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Your pelvic floor guide: why it’s important and what you can do to strengthen it
Written byLaura Harcourt
Reviewed byAndrew Chambler
Maintaining a healthy pelvic floor is important. This guide looks at the signs and potential causes of a weak pelvic floor and what you can do to strengthen it at home.
Summary
1What is the pelvic floor?
The pelvic floor refers to a group of muscles that sit at the base of your pelvis. They’re located just below your abdominal organs, which include...
2Signs you need to strengthen your pelvic floor
If you experience any of the following symptoms, it may be a sign of a weak pelvic floor or pelvic floor dysfunction: a sudden, urgent need to pass...
3What is a pelvic floor workout?
A pelvic floor workout includes specially designed exercises to strengthen the pelvic floor muscles. Increasing your pelvic floor strength can help...
With nearly 60% of women in the UK experiencing at least one symptom of poor pelvic health.1 While you might well think of pelvic floor complaints as an issue that only affects women, maintaining healthy and strong pelvic floor muscles can benefit everyone.
If your pelvic floor doesn’t work as it should, it can lead to issues with incontinence, uncomfortable sex and more severe issues like pelvic organ prolapse (more on that later). Luckily, there are some simple at-home exercises you can do to help get your pelvic floor back into shape.
In this guide to pelvic floor health, we’ll help you understand what the pelvic floor does and why it’s so important. We’ll also describe the signs of a weakening pelvic floor to look out for and give you three simple exercises you can do at home to strengthen your pelvic floor muscles. Let’s get started.
What is the pelvic floor?
The pelvic floor refers to a group of muscles that sit at the base of your pelvis. They’re located just below your abdominal organs, which include the bladder, intestines and the uterus in women. The role of the pelvic floor is to support these organs and keep them in place.2
A healthy and strong pelvic floor is really important for bladder and bowel function and can also help maintain sexual function in both men and women.3,4,5
When the pelvic floor doesn’t work as it should, we call it ‘pelvic floor dysfunction’. This happens when the pelvic floor muscles become strained or weakened, leading to issues such as uncontrollable leaks, involuntary passing of wind and sexual discomfort or pain.5
Another type of pelvic floor dysfunction that affects women is pelvic floor prolapse.6 This is an uncomfortable, and sometimes painful, condition in which the weakened pelvic floor is overstretched. When this happens, the pelvic floor no longer holds one or more of the pelvic organs (uterus, bladder or rectum) in their normal positions, causing them to bulge into the vagina.5,7
What can cause a weak pelvic floor?
There are all sorts of things that can cause a weak pelvic floor. We’ve covered some of the main reasons below.
1. Getting older
As we get older, the muscles of the pelvic floor naturally weaken as a result of the various hormonal and muscular changes that we go through.5,8,9
In fact, when it comes to pelvic floor dysfunction in women, age is thought to be the number one risk factor that can’t be controlled.2,8,10,11
2. Pregnancy
During pregnancy, the entire abdominal area is put under increased pressure as the baby grows. The pelvic floor muscles must stretch to accommodate the growing uterus while supporting the other abdominal organs, creating a potential role in the development of pelvic floor dysfunction.12,13,14
Some researchers suggest that hormones during pregnancy could affect the chemical structure that makes up the pelvic floor tissue, as well as the length of fibres of collagen tissue, which in turn could affect the rate at which pelvic floor tissues stretch. Bladder problems experienced during pregnancy could also play a part.15,16,17
3. Childbirth
Childbirth (and the way your baby is delivered) could also have a significant effect on your pelvic floor.12,13
During vaginal labour, pelvic muscles can stretch quite a lot. As the baby passes through the birth canal, these muscles are displaced and often torn. Assisted vaginal births with forceps or vacuum could also lead to a higher risk of pelvic floor problems.12,13,18,19
4. Heavy lifting
Whether your job requires you to lift heavy objects or you’re into strength training, your pelvic floor may be affected over time by heavy lifting.9,20 As you strain to lift heavy objects, your pelvic floor muscles must bear a lot of pressure as they brace to keep your abdominal organs in place.12,21
5. Obesity
Being significantly overweight could increase your risk of pelvic floor disorders. Excess weight on your frame may put pressure on your abdominal area, risking urinary incontinence and even pelvic organ prolapse.6,9,22,23
6. Prostate cancer treatment
Following some treatments for prostate cancer, some men may experience temporary problems such as leaking urine and passing wind involuntarily as a result of damage to the pelvic floor muscles. Pelvic floor exercises may be given as an intervention to help with the effects of prostate cancer treatment. Nevertheless, wider populations still need to be researched.27,24,25
7. Smoking
Among the many other risks associated with smoking, the persistent smoker’s cough can increase intra-abdominal pressure each time you cough. This pressure could lead to a gradual weakening of the pelvic floor muscles over time.9,11,20
Giving up smoking is one way you can help eliminate this risk.
