Pelvic Floor Strengthening: Part of your Daily Routine


By Tasha Mulligan, MPT, ATC, CSCS, a physical therapist, athletic trainer, and certified strength and conditioning specialist. She is the co-founder of PTpartners LLC and creator of Hab It: Pelvic Floor DVD.

A consistent commitment to strengthening our pelvic floor muscles can mean the difference between bladder control and leaking urine. If you have never been instructed in a thorough pelvic floor-strengthening program, you may be wondering, “What type of exercises do I need to do to gain better control?” The answer may be more complex than you thought, because a pelvic floor-strengthening program requires more than just Kegel exercises. There are a lot of muscles that work in coordination with our pelvic floor. Some enhance the contraction of our pelvic floor and others help to stabilize our pelvis and lumbosacral spine so our pelvic floor muscles have stable anchors to pull against. With this in mind, not only do we have to perform exercises that target our pelvic floor specifically, but we also need to strengthen our deepest core stabilizers that allow an optimal contraction of our pelvic floor.

As we begin to explore a thorough pelvic floor-strengthening program, we must first discuss the cornerstone of pelvic floor exercise, the Kegel contraction. A Kegel is best instructed as squeezing the muscles used to stop the flow of urine or the passing of gas. But did you know our pelvic floor muscles do more than just “squeeze”? They also, elevate, drawing up to a tighter position within our pelvic outlet. This second action of our pelvic floor muscles is often left out when outlining a pelvic floor strengthening routine. The best instruction for this action is “to visualize a string attached from your belly button down to your pelvic floor and you are attempting to pull it up ”. Our pelvic floor is a postural muscle so endurance exercises, such as pelvic floor elevation, is as important as the quicker tightening or squeezing action of our pelvic floor muscles that help us when we cough, laugh, or sneeze, such as Kegel exercises. The combination of elevation and Kegel contractions will work all the fibers of your pelvic floor muscles. A goal of 10 endurance/elevation holds and 50 quick-squeezing Kegel contractions per day is reasonable.

The second most important muscle to work in a pelvic floor-strengthening program is our transversus abdominus (TA). This muscle, otherwise known as our lower abdominals, wraps around our abdomen like a corset that narrows as it hugs our pelvic organs within our pelvis. Drawing the belly button up and in activates the transversus abdominus (TA). A contraction of our TA squeezes like a cone, displacing the pressure within our abdomen up and under our lower ribs, lifting the pressure from our pelvic floor. Our TA and pelvic floor actually work in coordination, each enhancing the contraction of the other. You can feel this coordinated effort as you elevate your pelvic floor following the instructions given above. Note that as you work to pull your pelvic floor up, your belly button automatically draws in, assisting this effort. Our TA, like our pelvic floor, is also a postural muscle that we must work through longer endurance holds, drawing our belly button “up and in” and holding it there as we continue with a regular breathing pattern for 10 seconds or more, at least 10 times throughout your day. You can see this muscle work as it will cinch up your midsection, lifting your chest, and you should feel the pressure lift from your pelvic floor.

It is very important to note that breathing normally throughout each exercise is a critical component of performing the exercises correctly and optimally. Breath holding is one of the most common mistakes made when trying to activate our transversus abdominus. Every time we hold our breath as we reach, as we lift, even as we get up from the couch, we work against the elevation and control of our TA and pelvic floor. Breath holding locks our ribs down, forcing the pressure within our abdomen down to the weakest link, which is the soft tissue of our pelvic floor. Anytime we overwhelm our pelvic floor with increased intra-abdominal pressure, we risk the inability of our pelvic floor to control the passage of urine, feces, and/or gas.

So far, we have reviewed the important components of a pelvic floor strengthening program that include performing both actions (tightening and elevating) of our pelvic floor, we have reviewed the contraction of our transversus abdominus which displaces pressure upwards to our expanding ribs, and we have cautioned against the bad habit of holding our breath and how it works against our pelvic floor.

