Pelvic Floor Exercises and Instructions
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Medically reviewed by Amy Kwan, PT, DPT
Pelvic floor exercises can help strengthen weak muscles and relax muscles that are too tight. These muscles hold the pelvic organs—bladder, intestines, urethra, rectum, and additionally the vagina, cervix, and uterus in females, and prostate in males—in place. People of any age can experience pelvic floor conditions that can benefit from pelvic floor exercises.
This article discusses pelvic floor exercises—what they are, how to do them, and potential benefits and side effects.
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Where Is the Pelvic Floor?
All people no matter their sex or gender have a pelvic floor. It is located below your abdomen in your pelvis—the curved bone structure between your hips—and supports the organs in your pelvis.
Before Starting Pelvic Floor Exercises
Before you start pelvic floor exercises, consult with a healthcare provider to ensure your symptoms are related to muscle tightness or weakness and not an underlying health condition like pelvic organ prolapse (when pelvic organs drop because of muscle weakness) or bladder problems (like bladder control loss).
Pelvic floor exercises, or Kegel exercises, are not for everyone. Kegels can help strengthen the pelvic floor, but if your muscles are tight, they can worsen your condition.
Consider seeing a physical therapist specializing in pelvic floor therapy to ensure you perform the most appropriate exercises for your condition.
Pelvic Floor Exercises for Men vs. Women
In addition to supporting the uterus (womb), vagina, and cervix (the lower, narrow end of the uterus where it enters the vagina) in people with female anatomy, it also supports the bladder, rectum (the last section of the large intestine), and urethra (the tube that empties urine from the bladder). Pelvic floor exercises can benefit any person of any gender, regardless of their anatomy.
Pelvic Floor Exercises for Tight (Hypertonic) Muscles
Tight (hypertonic) pelvic floor muscles can cause health concerns like bladder problems or pain during intercourse. Exercises for tight muscles focus on relaxing the pelvic floor.
Deep Breathing (Diaphragmatic Breathing)
Diaphragmatic breathing reduces muscle tension throughout the body, including the pelvic floor. It also helps to decrease the pain that tight pelvic floor muscles can cause. Perform as follows:
Lie on your back on a firm surface.
Bend your knees and place your feet flat on the floor.
Place one hand on your chest and the other on your belly.
Slowly breathe in through your nose, filling your belly with air. The hand on your stomach should rise while the hand on your chest stays still.
Pucker your lips (like you're blowing out candles) and slowly blow the air back out.
Perform for five breaths.
Adductor Stretch
If the adductors (inner thigh muscles) are very tight, rest your knees on pillows during this stretch to decrease muscle tension. Perform as follows:
Lie on your back on a firm surface.
Bend both knees and bring the soles of your feet together, with the outer border of each foot resting on the ground.
Slowly allow your knees to drop to the sides—you should feel a stretch along the inside of your thighs.
Hold for 20 to 30 seconds, and repeat three times.
Child's Pose
The child's pose spreads your pelvic bones apart to help stretch your pelvic floor muscles. Perform as follows:
Begin on your hands and knees.
Keeping your elbows straight, sit back on your heels while kneeling.
Bend forward and rest your belly on your thighs.
Rest your forehead on the ground between your shoulders.
Take several deep breaths.
Happy-Baby Pose
Use your arms to gently stretch your pelvis open to help stretch pelvic floor muscles with the happy baby pose. Perform as follows:
Lie on your back on a firm surface.
Bend both knees and bring your feet toward your hands.
Grasp the outer edge of each foot with your hands.
Pull your knees toward your armpits and relax your knees outward.
Hold for several breaths.
If this pose is too difficult, place your hands behind your knees instead.
Pelvic Floor Exercises for Weak (Hypotonic) Muscles
Excess strain on the pelvic floor muscles from chronic coughing due to smoking, pressure from chronic constipation, pregnancy, and childbirth can weaken these muscles. Additional factors such as age, weak tissues, and surgery can weaken your pelvic floor muscles.