What are the signs you need to strengthen your pelvic floor?
If you experience any of the following symptoms, it may be a sign of a weak pelvic floor or pelvic floor dysfunction:5
- a sudden, urgent need to pass urine
- pain while urinating
- involuntary passing of small amounts of urine when coughing, sneezing, laughing or exercising
- passing wind accidentally
- bowel incontinence
- painful or uncomfortable intercourse
- constipation
- erectile dysfunction
- chronic pelvic pain
The good news is that it’s never too late to strengthen your pelvic floor muscles. By including pelvic floor training in your regular exercise regime, you can prevent symptoms and promote lifelong pelvic floor health.
What is a pelvic floor workout?
A pelvic floor workout includes specially designed exercises to strengthen the pelvic floor muscles.26
Increasing your pelvic floor strength can help prevent urinary incontinence, treat pelvic organ prolapse and even improve your sex life by increasing sensitivity and making orgasm stronger.26
If you consistently do pelvic floor exercises with the correct form, you should notice results after a few months.
What are the best exercises for your pelvic floor?
If you’re pregnant or have just given birth, the NHS recommends that you focus on your pelvic floor health in a more targeted way to prevent and treat pelvic floor problems.17
However, everyone should try and incorporate pelvic floor exercises into their regular daily routine to help keep their pelvic floor healthy.26
Read on to learn how to do these top three pelvic floor exercises.
When you think of pelvic muscle exercises, Kegels probably come to mind. Kegel exercises are simple pelvic floor muscle contractions that both men and women can do to strengthen their pelvic floor.27,28
You can do Kegel exercises standing, sitting or lying down.
- Find the muscles you’ll be targeting by imagining that you’re trying to stop passing gas
- Clench those muscles and hold them tightly for five to ten seconds
- Release for five seconds
- Do this at least ten times, three times per day
In addition to strengthening your legs and glutes (your buttocks muscles), squats can strengthen your pelvic floor muscles.29
- Stand with feet about hip-width apart
- Exhale as you bend your knees as if you’re going to sit in a chair
- Hold the squat position and continue exhaling
- Push through your feet to straighten your knees and return to standing. Focus on tightening your pelvic floor muscles while inhaling
- Repeat up to ten times
If you’re looking for a pelvic floor-friendly core exercise that engages your hips, buttocks, legs and pelvic floor, look no further than the bridge exercise.
- Lie on your back on a carpet, rug or yoga mat with your feet flat on the floor
- Bring your knees up to bend at a 90-degree angle. Ensure your head, hands, feet and shoulders are in contact with the floor
- Raise your pelvis until your back is straight
- Hold this pose for five to ten seconds
- Gently lower your pelvis back down to the floor
- Perform up to 30 times per day, every day
Pelvic floor trainers
For women who want to take their pelvic training to the next level, pelvic floor trainers may offer extra reassurance that they’re making progress and doing Kegel exercises correctly.30
Pelvic floor trainers are internal or external devices that may help strengthen the pelvic floor. They often connect to a mobile phone via an app. Some pelvic floor trainers, like the Intima KegelSmart, use a simple vibration-guided programme to guide users through their daily exercises while registering pelvic muscle strength and monitoring improvement.30
Although you can strengthen your pelvic floor without a device, some women find that the feedback and guidance provided by a pelvic floor training device are invaluable for supporting their workout.
