Pelvic floor muscle training is the recommended first-line treatment for stress urinary incontinence and for mild to moderate pelvic organ prolapse. Done properly, it works for the substantial majority of people.
The difficulty is the phrase "done properly". Studies that actually check technique repeatedly find that a large proportion of women perform the contraction incorrectly when working from written or verbal instruction alone — and a meaningful minority bear down instead of lifting, which is not a weaker version of the exercise but the opposite of it.
That is the single reason so many people conclude pelvic floor exercises do not work. Usually the exercise was fine; the execution was not.
Finding the right muscles
The pelvic floor is a sling of muscle running from your pubic bone at the front to your tailbone at the back, supporting the bladder, bowel and — in women — the uterus, and forming the closure mechanism for the urethra and anus.
A correct contraction is a squeeze and lift: an inward and upward movement, as though drawing the openings up and in towards your body. Two useful cues — imagine trying to stop yourself passing wind while also stopping the flow of urine, and hold both while breathing normally.
Then let go completely. The relaxation phase matters as much as the squeeze, and it is where most people are least aware of what is happening.
Do not practise by stopping your urine flow mid-stream. It is a reasonable one-off test of whether you can locate the muscle, but done repeatedly it interferes with normal bladder emptying and can cause incomplete voiding.
The five most common mistakes
If your exercises are not working, the cause is very likely on this list.
- Bearing down instead of lifting. The most serious error. It pushes the pelvic organs downwards and can worsen prolapse and leaking. If you feel pressure downwards or a bulging sensation, you are doing the opposite of the exercise.
- Squeezing the buttocks, thighs or abdomen instead. If your bottom lifts off the chair or your thighs tense, larger muscles are doing the work and the pelvic floor is barely engaging.
- Holding your breath. Very common, and it increases intra-abdominal pressure — working against what you are trying to achieve. You should be able to talk throughout.
- Only ever doing long holds. The pelvic floor needs both endurance (long holds) and speed (quick, sharp contractions). Quick contractions are what stop leaking during a cough or sneeze, and they are usually the part people skip.
- Never fully relaxing. If the muscle never returns to rest, it becomes overactive — which causes pain, urgency and incomplete emptying. Full release between repetitions is part of the exercise, not a pause in it.
A standard programme
This is the general pattern used as a starting point. An individual programme should be based on your own assessed strength and endurance — these numbers are a template, not a prescription.
Long holds (endurance)
Squeeze and lift, hold for as long as you can up to about 10 seconds, then release completely and rest for the same length of time. Repeat up to 10 times. If you can only hold for 3 seconds, hold for 3 — building from your actual starting point is what produces progress.
Quick contractions (power)
Squeeze and lift quickly and strongly, then release immediately. Repeat up to 10 times. These train the reflex response that prevents leaking during sudden pressure rises.
How often
Three sets of both each day, for at least three months. UK guidance recommends a supervised programme of at least three months as first-line treatment for stress incontinence.
Progress the position
Start lying down, which is easiest. Progress to sitting, then standing, then during movement. Strength that only exists lying down will not help you when you sneeze in the supermarket.
Add "the knack"
Consciously squeeze and lift immediately before you cough, sneeze, laugh or lift. This single habit often reduces leaking noticeably within days, well before strength has changed.
Then make it functional
The endpoint is a pelvic floor that responds automatically during real activity — running, lifting, carrying — not one that performs well only during exercises.
When strengthening is the wrong treatment
This is the part that almost never appears in general advice, and it matters a great deal.
If your pelvic floor is overactive — held in sustained contraction and unable to relax — strengthening exercises will make you worse. Overactivity is the usual finding in pelvic pain, painful sex, vaginismus, urgency and incomplete emptying, and treatment for it involves learning to release and lengthen, not squeeze.
Signs that this may apply to you: pelvic floor exercises make your symptoms worse; you have pelvic, vulval or rectal pain; sex is painful; you have urgency, hesitancy or a stop-start stream; you strain to empty your bowels; you cannot feel any release after a contraction.
If any of those apply, stop the exercises and get assessed. Continuing to strengthen an overactive muscle is one of the most common ways people make their symptoms substantially worse over months.
This is also why "just do your Kegels" is unsafe general advice. Whether you should strengthen or release depends on an assessment that a leaflet cannot perform.
How long until it works
The knack — pre-contracting before a cough or lift — can reduce leaking within days, because it is a technique change rather than a strength change.
Genuine strength gains follow the same physiology as any other muscle: early improvement from better neural recruitment within four to six weeks, and structural change over three to six months. This is why guidance specifies at least three months of consistent training before judging the outcome.
If you have trained consistently and correctly for three months with no change, that is meaningful information. It usually points to a technique problem, an overactive rather than weak pelvic floor, or a contributing factor such as chronic constipation, chronic cough or significant prolapse that needs addressing alongside. It is a reason to be assessed, not a reason to give up.
Frequently Asked Questions
How do I know if I am doing pelvic floor exercises correctly?
A correct contraction is an inward and upward squeeze and lift, with no buttock, thigh or abdominal tensing, no breath-holding, and no downward pressure. You should be able to talk throughout. The most reliable way to know is assessment by a pelvic health physiotherapist, because studies consistently show that a large proportion of people perform the contraction incorrectly when working from written instructions alone.
Why are my pelvic floor exercises not working?
The most common reasons are incorrect technique — particularly bearing down instead of lifting, or substituting buttock and thigh muscles — omitting quick contractions, never fully relaxing between repetitions, or an underlying overactive rather than weak pelvic floor, in which case strengthening makes things worse. Contributing factors such as chronic constipation or a chronic cough can also prevent progress.
How many pelvic floor exercises should I do a day?
A common starting programme is three sets daily, each comprising up to 10 long holds of up to 10 seconds and up to 10 quick contractions, continued for at least three months. Those numbers are a template — an individual programme should be based on your assessed strength and endurance, starting from what you can currently manage rather than a fixed target.
Can pelvic floor exercises make things worse?
Yes, in two situations. If you bear down instead of lifting, you increase downward pressure on the pelvic organs, which can worsen prolapse and leaking. And if your pelvic floor is already overactive — typical in pelvic pain, painful sex, urgency and incomplete emptying — strengthening adds tension to a muscle that cannot relax, and symptoms usually deteriorate. Both are reasons to be assessed rather than to persevere.
Should I stop my urine flow to test the muscles?
As a one-off check that you can locate the muscle it is acceptable, but do not use it as an exercise. Repeatedly interrupting urine flow interferes with normal bladder emptying and can lead to incomplete voiding, which brings its own problems including infection risk.
Do pelvic floor trainers and apps work?
They can help with motivation and adherence, and some devices provide useful feedback. However, most cannot tell whether you are contracting correctly or bearing down, so a device used with poor technique reinforces the error. They work best after assessment has confirmed your technique is right — which is the opposite of how they are usually marketed.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
Get Your Technique Checked
A large proportion of people contract incorrectly from written instructions alone. One appointment usually settles it.
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