If you leak urine when you cough, sneeze, or laugh, you’ve probably heard someone suggest Kegel exercises. The advice is so common it’s almost reflexive: bladder problems? Do your Kegels. But here’s what most people don’t realise: roughly a third of women who attempt pelvic floor exercises do them incorrectly, and for some people, strengthening exercises can actually make symptoms worse.

I want to walk you through how pelvic floor exercises actually work, when they help, when they don’t, and how to do them properly. Because the difference between effective pelvic floor training and wasted effort often comes down to technique and understanding your specific situation.

How Your Pelvic Floor Affects Bladder Control

The pelvic floor is a group of muscles that stretch like a hammock from your pubic bone to your tailbone. These muscles support your bladder, bowel, and (in women) the uterus. When they contract, they help close the urethra and keep urine from leaking. When they relax, they allow you to urinate.

In stress urinary incontinence, the pelvic floor muscles can’t generate enough force to keep the urethra closed when abdominal pressure increases suddenly. Coughing, sneezing, jumping, or lifting creates downward pressure, and weak muscles let urine escape.

In urge incontinence and overactive bladder, the situation is different. Here, involuntary bladder contractions create sudden urges to urinate. Research shows that voluntarily contracting the pelvic floor muscles can actually suppress these bladder contractions 1. The pelvic floor and bladder have a reciprocal relationship: when one contracts, the other tends to relax.

This is why pelvic floor muscle training is recommended as first-line treatment for most types of urinary incontinence. According to a 2024 Cochrane review, it’s effective for reducing symptoms in women with stress, urge, and mixed incontinence 2.

1. Finding Your Pelvic Floor Muscles

This is where most people go wrong before they even start. Studies suggest that 25 to 50 percent of women cannot correctly activate their pelvic floor muscles when simply given written instructions 3.

The classic advice is to imagine stopping the flow of urine midstream. That’s a reasonable way to identify the muscles initially, but don’t actually practice stopping urine flow regularly. Interrupting urination can prevent complete bladder emptying and potentially increase urinary tract infection risk.

Another way to find these muscles: imagine you’re trying to avoid passing gas in a quiet room. The squeeze you feel at the back of your pelvic floor uses the same muscle group.

For women: You can also insert a clean finger into the vagina and try to squeeze around it. If you feel pressure on your finger, you’re activating the right muscles.

For men: The muscles that stop urine flow are the same ones that make your penis lift slightly when you contract them. Visualising this movement can help you identify the correct muscles.

What you should NOT feel: Your buttocks clenching, your thighs squeezing together, or your abdomen pushing outward. These are signs you’re engaging the wrong muscles. Your stomach should stay soft, and you should be able to breathe normally throughout.

2. Basic Kegel Exercise Technique

Once you’ve identified the right muscles, here’s the basic approach:

Empty your bladder first. A full bladder makes the exercises uncomfortable and less effective.
Get comfortable. Lying down with knees bent is easiest when you’re learning. Later, you can do these sitting or standing.
Contract the pelvic floor muscles. Imagine lifting them up and in. Don’t push down.
Hold for 3 to 5 seconds. This builds strength in the slow-twitch muscle fibres that provide sustained support.
Relax completely for 3 to 5 seconds. The relaxation phase is just as important as the contraction. Muscles that never fully relax become fatigued and dysfunctional.
Repeat 10 times. This counts as one set.
Do 3 sets daily. Morning, afternoon, and evening works well for building the habit.

Progression: As you get stronger, gradually increase your hold time to 8 to 10 seconds. You can also add “quick flicks” after your sustained holds: rapid contract-and-release repetitions (1 to 2 seconds each) for 10 reps. These train the fast-twitch fibres that respond to sudden stress like coughing 4.

3. The “Knack” Technique for Immediate Protection

This is one of the most useful things you can learn. The knack involves preemptively contracting your pelvic floor just before and during activities that trigger leakage.

About to cough? Squeeze first, then cough. Need to sneeze? Contract, then sneeze. Lifting something heavy? Engage your pelvic floor before you lift.

Research shows that the knack can provide immediate improvement in leakage even while your overall pelvic floor strength is still building 5. It’s a practical skill you can use right away.

My take: I think the knack is underappreciated. It gives people something they can do today, not just months down the line. Once it becomes automatic, you barely think about it.

