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INTRODUCTION — The "pelvic floor" refers to a group of muscles that support the organs in the pelvis. These organs include the bladder and rectum; in the female pelvis, they also include the uterus (figure 1).
The pelvic floor muscles play an important role in bladder and bowel control. Like any muscles, they can become injured or weakened. Contributing factors can include pregnancy, vaginal childbirth, obesity, and certain types of surgery; however, these muscles can also become weaker over time due to normal aging.
WHAT DO PELVIC FLOOR MUSCLE EXERCISES DO? — The goal of these exercises (which are sometimes called "Kegel" exercises) is to strengthen the pelvic floor muscles. When these muscles become weak, it increases the risk of problems such as:
●Urinary incontinence – This is when a person leaks urine or loses bladder control. One type, "stress incontinence," occurs when the muscles and tissues around the urethra (figure 2) do not stay closed properly when there is increased pressure in the abdomen (for example, when the person coughs, sneezes, or does something strenuous). Stress incontinence is common in people who have given birth. It can also happen after surgery to treat prostate cancer or an enlarged prostate.
Another type is called "urge incontinence"; this is when a person regularly feels a sudden urgent need to urinate.
●Fecal incontinence – This refers to the involuntary loss of liquid or solid stool. "Anal incontinence" can also mean the involuntary passing of gas. Injury to the pelvic floor muscles (for example, during vaginal childbirth) can contribute to incontinence.
●Pelvic organ prolapse – This is when the bladder, rectum, or uterus drop down and bulge into the vagina. This can happen if the pelvic floor is weakened and unable to support the organs (figure 3). While some people with pelvic organ prolapse have no symptoms, others notice a feeling of fullness or a bulge in the vagina.
If you have any of these problems, doing exercises to strengthen your pelvic floor may help improve symptoms (see 'Treating existing problems' below). These exercises have not consistently been shown to prevent new problems from developing. (See 'Reducing the risk of new problems' below.)
If you are interested in trying pelvic floor muscle exercises, it is a good idea to talk with your health care provider first. There are some situations in which these exercises are not recommended: for example, in the case of certain types of injury that can result from childbirth (which need to heal before exercise can be beneficial). These exercises may also worsen symptoms in people with a condition called myofascial pelvic pain syndrome (in which abnormalities of the pelvic muscles and surrounding tissues can cause pain with sex or bladder problems). People with this condition are typically treated by a physical therapist with specialized training.
Your provider can help you understand whether pelvic floor muscle exercises are likely to be helpful for your situation, teach you how to do the exercises correctly, and refer you to a physical therapist if needed. (See 'The role of the physical therapist' below.)
LEARNING THE PROPER TECHNIQUE — As mentioned above, your health care provider can help you identify which muscles to contract for these exercises. They might do this by inserting a finger into your vagina and asking you to squeeze your pelvic muscles.
You will want to tighten the muscles as though you are trying to stop the flow of urine or hold back gas. However, it is not recommended that you practice this by actually stopping the flow of urine while you are on the toilet. There is concern that this could lead to a urinary tract infection. It may help to imagine that you are sitting on a marble (do not use a real marble) and using your pelvic muscles to lift it off the chair. Think about squeezing the muscles closest to your vagina and anus.
While it can be challenging to learn how to contract your pelvic floor muscles without using your abdominal, buttock, or thigh muscles, it is important to learn to do so in order for the exercises to be effective. This will get easier with time and practice.
Once you have figured out how to isolate the right muscles, you can begin to strengthen them. To do this:
●Contract – Squeeze your pelvic floor muscles.
●Hold – Keep contracting the muscles for 8 to 10 seconds. In the beginning, you may not be able to hold the contraction for this long, but over time, you will build up strength.
●Relax – Relax your pelvic floor fully. This step is as important as contracting the muscles.
Over time, try to hold the muscle contraction harder and for a longer time before relaxing. As with other forms of exercise, you will become stronger with practice, and you will need to keep up your routine in order to notice long-term effects. It can help to work with a pelvic floor physical therapist; these are trained professionals who can teach you how to do these exercises effectively. (See 'The role of the physical therapist' below.)
You can do these exercises in any position (standing, sitting, or lying down) and work them into your daily routine in a way that is convenient for you.
