The pelvic floor is a bowl of muscles at the bottom of the pelvis that holds up the bladder, bowel and uterus, closes the urethra and back passage and works with every breath, lift and step. When it weakens, from pregnancy, childbirth, the hormonal change of menopause, heavy lifting, chronic coughing, overweight or simply age, leakage with coughing and jumping, heaviness, prolapse and sometimes pain follow. Pelvic floor training (Kegel exercises) is the best documented treatment for stress incontinence and prevents prolapse, and it works for both women and men. But it has to be done correctly: many people squeeze with the wrong muscles, hold their breath or push downwards, and some need to teach the pelvic floor to relax rather than tighten. Here is how to find the muscles, a programme in three levels, how often and for how long, what applies in life's different phases, when relaxation is right and when to see a doctor.
How to find the pelvic floor
Sit or lie comfortably. Imagine holding back wind and at the same time stopping the flow of urine: the feeling that it "closes and lifts" inwards and upwards around the back passage, vagina or urethra is the pelvic floor. Thighs, buttocks and abdomen should be relaxed, and you should be able to breathe normally. Check with a hand on the stomach that it does not tighten, and with a mirror that the perineum draws slightly inwards, not bulges out. If you feel nothing, or it pushes outwards when you try to squeeze, you are squeezing incorrectly; then get help from a physiotherapist specialising in the pelvic floor, who can feel and give feedback. (Stopping the flow of urine on the toilet is a way to find the muscles once, not an exercise; it can disturb bladder emptying.)
The programme: three levels
- Level 1 – find and hold (weeks 1–2). Lie on your back with bent knees. Squeeze lightly, hold three seconds, relax completely for six seconds. Ten repetitions, three times a day. The relaxation is as important as the squeeze.
- Level 2 – endurance and speed (weeks 3–6). Long squeezes: hold six to ten seconds, rest as long, ten repetitions. Quick squeezes: squeeze maximally for one second, release completely, ten repetitions. Do both, sitting and standing, three times a day.
- Level 3 – in function (from week 6). Squeeze just before you cough, sneeze, lift or jump ("the knack"), and hold the squeeze during the lift. Build squeezes into everyday movements: when you get up, carry bags, climb stairs. Continue level 2 two to three times a week as maintenance.
Breathe throughout; squeezing on the exhale is easiest. Expect clear improvement after six to twelve weeks and then continue for life, as with all other strength. Apps with reminders help many people remember.
The pelvic floor in life's phases
- During pregnancy: train from the start; it reduces the risk of leakage during and after pregnancy. Combine with movement within the pain limit, and with pelvic pain read Pelvic girdle pain in pregnancy.
- After the birth: start with light squeezes as soon as it feels okay, often within a few days, even after a caesarean. Increase gradually. Leakage, heaviness or a bulge in the vagina after eight to twelve weeks should be assessed by a midwife or physiotherapist. Tailbone pain after childbirth: Tailbone pain.
- In menopause: lower oestrogen makes the mucous membranes and supporting tissue thinner, and leakage and heaviness increase. Pelvic floor training plus local oestrogen through healthcare helps most people. More on this period in Menopause.
- Men: the same muscles, the same exercises. Especially important after prostate surgery (ideally start before) and with post-micturition dribble. The squeeze feels like lifting the scrotum and drawing in the base of the penis.
- Athletes and heavy lifting: leakage with jumping and lifting is common even in young, fit women. Squeeze before loading, exhale in the lift, and reduce the load until the pelvic floor keeps up.
When you need relaxation instead of strength
A pelvic floor can also be too tight: with pain during sex, difficulty emptying the bladder or bowel, urgency without leakage, pain in the pelvis, tailbone or groin, and often in people who are stressed, hold their breath or squeeze reflexively all day. Then squeezing exercises make it worse. Signs: you can squeeze but not release completely, or it hurts to squeeze. What helps is deep belly breathing lying on your side or in child's pose, consciously "letting down" the pelvic floor on the exhale, heat, sitting on a soft ball and breathing slowly, and treatment with a pelvic floor physiotherapist. Gentle cupping of the buttocks and lower back can help the outer muscles let go, see Piriformis syndrome, but cupping is never used in or near the genital area.
When to see a doctor
See a doctor if you have leakage affecting your daily life despite three months of training, a bulge or heaviness in the vagina, difficulty emptying the bladder or bowel, blood in the urine, pain during sex, recurrent urinary tract infections, sudden inability to pass urine (urgent), or leakage after prostate surgery that is not improving. Healthcare can offer a physiotherapist, aids, local oestrogen, a pessary and if needed surgery.
Frequently asked questions
How often should you do pelvic floor training?
Three times a day for six to twelve weeks to build strength, then two to three times a week as maintenance, for life. Also add squeezes before coughing, lifting and jumping.
How do I know I am squeezing correctly?
The feeling is that it closes and lifts inwards and upwards around the back passage and urethra while the abdomen, buttocks and thighs are relaxed and you breathe normally. If it pushes outwards, or the stomach tightens, you are squeezing incorrectly. A physiotherapist can check and give feedback.
Can men train the pelvic floor?
Yes, the same muscles and the same exercises. It is especially important with post-micturition dribble and before and after prostate surgery, where training shortens the period of leakage.
How long before it helps?
Most people notice a difference after six to twelve weeks of regular training. Prolapse and leakage after childbirth can take longer. If you stop, the effect gradually disappears.
What do I do if it hurts to squeeze?
Then the pelvic floor is probably too tight and needs relaxation instead: deep belly breathing, consciously releasing on the exhale, heat and treatment with a physiotherapist. Stop the squeezing exercises until you have had help.
Sources
- 1177 Vårdguiden (Swedish national health guide), search for "bäckenbottenträning" for medical information and when to seek care.
- Curam's training material on pregnancy health and recovery, developed together with trained therapists.
Related guides
- Core exercises at home – 10 exercises for a strong trunk
- Sluggish bowels and constipation – self-care and abdominal massage
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
