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The What, Why and How of Pelvic Floor Muscle Exercises

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by

Jane Clarke

Most people have heard of pelvic floor muscle exercises (PFMEs), sometimes called ‘Kegals’. We know it is good to do them but understanding the ‘why’ and ‘how’ remains a barrier to doing them consistently1. PFMEs are also commonly associated with women’s health, for example after having a baby, but few people realise these muscles are essential for both men and women throughout their lives. 

What is the pelvic floor?

The pelvic floor is a group of muscles, ligaments, and fascia that stretch like a supportive hammock from the pubic bone at the front to the tailbone at the back. These muscles support the bladder and bowel, and in women they also support the uterus or womb. Openings for the bladder, bowel and, in women, the vagina pass through the pelvic floor.

The pelvic floor works alongside the abdominal and back muscles to provide stability for the spine, trunk, and pelvis, sometimes collectively referred to as your ‘core’ . Pelvic floor muscles contract automatically when you cough, sneeze, laugh or lift something heavy, helping to prevent leakage of urine or stool. It also relaxes when you pass urine or have a bowel movement.

Aside from their role in continence, the pelvic floor also plays an important role in sexual function. They contribute to vaginal sensation and orgasm in women, while in men they help support erections and ejaculation. Growing evidence shows that PFMEs can improve aspects of sexual function in both men and women.2, 3

Why do pelvic floor muscles become weak or dysfunctional?

Like any muscle, the pelvic floor can become weaker. It can also be overstretched or injured in some circumstances. Less often, the muscles might become too tight and not be able to relax properly. Both weakness, injury, and excessive tension can cause symptoms including incontinence, pain, and sexual dysfunction. 

Common factors that affect pelvic floor function include pregnancy, childbirth, ageing, menopause, pelvic injury or trauma, chronic constipation, heavy lifting, high-impact sports, prostate surgery, chronic cough, radiation to the pelvic area, obesity, pelvic surgery, health conditions that affect the strength of connective tissues, and neurological conditions such as Parkinson’s, multiple sclerosis, and spinal cord injury. 

Lifestyle and behavioural habits can also affect pelvic floor function. Straining to empty the bowels, high impact exercise, poor lifting techniques, inadequate physical activity and ongoing constipation all place extra stress on the pelvic floor over time.

What happens when the pelvic floor is not working properly?

Depending on the cause, pelvic floor dysfunction can develop gradually over time or occur suddenly. It can affect both men and women of any age. Symptoms of a weakened or damaged pelvic floor might include: 

  • Leaking urine or stool, especially when lifting, exercising, coughing, or laughing. 
  • A sudden urge to urinate that is difficult to control
  • Difficulty controlling wind or bowel motions
  • A feeling of heaviness or bulging in the vagina, particularly toward the end of the day (pelvic organ prolapse)
  • Reduced sensation and arousal, or pain during intercourse in women
  • Erectile difficulties or premature ejaculation in men

If the pelvic floor muscles become too tight, symptoms might include:

  • Difficulty emptying the bladder or bowel completely
  • Constipation or straining to empty the bowel
  • Urinary frequency, urgency, hesitancy, or a slow urine stream
  • Pelvic, lower back, or genital pain
  • Pain during or after sex

While some of these symptoms may be common, they should never be accepted as a normal part of life. 

How do pelvic floor muscle exercises help?

PFMEs aim to improve the strength, endurance, coordination and timing of the pelvic floor muscles. They are recognised as a ‘first-line’ conservative treatment for all forms of incontinence4, sexual dysfunction2, 3, and pelvic organ prolapse5.  

For men, PFMEs are widely recommended before and after prostate surgery to help speed recovery of urinary continence6. The same exercises can also improve erectile function in these men, particularly when combined with specialist assessment and supervised rehabilitation3.

Doing the exercises correctly

Many people are unsure of how to locate their pelvic floor muscles, how to contract them, or what the exercises consist of. A useful way to identify the pelvic floor muscles is to gently tighten around the anus, as though stopping wind, while at the same time lifting around the urethra (and vagina in women). In men, the base of the penis and testes should lift slightly during a contraction. Exercises can be done standing, sitting up straight, or lying down. The buttocks, thighs and abdominal muscles should remain as relaxed as possible, and you should continue to breathe normally. 

According to Continence Health Australia7, 8 , PFME regimes for both men and women consist of contracting the pelvic floor for a period of 5-8 seconds, then releasing completely. These contractions should be repeated 8-10 times per set, with each set performed 3 times a day.  An additional 8-10 quick squeezes can be added to each set for further strengthening. When performed correctly, improvements in pelvic floor function should become noticeable within weeks8. 

Aside from PFMEs, it is also important to avoid behaviours and activities which can further damage and weaken the pelvic floor. For example, prevent and treat constipation, manage chronic lung conditions effectively, consider smoking cessation, modify intensive exercises and lifting techniques, and aim for a healthy lifestyle to achieve optimal weight and fitness levels. 

When PFMEs may not be appropriate

PFMEs are not the answer for everyone. For people with excessively tight pelvic floor muscles, repeatedly strengthening the muscles actually make symptoms worse. These individuals often benefit more from learning how to relax the pelvic floor using targeted relaxation and breathing techniques, often with the help of a specialised healthcare professional. 

PFME may also be less effective if there has been significant nerve injury or major muscle damage from things like birth injuries or prostate removal, although many people can still achieve worthwhile improvements with an individualised rehabilitation programme.

When should you seek professional help?

If you have been performing pelvic floor muscle exercises for over three months and are not seeing any improvements, or if you are unsure about how to locate and exercise your pelvic floor muscles, seek advice from a healthcare professional with expertise in pelvic health. Likewise, if you have symptoms of an overly tight pelvic floor, have a degenerative neurological condition, or have suffered significant trauma or damage to the pelvic region, getting advice from a specialised healthcare professional is advised. 

The pelvic floor is an essential part of lifelong health for everyone. Whether your goal is improving bladder control, preventing bowel leakage, enhancing sexual wellbeing or simply maintaining good pelvic health as you age, learning how these muscles work, and looking after them, is one of the best investments you can make in your health and wellbeing.

References 

  1. Koçyiğit, K., Ortancıl, Ö., Tezel, N. et al. 2026. The Effect of Pelvic Floor Health Education on Knowledge and Awareness Levels in Patients with Urinary Incontinence. Int Urogynecol J, 37, 597–604. https://doi.org/10.1007/s00192-025-06350-4
  • Jorge, C. H., Bø, K., Chiazuto Catai, C., Oliveira Brito, L. G., Driusso, P., & Kolberg Tennfjord, M. 2024. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 231(1), 51–66.e1. https://doi.org/10.1016/j.ajog.2024.01.001
  • Alouini, S., Memic, S., & Couillandre, A. 2022. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. International Journal of Environmental Research and Public Health, 19(5), 2789. https://doi.org/10.3390/ijerph19052789
  • Wang, T., Wen, Z. & Li, M. 2022. The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis. Int Urogynecol J 33, 1789–1801. https://doi.org/10.1007/s00192-022-05139-z
  • Zhou, L., Chen, Y., Yuan, X., Zeng, L., Zhu, J. & Zheng, J. 2023. Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis. Front. Public Health 11:1186067. doi: 10.3389/fpubh.2023.1186067