence Helpline (freecallTM) on 1800 33 00 66 for free advice and access to a wide range of information.
• Learn how to correctly exercise your pelvic floor muscles It is very important to correctly identify your pelvic floor muscles before moving into a regular pelvic floor muscle exercise program.
• See a health professional if you are unsure about your exercises or continue to experience symptoms If you experience any difficulty identifying the correct muscles or are unsure if you are performing the exercises correctly, please see a health professional.
• Keep your pelvic floor muscles in good working order for life As with any muscles, fitness involves regular training. This applies to the pelvic floor as well. Develop it as a daily habit, like brushing your teeth.
• Maintain general fitness and keep your weight within a healthy range Maintaining general fitness and keeping your weight within the recommended range will assist you in all facets of your health and wellbeing.
• Remember that improved control for some may involve learning to relax your muscles Just exercising the pelvic floor is not a self-help treatment for incontinence. If there is a problem with bladder or bowel control, it is important to be properly assessed as weak pelvic floor muscles are just one of the many causes of incontinence.

Identifying your pelvic floor muscles

Method 1 - Stopping the flow

The first step in performing pelvic floor muscle exercises is to identify the correct muscles. There are several ways which may help you to correctly identify the different parts of your pelvic floor muscles.

One way is to try to stop or slow the flow of urine midway through emptying the bladder. Stopping the flow of urine repeatedly on the toilet is not an exercise, but a way of identifying your pelvic floor muscles. This should only be done to identify which muscles are needed for bladder control.

If you can stop the flow of urine over the toilet for a second or two, then relax and finish emptying without straining. This 'stop-test' may help you identify the muscles around the front passage which control the flow of urine. It is not recommended as a regular exercise.

Method 2 - Visualisation

Another method to identify your pelvic floor muscles is to imagine stopping the flow of urine and holding in flatus (wind). This can be done lying down, sitting or standing with legs about shoulder width apart.

• Relax the muscles of your thighs, bottom and tummy.
• Squeeze in the muscles around the front passage as if trying to stop the flow of urine.
• Squeeze in the muscles around the vagina and suck if upwards inside the pelvic.
• Squeeze in the muscles around the back passage as if trying to stop the passage of passing flatus.
• The muscles around the front and back passages should squeeze up and inside the pelvis.
• Women who are familiar with using tampons can imagine squeezing in the vagina as if squeezing a tampon up higher in the vagina.
• Identify the muscles that contract when you do all these things together. Then relax and loosen them.

Getting the technique right

This is the most important part of the pelvic floor muscle exercises as there is no point doing them if you are not doing them correctly.

Imagine letting go like you would to pass urine or to pass flatus. Let your tummy muscles hang loose too. See if you can squeeze in and hold the muscles inside the pelvis while you breathe. Nothing above the belly button should tighten or tense. Some tensing and flattening of the lower part of the abdominal wall will happen. This is not a problem, as this part of the tummy works together with the pelvic floor muscles.

Try tightening your muscles really gently to feel just the pelvic floor muscles lifting and squeezing in. If you cannot feel your muscles contracting, change your position and try again. For example, if you cannot feel your muscles contracting in a seated position, try lying down or standing up instead.

After a contraction it is important to relax the muscles. This will allow your muscles to recover from the previous contraction and prepare for the next contraction.

It is common to try too hard and have too many outside muscles tighten. This is an internal exercise and correct technique is vital.

Doing pelvic floor muscles exercises the wrong way can be bad for you, so please see a health professional if you cannot feel your muscles hold or relax.

Exercising your pelvic floor muscles

If you have mastered the art of contracting your pelvic floor muscles correctly, you can try holding the inward squeeze for longer (up to 10 seconds) before relaxing. Make sure you can breathe easily while you squeeze.

If you can do this exercise, repeat it up to 10 times, but only as long as you can do it with perfect technique while breathing quietly and keeping everything above the belly button relaxed.

This can be done more often during the day to improve control.

When to seek professional help

Seek professional help when you have bladder or bowel control problems with symptoms such as:

• bladder or bowel frequency or urgency to go to the toilet;
• accidental leakage or urine, faeces or wind;
• difficulty emptying the bladder or bowel;
• vaginal heaviness or a bulge; and
• pain in the bladder, bowel or pelvic floor are, in the back when exercising the pelvic floor or during intercourse.

These problems may not necessarily be linked to weak pelvic floor muscles and should be properly assessed.

Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored. The exercises described are only a guide and may not help if done incorrectly or if the training is inappropriate.

Incontinence can have many causes and should be individually assessed before starting a pelvic floor muscle training program. Tightening or strengthening pelvic floor muscles may not be the most appropriate treatment so speak to a health professional if you have persistent problems with your bladder or bowel.

Health professionals

Continence and women's health or pelvic floor physiotherapists specialise in pelvic floor muscle exercises. They can assess your pelvic floor function and tailor an exercise program to meet your specific needs. They can also prescribe other treatment options such as biofeedback and discuss relevant lifestyle factors with you.

For a list of continence and women's health or pelvic floor physiotherapist, visit the Australian Physiotherapist Association