Many women start experiencing urine leakage or heaviness/dragging in the vagina region as they age.
It is common to have weakened pelvic floor muscles after childbirth because of the pregnancy and delivery. It is also common to start having issues after reaching menopause, after gaining weight, or increasing the intensity or impact of sporting activities. While having weak pelvic floor muscles is common, it is not normal, and can be treated. Doing correct pelvic floor muscle exercises on a regular basis will help improve many pelvic floor dysfunctions such as urinary incontinence and pelvic organ prolapses.
On this page, you can find the following information:
- Where are my pelvic floor muscles and what do they do?
- Why do pelvic floor muscles become weak?
- How can I strengthen my pelvic floor muscles?
- Helpful hints.
Key points about pelvic floor training:
- Pelvic floor muscle weakness can be improved with the correct training. By improving your pelvic floor, your symptoms will reduce.
- Even people with very weak muscles can improve.
- A pelvic health physiotherapist or continence advisor can ensure you are doing exercises correctly and then design an individual programme tailored for you.
- Improvement in pelvic floor muscle strength will take between 3 and 6 months of regular training of the muscles.
The pelvic floor consists of a layer of muscles stretching from your pubic bone at the front, to your tailbone at the back.
Image: BruceBlaus wikimedia
Your pelvic floor muscles help:
- support your bladder, bowel and uterus (womb)
- close off your bladder and bowel outlets to help prevent leakage
- control problems such as frequency and urgency (needing to pee often or quickly)
- empty your bladder and bowel
- aid sexual response and orgasm
- contribute to core stability.
A number of factors can contribute to pelvic floor muscle weakness:
- straining to empty the bladder or bowel with or without constipation
- persistent heavy lifting
- chronic cough (from smoking, chronic bronchitis or asthma)
- being overweight
- lack of use (not doing pelvic floor exercises).
The best results will be achieved by seeking help from a pelvic health physiotherapist or continence advisor who will assess you individually and design a customised training programme ideally suited to you.
Strengthening your pelvic floor muscles can take 3-6 months of regular exercises.
Find your pelvic floor muscles
The first step is to correctly identify the muscles:
- Sit or lie down on a comfortable surface like your bed.
- Relax your thighs, buttocks and tummy/puku muscles. Breathe normally, don’t hold your breath or change your breathing pattern
- Lift and squeeze your pelvic floor and hold the contraction for 5 seconds. To get the correct contraction, you can imagine stopping from farting, or stopping from peeing. Or you can imagine you are squeezing around a tampon and trying to suck it up into your vagina. As everyone’s brain works differently, it's best to trial different words to see what works for you.
If you're not sure you're doing it right, try to stop your flow when passing urine (peeing), then restart it. Only do this to identify and test the correct muscles to use once. Don't exercise your pelvic floor muscles this way as it can cause issues with your pelvic health. You can also test your pelvic floor muscles by placing 1-2 clean fingers into your vagina and squeezing your muscles around them. The muscles should be squeezing around your fingers, and lifting your fingers into the vagina.
If you are unable to feel any definite squeeze and lift action in your pelvic floor muscles, it is important that you seek professional advice from a pelvic health physiotherapist or continence advisor. They can assess you internally to make sure you are doing the exercises correctly.
Here is a directory of pelvic health physiotherapists in Aotearoa New Zealand.
What exercises can I do?
At first you may need to perform these exercises while sitting or lying down. As the muscles strengthen, you can progress to exercise standing up. As with any muscle training activity, start with what you can achieve and progress from there.
Over time, increase both how long you hold the contraction for, as well as how many times you repeat the exercise in a row. Do the exercises daily for the best improvement possible. Long contractions of the muscle (up to 10 seconds) combined with short fast contractions (10 times for 1 second) work the best to get your pelvic floor strong with great control.
- keep your weight within a healthy range for your height and age
- seek medical advice for chronic cough
- develop good bowel habits.
There are health professionals qualified to help you with bladder control problems. Ask your GP for advice or contact Continence NZ.
Pelvic floor muscles - a patient's guide Family Doctor, NZ,
How physio can help pelvic floor disorders Physiotherapy NZ
Pelvic floor muscle training in women Continence NZ
Pelvic floor information Pelvic floor first, Australia
Pelvic floor muscle training for women Continence Foundation of Australia & Department of Health, Australia
- Pelvic floor muscle training in women Continence NZ
- Pelvic Floor Guide Continence NZ, 2022
- Kegel exercises Mayo Clinic, US, 2020
- Bø K, Brækken IH. Pelvic floor muscle training in prevention and treatment of pelvic organ prolapse In: Santoro GA, Wieczorek AP, Sultan AH. (eds) Pelvic Floor Disorders; Springer International Publishing, 2021
Information for healthcare providers
- Dumoulin C, Cacciari L, Hay-Smith EC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women Cochrane Database of Systematic Reviews 2018, Issue 10.
- Hagen S, Glazener C, McClurg D, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL) – a multicentre randomised controlled trial The Lancet 2017;389 910067:393-402.
- Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY) – a multicentre randomised controlled trial The Lancet 2014;383(9919):796-806.
Dr Melissa Davidson is the only Specialist Physiotherapist in Pelvic Health currently registered with the New Zealand Physiotherapy Board. She has a private practice treating people with all aspects of pelvic health (melissadavidson.org) and provides professional coaching and mentoring for physiotherapists and other health professionals wanting to further their skills in pelvic health practice (drmelissadavidson.com).