How often should I do these exercises? — A typical regimen involves doing this exercise (to contract your pelvic floor muscles, hold, then relax) 8 to 12 times per session, for three sessions every day, if possible. This routine should continue for at least 15 to 20 weeks. Your health care provider can talk to you about your specific situation and whether you should follow a different regimen. It takes time to strengthen your pelvic floor muscles, especially if they have been weakened or injured, so try to be patient and keep working on it.
The role of the physical therapist — Some people benefit from working with a physical therapist or specially trained nurse. This can help to ensure that you are using the correct technique in order to get the most out of your exercises.
In addition, these providers may use other methods to help you improve your technique and maximize results, such as:
●Biofeedback – This typically involves inserting a sensor into your vagina that can identify which muscles you are contracting and measure the strength of each contraction. This can help if you are having trouble isolating your pelvic floor muscles and can also give you an idea of your progress as you strengthen these muscles over time.
●Electrical stimulation – This can be done along with biofeedback. It involves placing a device into the vagina or anus; the device delivers a small electrical current that causes the pelvic floor muscles to contract.
●Vaginal weights – You can purchase weighted cones that you hold in your vagina to help increase strength. You use your pelvic floor muscles to keep the weight in place during your normal daily activities. While there is limited evidence supporting this approach, some people find that it helps them strengthen their pelvic floor. Vaginal weights are easy to use, relatively inexpensive, and can be purchased online.
BENEFITS OF PELVIC FLOOR MUSCLE EXERCISES
Treating existing problems — In addition to strengthening your pelvic floor muscles in general, exercises can sometimes help in the following situations:
●Preventing leakage of urine in stress incontinence – Stress incontinence (ie, leaking urine when doing certain things that stress the pelvic muscles) is common. Once you know how to contract your pelvic floor muscles effectively, you can get into the habit of doing this any time you are about to laugh, cough, sneeze, lift something heavy, or do anything else that might cause leakage.
●Controlling sudden urges to urinate – People with urge incontinence feel a strong need to urinate all of a sudden. If you have this urge, rather than running to the bathroom, sit or stand still and contract your pelvic muscles. Once the urge decreases, you can then go to the toilet.
●Improving fecal and anal incontinence (the involuntary leakage of stool or gas).
●Relieving symptoms of pelvic organ prolapse, such as a feeling of fullness or pressure in the vagina.
If you have any of these problems and pelvic floor muscle exercises do not seem to be helping after several months, talk to your health care provider. They may recommend changing the way you do the exercises or trying other approaches. While pelvic floor muscle exercises can be beneficial, many people with incontinence or pelvic organ prolapse need other treatments as well. (See "Patient education: Urinary incontinence in women (Beyond the Basics)" and "Patient education: Urinary incontinence treatments for women (Beyond the Basics)" and "Patient education: Fecal incontinence (Beyond the Basics)".)
Reducing the risk of new problems — People often wonder whether they can reduce their risk of developing incontinence or pelvic organ prolapse after pregnancy and childbirth. Evidence is mixed as to whether doing pelvic muscle exercises during pregnancy can help with this. While there is no way to definitively prevent the pelvic floor from becoming weakened (due to pregnancy, childbirth, obesity, or just normal aging), exercises may help since they strengthen the muscles that support the pelvic organs. In addition, pelvic floor exercises are unlikely to be harmful in most situations.
WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Pelvic muscle (Kegel) exercises (The Basics)
Patient education: Urinary incontinence in females (The Basics)
Patient education: Treatments for urgency incontinence in females (The Basics)
Patient education: Fecal incontinence (The Basics)
Patient education: Pelvic organ prolapse (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Urinary incontinence in women (Beyond the Basics)
Patient education: Urinary incontinence treatments for women (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Effect of pregnancy and childbirth on urinary incontinence and pelvic organ prolapse
Female urinary incontinence: Treatment
Pelvic organ prolapse in females: Epidemiology, risk factors, clinical manifestations, and management
Sexual function in females with pelvic floor and lower urinary tract disorders
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)
●American Academy of Family Physicians
●Pelvic Floor Disorders Research Foundation
●National Association for Continence
1-800-BLADDER
(www.nafc.org)