Here are some exercises to strengthen weak pelvic floor muscles.
Kegels
Kegels help strengthen muscles that support your bladder. Perform as follows:
Lie on your back on a firm surface.
Tighten your pelvic floor muscles—squeeze your muscles as if trying to stop the flow of urine midstream.
Hold for three to five seconds, then relax.
Repeat 10 times.
Perform Kegels at least three times per day. Once you've mastered Kegels lying down, you can do them while sitting or standing.
Kegels and Bridges
Advance your pelvic floor strength by combining Kegels with a hip bridge. This exercise also strengthens abdominal and low back muscles that support your pelvic floor. Perform as follows:
Lie on your back on a firm surface.
Bend your knees and place your feet flat on the floor.
Squeeze your buttocks and lift your hips off the floor. Keep your shoulder blades in contact with the floor.
While in the bridge position, contract your pelvic floor for three seconds.
Relax your pelvic floor and lower your hips back down to the ground.
Repeat 10 times.
Kegels With Clamshells
Clamshells strengthen muscles in the hips that work with your pelvic floor muscles. Perform as follows:
Lie on your right side with your legs stacked on each other.
Bend your knees at approximately 45 degrees.
Contract your pelvic floor muscles and lift your top knee toward the ceiling (like a clamshell opening). Hold for two to three seconds.
Lower your leg back down and relax your pelvic floor.
Do 10 repetitions on each leg.
Exercising With Pelvic Floor Dysfunction
While some exercises improve pelvic floor function, others can make it worse. One 2018 study looking at elite athletes found that 52% of female athletes in the study experienced urinary incontinence, with the highest rates seen in gymnasts.
Most people are probably not taking to the gym mat regularly, but this study illustrates the effects of high-impact exercise on pelvic floor health.
Some examples of high-impact exercises to avoid when dealing with pelvic floor dysfunction include the following:
Heavy weight lifting
Running
Activities that require jumping
High-intensity conditioning exercises (such as step aerobics)
Safe, low-impact alternative exercises include:
Walking
Yoga
Swimming
As your pelvic muscles improve, you can progress to higher-level activities.
Benefits of Pelvic Floor Exercises
Pelvic floor exercises can help treat conditions and symptoms related to both tight and weak pelvic floor muscles.
For Hypertonic Muscles
Hypertonic (tense) pelvic floor muscles can occur from trauma during childbirth and conditions such as irritable bowel syndrome.
Hypertonic pelvic floor muscles can cause:
Pain during sex
A strong urge to urinate or urinary incontinence
Constipation
Pelvic or abdominal pain
Relaxation exercises can reduce pain and decrease the incidence of incontinence.
For Hypotonic Muscles
Pelvic floor muscles can weaken after childbirth and develop from intense exercises like heavy weight lifting.
Weak pelvic floor muscles can cause:
Urinary or fecal incontinence
Uncontrollable passing of gas
Strengthening exercises can reduce incontinence and the excessive passing of gas, as well as support internal organs. However, in severe cases, pelvic organ prolapse can require surgery.
Managing the Side Effects of Pelvic Floor Exercises
While pelvic floor exercises should not increase pain, conditions that affect these muscles are often painful.
Treatments that can help decrease this pain include:
Medications (such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen), neuropathic pain medications, or muscle relaxants)
Moist heat
Gentle stretching
How Long Does It Take to Improve Your Pelvic Floor Muscles?
Whether you are trying to decrease tightness in your pelvic floor muscles or improve your strength, it can take several months (or longer) to see improvements. If you do pelvic floor exercises consistently and are concerned that your symptoms aren't changing, consider seeing a physical therapist specializing in pelvic health.
Summary
Pelvic floor muscles can be too tight (hypertonic) or too weak (hypotonic)—both causing unwanted side effects such as incontinence, the excessive passing of gas, and pain. Exercises can be performed to either stretch and strengthen these muscles, depending on your underlying issue. A physical therapist who specializes in pelvic health therapy can provide you with an individualized exercise plan.