Now, let’s finish with a quick review of the stabilizers of our pelvis and lumbo-sacral spine. These muscles help provide a stable structure for our pelvic floor muscles to pull on when tightening and elevating. So what are these important muscles that provide much needed stability? They are: the multifidi muscles of our low back, our deep hip rotators, and our inner thigh muscles. Your multifidi muscles can be strengthened in a standing position by rotating your pelvis slightly, giving a lift to your buns. When performing this subtle exercise, it is important to visualize your tailbone lifting with each contraction. Your pelvic floor is attached to your tailbone and will, therefore, tighten slightly with each multifidi lift.

The second exercise that will work to strengthen our inner thighs and deep hip rotators, is simply squeezing a ball or pillow between your knees while sitting and in that same seated position, and then pushing your knees apart against the resistance of your own hands placed at the outside of each knee. A good goal is to perform 15 repetitions per day of each of the stabilizing muscles.

With the exercises described in this article, you have been given a great start to a thorough pelvic floor rehab program. If you have difficulty with any of the exercises as instructed, you should consult with a physical therapist in your area, specializing in pelvic floor rehabilitation.

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123 Responses to Pelvic Floor Strengthening: Part of your Daily Routine

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    I am an occupational therapist in Florida working in a skilled nursing facility. I have developed a continence exercise program that is working very well with my residents. I am looking for more educational opportunities for myself to advance my knowledge and ability to help others. Do you have any ideas or programs for continuing education?

    Thank you so much

    Kimberly Metz OTR/L

    Indian River Estates

    2200 Indian Creek Blvd

    Vero Beach, Florida 32966

    [email protected]

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    • Francisca says:

      Its very true. It helps develop the PC or plveic floor muscles. This aids in Bladder control and helps prevent incontinence that can come with aging. It also helps with lower back strength.Ben Wa balls or Kegel balls are one way of exercising these muscles. Another way is to practice the Clenching motion on your own- it can be done anywhere, but the most FUN way is to do it during intercourse. The male partner feels the squeezing and tightening muscles, and it can also add to the power of the female orgasm!References :

    • Nour says:

      I had prostate suegrry and this helped tremendously in improving my bladder control. The doctor may tell you what to do (for Kegel exercises), but this Super Kegel Exerciser basically helps you to a get a physical idea of what muscles you actually need to use for the Kegel exercises. I recommend pulling the closed tip all the way to the front (so your rear inside thigh muscles are resting against the Super Kegel flaps). Ensure the unit (while level) is pushed up as far as possible (towards the private part(s). Then squeeze your leg muscles in and let out; do this for about 25 times. Next, squeeze your leg muscles in, but hold for a count of 10, then release. Do that at least 3 times. Do these set of exercises at least 2 3 times a day. Again this is more of you learning (mentally) what muscles you are actually controlling in order to do the Kegel exercises. You can adjust the tension strength, but the unit doesnt move as much as you think it would. Overall, the Super Kegel is effective in helping you re-strengthen those muscles needed for bladder control.

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      • Massiv says:

        If the Klegels dont work for you, consider going to a liouogrst that specializes in working with females. My first doctor prescribed medication that didnt really help and he offered no other options. I was seriously considering not running anymore. I found a new doctor and after some tests, discovered that my muscles down there were not firing right, so Klegels alone were not going to fix this. She set me up with a pessary (a ring that is instered into the vagina) and all my problems have been solved. I dont even know that its there and I can run as long and hard as I want!

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    • Karla says:

      I spent a lot of time at a urologist for EXACTLY this pbeolrm. He finally prescribed me Detrol, which is sort of helping. I have found that the Kegals do not help at all, but as I increase my running, my muscles get stronger, my core gets stronger and that has helped substantially. I know the embarrassment it is humilitating. But being a mom and being able to run has helped me to work through the horror of wetting myself sometimes!

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    • Maria says:

      I also had three natural bhtris, had this problem, and Kegels never helped. Started running a year ago (again) at the ripe old age of 51 and just finished a 10-miler. Running really helped strengthen the muscles, but I still leak, so I wear a thin maxi-pad every time I run. Eases my mind and I never think about it any more. No embarrassment!

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    • Christine says:

      I have had 3 children also nllaratuy and have started back running I am stronger faster and fitter than before but when running down hill I have involuntary leakage which is frustrating .I am short of asking for a sling and tuck to stop this happening would rather sought it natuarally than resort to surgery ..must try the tampon thing I do think it is because my uterus has prolapsed and is pushing the bladder forward

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