The final say
A weak pelvic floor can cause symptoms that include incontinence and discomfort during sex.5,26
Maintaining a healthy and strong pelvic floor is important for both men and women, but it’s especially vital as you age, if you’re pregnant or recently had a child, or if you experience any of the symptoms of pelvic floor dysfunction.3,4,5
You can incorporate pelvic floor exercises into your regular workout or perform them together as part of a focused pelvic floor workout. When done properly, these exercises are a simple and effective way to strengthen your pelvic floor muscles from the comfort of your own home.
The advice in this article is for information only and should not replace medical care. Please also note scientific evidence for this topic is very limited and although there are emerging studies, more clinical studies need to be conducted. Please check with your GP or healthcare professional before trying any treatments and making any health-related decisions.
- Royal College of Obstetricians & Gynaecologists. RCOG calling for action to reduce number of women living with poor pelvic floor health [Internet]. [2023 November 3; cited 2024 Mar 8]. Available from: https://www.rcog.org.uk/news/rcog-calling-for-action-to-reduce-number-of-women-living-with-poor-pelvic-floor-health
- NHS Inform. Pelvic floor muscles [Internet]. 2023 [cited 2024 Mar 8]. Available from: https://www.nhsinform.scot/healthy-living/womens-health/middle-years-around-25-to-50-years/pelvic-health/pelvic-floor-muscles/
- Vilas Boas Sartori D, Kawano PR, Yamamoto HA, Guerra R, Pajolli PR, Amaro JL. Pelvic floor muscle strength is correlated with sexual function. Investigative and Clinical Urology. 2021;62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801170/
- Cohen D, Gonzalez J, Goldstein I. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sexual Medicine Reviews. 2016 Jan;4(1):53–62. Available from: https://www.sciencedirect.com/science/article/abs/pii/S2050052115000025
- Grimes WR, Stratton M. Pelvic Floor Dysfunction [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559246/
- NHS Choices. Overview - Pelvic organ prolapse [Internet]. 2024 [cited 2024 May 10]. Available from: https://www.nhs.uk/conditions/pelvic-organ-prolapse/
- Royal College of Obstetricians & Gynaecologists. Pelvic organ prolapse [Internet]. 2019 [cited 2024 Mar 8]. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-organ-prolapse/
- Alperin M, Cook M, Tuttle LJ, Esparza MC, Lieber RL. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles. American journal of obstetrics and gynecology [Internet]. 2016 Sep 1 [cited 2024 May 10];215(3):312.e1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003683/
- What causes pelvic floor disorders (PFDs)? [Internet]. https://www.nichd.nih.gov/. 2020 [cited 2024 May 10]. Available from: https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/causes#f2
- Rocío Adriana Peinado-Molina, Hernández-Martínez A, Martínez-Vázquez S, Julián Rodríguez-Almagro, Juan Miguel Martínez-Galiano. Pelvic floor dysfunction: prevalence and associated factors. BMC public health [Internet]. 2023 Oct 14 [cited 2024 May 10];23(1). Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16901-3
- National Institute for Health and Care Excellence. Pelvic floor dysfunction: prevention and non-surgical management [Internet]. [Published 2021 December 9; cited 2024 Mar 8]. Available from: https://www.nice.org.uk/guidance/ng210/chapter/Recommendations#risk-factors-for-pelvic-floor-dysfunction
- Zhang S, Li B, Liu J, Yang L, Li H, Hong L. The causal effect of reproductive factors on pelvic floor dysfunction: a Mendelian randomization study. BMC women’s health [Internet]. 2024 Jan 28 [cited 2024 May 10];24(1). Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-02914-6
- Ashton-Miller JA, John O.L. DeLancey. On the Biomechanics of Vaginal Birth and Common Sequelae. Annual review of biomedical engineering [Internet]. 2009 Aug 1 [cited 2024 May 10];11(1):163–76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897058/
- NHS Inform. How to look after your pelvic floor [Internet]. 2023 [cited 2024 Mar 8]. Available from: https://www.nhsinform.scot/ready-steady-baby/pregnancy/looking-after-yourself-and-your-baby/how-to-look-after-your-pelvic-floor/
