Pelvic Floor Exercises

Women's Sports Medicine Center
Hospital for Special Surgery

Do you ever lose urine when you are sneezing, laughing, coughing, jumping, or exercising? Have you noticed less sexual sensation in the vagina, especially after childbirth?

Pelvic floor exercises can help.

If you answered "yes", these exercises are especially for you. Incontinence is the involuntary loss of urine and can occur in young, active women, particularly during high impact sports. Contrary to popular belief, incontinence is NOT an inevitable effect of childbirth and aging. Strengthening a little known group of muscles called the "pelvic floor" can provide needed support and control.

The pelvic floor performs three vital functions: they control urination and defecation (going to the bathroom), enhance your sexual pleasure during orgasm and support your pelvic organs. These muscles stretch like a hammock around all three openings: the urinary tract, vaginal opening and anus. Just like other muscles in the body, pelvic floor muscles can atrophy or they can become stronger with training.

How do you find the pelvic floor muscles?

If you’re not sure where these muscles are, you can find them by trying to stop the flow of urine when you’re going to the bathroom. DON’T perform the exercises when using the toilet. Just identify where the muscles are, so you can do the exercises later. Another way to find your pelvic floor muscles: Imagine yourself sneezing and then trying to prevent yourself from "passing gas." You’ll squeeze the muscles around your anus and vagina to hold it back. We also use the pelvic floor muscles during sexual activity: think of having intercourse and using the muscles of your vagina to tighten around your partner’s penis or finger. Develop an awareness of the many ways you use your pelvic floor and how it feels when the muscles are contracting.

When should you perform pelvic floor exercises?

Pelvic floor exercises (also known as Kegel exercises) should be performed 1-2 times daily. Ideal opportunities for performing pelvic floor exercises are:

  • when reading or relaxing in bed
  • when watching television
  • while waiting in line
  • while driving or commuting
  • during the cool-down/stretching portion of a workout or between sets during a strength workout.

If your pelvic floor muscles are weak, you’ll want to do these exercises lying down. As your pelvic floor becomes stronger, you can perform these exercises in a sitting or standing position. You should notice a difference after several weeks of faithful exercise.

How do you perform pelvic floor exercises?

There are two types of exercises which you should do each day: long holds and short contractions.

Long holds: Start by focusing your attention on the pelvic floor area. Squeeze or "lift and hold" the pelvic floor muscles for 5 seconds duration. Then release. When you do this exercise, visualize a circle closing as the muscles tighten and opening as they relax. "Draw your muscles in" at the urinary, vaginal and anal openings. Gradually increase the length of your hold to 10 seconds. Start with 3 repetitions. When you’re able to hold for 10 seconds, gradually increase the number of repetitions to 10-30. Let your muscles rest in between each repetition. (If you hold for 5 seconds, relax for 5 seconds. If you hold for 10 seconds, relax for 10 seconds.)

Short contractions: Focus your attention on your pelvic floor muscles. Pull up and in, hold just 1-2 seconds and relax. Repeat these quick contractions until your muscles are too tired to continue. Build up to 30 repetitions.

Important technique tips:

  • Start with as many repetitions as you can tolerate. Progress slowly by gradually increasing the number of repetitions or the length of your long holds.
  • Make sure your stomach, buttocks and inner leg muscles all stay relaxed during pelvic floor exercises. Don’t strain or bear down. The only muscles contracting or moving should be your pelvic floor.
  • Don’t hold your breath during pelvic floor exercises. If you count out loud, that may prevent you from holding your breath. Try breathing out as you squeeze your pelvic floor. "Exhale on the effort" is a good slogan to remember. It’s tricky at first, but you’ll get it!
  • Once you have a solid routine of pelvic floor exercises in place, prevent stress urinary incontinence by training your pelvic floor to be strong during an abdominal contraction or while coughing or sneezing. When you sense a sneeze or cough coming, squeeze your pelvic floor to support your bladder.

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