Pelvic floor exercises: do they work and how often?

What are pelvic floor exercises?

Pelvic floor exercises work the muscles in a simple pattern: a squeeze, a hold and a full release. The routine comes in two speeds. Slow squeezes are held for a moment before you let go, and quick squeezes are short. The daily target pairs the two, which is why it is written as sets of slow squeezes plus quick ones.

Letting go is half the exercise. NIDDK, which publishes plain-language guidance on Kegels, advises relaxing the pelvic floor fully after every squeeze, so that each repetition ends with the muscles at rest and not held half-tight.

The reasons women take up the routine shift over the years, from pregnancy and birth to the changes around menopause and after, and the table further down sets out each stage. If you would like your technique checked at any point, the specialist is a pelvic floor physical therapist, often shortened to pelvic floor PT (UK: pelvic health physiotherapist).

Do pelvic floor exercises work?

For urinary incontinence, the trial evidence favors training. The 2018 Cochrane review by Dumoulin and colleagues compared pelvic floor muscle training with no treatment across 31 trials and 1,817 women, and a 2019 summary in American Family Physician sets out the results. The cure figure at the top of this page comes from that review. Controls are the women in a trial who were assigned no training, so the gap between the two groups is the part of the result the exercises can claim.

That first figure counts only women who said their leaking had gone. A wider measure also counts women whose leaking got better without stopping completely. For stress urinary incontinence, which is leaking when you cough, laugh, sneeze or exercise, about 72% of women reported cure or improvement with training, against 11.4% of controls. So most women with this kind of leaking who trained reported a change for the better, and most who did not train reported none.

The review also looked at every type of urinary incontinence together. Here 32.9% of women reported cure with training, against 6.2% of controls, which works out to a number needed to treat of 4. In plain words, for every four women who train, one more reports being cured than would have without training. The share reporting cure is lower than for stress incontinence alone, so the kind of leaking you have is worth knowing when you set your expectations.

Leaking is not the only change the routine is suggested for. From perimenopause onward, urinary urgency also becomes more common, and pelvic floor training is among the options for it. If dryness is the symptom that brought you here, our guide on how to treat vaginal dryness is the page for that.

How many pelvic floor exercises should you do, and how often?

NIDDK's basic routine counts the work a little differently from the daily target at the top of this page: it builds up to 10–15 repetitions, done at least 3 times a day. The two overlap more than they differ. Each comes to three short rounds a day, and the repetition ranges overlap.

Where a single recommendation helps, ours is to treat the daily sets as the target and NIDDK's gradual build-up as the way to reach it. That keeps the early days light and gives you a clear number to settle into.

The target is daily, not a few times a week, and it stays the same at each adult stage in the table below. Pregnancy and the months after birth are when it is especially worth keeping up. The 2019 guideline by Goom, Donnelly and Brockwell places pelvic floor work and walking early in the gradual return after birth, and for readers in those postpartum (UK: postnatal) months our page on postpartum exercise covers the rest of that return.

What did the studies show, and what did they not show?

The review's findings are not all equally firm. Only one outcome, cure of stress urinary incontinence, was rated high quality. The other outcomes were rated moderate, and the studies were generally small, so the exact percentages could shift as larger trials report. This does not undo the main finding. It simply marks where the evidence is strongest, which is leaking with a cough, a laugh or a jump.

Time is the second limit. The trials ran from 6 weeks to 6 months, so they describe what happens over the first months of training and say much less about the years after. On safety the picture is reassuring: seven trials reported adverse effects, all of them mild, and these were no more common with training than without.

It also helps to know what was measured. Cure and improvement were reported by the women themselves, which is the outcome that matters most day to day, though it is not the same as a measured test. And the comparison was training against no treatment for urinary incontinence, so the figures speak to leaking. They do not tell us how well the routine delivers the other aims it is suggested for, such as core support or prolapse prevention, and they say nothing either way about a pelvic floor exerciser or any other device.

Next steps

A gentle way to begin is to pick a quiet moment today and try a few slow squeezes, letting go completely after each one. If leaking or urgency is bothering you, it is worth raising with your doctor (your GP in the UK), and the guides linked above go further on exercise after birth and on dryness. From there, the pace, the routine and the kind of support are yours to choose. Your stage of life and your symptoms are your own, and pelvic floor training is not one size fits all.