- Baruch Y, Stefano Manodoro, Barba M, Cola A, Re I, Frigerio M. Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference? Healthcare [Internet]. 2023 Apr 11 [cited 2024 May 10];11(8):1096–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137441/
- Hage-Fransen MAH, Maaike Wiezer, Otto A, Wieffer-Platvoet MS, Slotman MH, Maria, et al. Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis. Acta obstetricia et gynecologica Scandinavica [Internet]. 2020 Nov 2 [cited 2024 May 10];100(3):373–82. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14027
- NHS. Exercise in Pregnancy [Internet]. 2023 [cited 2024 Mar 8]. Available from: https://www.nhs.uk/pregnancy/keeping-well/exercise/
- J. Larsudd-Kåverud, J. Gyhagen, S. Åkervall, Molin M, Milsom I, Wagg A, et al. The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery—a national register study. American journal of obstetrics and gynecology [Internet]. 2023 Jan 1 [cited 2024 May 10];228(1):61.e1–13. Available from: https://www.ajog.org/article/S0002-9378(22)00591-9/fulltext
- Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA [Internet]. 2018 Dec 18;320(23):2438. Available from: https://jamanetwork.com/journals/jama/fullarticle/2718794
- Gillor M, Saens P, Hans Peter Dietz. Demographic risk factors for pelvic organ prolapse: Do smoking, asthma, heavy lifting or family history matter? European journal of obstetrics, gynecology, and reproductive biology/European journal of obstetrics & gynecology and reproductive biology [Internet]. 2021 Jun 1 [cited 2024 May 10];261:25–8. Available from: https://www.ejog.org/article/S0301-2115(21)00167-6/abstract
- Aybüke Koyuncu, Kadota JL, Mnyippembe A, Njau PF, Tula Ram Sijali, McCoy SI, et al. Heavy Load Carrying and Symptoms of Pelvic Organ Prolapse among Women in Tanzania and Nepal: An Exploratory Study. International journal of environmental research and public health/International journal of environmental research and public health [Internet]. 2021 Jan 31 [cited 2024 May 10];18(3):1279–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908160/
- Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women. Obstetrics and gynecology (New York 1953 Online)/Obstetrics and gynecology [Internet]. 2014 Jan 1 [cited 2024 May 10];123(1):141–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970401/
- Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and Pelvic Floor Disorders: A Review of the Literature. Medical Science Monitor. 2016 Jun 3;22:1880–6. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1521693423000974
- Wang L, Li Y, Qi Z, Wang W. Barriers and facilitators of the implementation of the application of pelvic floor muscle training in patients with prostate cancer: a scoping review. Frontiers in public health [Internet]. 2023 Sep 12 [cited 2024 May 10];11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10523151/
- Mungovan SF, Carlsson SV, Gass GC, Graham PL, Sandhu JS, Akin O, et al. Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nature reviews Urology [Internet]. 2021 Apr 8 [cited 2024 May 10];18(5):259–81. Available from: https://www.nature.com/articles/s41585-021-00445-5
- NHS. What are pelvic floor exercises? [Internet]. 2018 [cited 2024 Mar 8]. Available from: https://www.nhs.uk/common-health-questions/lifestyle/what-are-pelvic-floor-exercises/
- Michael's Hospital S. Pelvic floor exercises and continence advice for women Patient information service [Internet]. [cited 2024 May 10]. Available from: https://www.ruh.nhs.uk/patients/patient_information/Pelvic_floor_exercise_and_continence_advice.pdf
- National Institute of Diabetes and Digestive and Kidney Diseases. Kegel Exercises [Internet]. 2021 [cited 2024 Mar 8]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises
- Pelvic Floor Exercises for Women - North Tees and Hartlepool NHS Foundation Trust [Internet]. North Tees and Hartlepool NHS Foundation Trust. 2024 [cited 2024 May 10]. Available from: https://www.nth.nhs.uk/resources/pelvic-floor-exercises-for-women/
- Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery [Internet]. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 [cited 2024 May 10]. Available from: https://www.tandfonline.com/doi/abs/10.1080/14767058.2020.1723541
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