4. Why Technique Matters More Than Quantity

A common mistake is treating Kegel exercises like a numbers game. More must be better, right? Not necessarily.

The research is clear that supervised pelvic floor muscle training with professional guidance produces better outcomes than unsupervised exercises 6. The main reason isn’t that supervised patients do more exercises. It’s that they do them correctly.

Incorrect technique includes:

Bearing down instead of lifting up: Some people push their pelvic floor outward rather than contracting it inward. This is counterproductive and can worsen prolapse.
Holding your breath: This increases abdominal pressure and works against what you’re trying to achieve.
Using accessory muscles: If your buttocks, thighs, or abs are doing the work, your pelvic floor isn’t getting trained.
Skipping the relaxation phase: Muscles need to relax to recover. Constant tension leads to pelvic floor dysfunction.

If you’ve been doing Kegels for months without improvement, technique problems are the most likely explanation. Consider seeing a pelvic floor physiotherapist who can assess whether you’re activating the correct muscles. Biofeedback devices can provide visual or auditory confirmation of proper technique 7.

5. When Your Pelvic Floor Needs Relaxation, Not Strengthening

Here’s something that surprises many people: not everyone with bladder problems needs stronger pelvic floor muscles. Some people have the opposite problem, a pelvic floor that’s too tight and won’t relax properly.

A hypertonic (overactive) pelvic floor stays partially contracted all the time. Instead of causing leakage, this can lead to difficulty starting urination, incomplete bladder emptying, urinary retention, pelvic pain, and painful bladder syndrome.

If you have these symptoms, traditional Kegel exercises may make things worse. You’re essentially trying to strengthen muscles that are already in spasm.

Signs you might have a hypertonic pelvic floor:

Difficulty starting to urinate
Weak or intermittent urine stream
Feeling like you can’t fully empty your bladder
Chronic pelvic pain
Pain during or after intercourse

For these situations, pelvic floor relaxation exercises (sometimes called “reverse Kegels” or “down-training”) are more appropriate. These involve consciously releasing tension in the pelvic floor rather than building it.

Basic relaxation technique:

Lie in a comfortable position with your hips and knees supported.
Take a slow breath in through your nose, letting your belly expand.
As you exhale gently, visualise your pelvic floor dropping and opening, as if you’re about to urinate.
Don’t push or strain. Just let go of any tension.
Continue for 5 to 10 breath cycles.

Yoga poses like child’s pose and happy baby can also help stretch and relax tight pelvic floor muscles. But if you suspect pelvic floor hypertonicity, I’d recommend seeing a specialist rather than self-treating. The wrong exercises can worsen the problem 8.

6. Pelvic Floor Exercises for Men

While women get most of the attention when it comes to pelvic floor training, these exercises benefit men too. They’re particularly useful for:

Urinary symptoms related to benign prostatic hyperplasia
Recovery after prostate surgery
Overactive bladder in men
Post-void dribbling

The technique is essentially the same. Men should contract the muscles that would stop urine flow and make the penis lift slightly. Avoid clenching the buttocks or holding your breath. Hold for 5 to 10 seconds, relax fully, and repeat.

Men often find these exercises easier to do while sitting or standing rather than lying down. The key is consistency: aim for 3 sets of 10 repetitions daily.

7. How Long Until You See Results?

I won’t sugarcoat this: pelvic floor muscle training takes time. You’re essentially doing strength training for an internal muscle group, and like any strength training, adaptation doesn’t happen overnight.

Most studies show initial improvements at 6 to 8 weeks, with more significant benefits appearing at 3 to 6 months of consistent practice 9. A meta-analysis found that women who stuck with their exercise programme for at least three months had significantly better outcomes than those who stopped earlier.

The frustrating truth: Many people give up before exercises have had time to work. If you’ve been doing correctly-performed Kegels for just two or three weeks and you’re not seeing improvement, that’s normal. Keep going.

Once you’ve achieved your goals, you can’t just stop. Muscles weaken without continued use. Most experts recommend continuing maintenance exercises indefinitely, perhaps reducing from three times daily to once daily.

8. Combining Exercises with Other Strategies

Pelvic floor exercises work best as part of a broader approach to bladder health. Consider combining them with:

Bladder training: For urge incontinence and frequent urination, bladder training involves gradually extending the time between bathroom visits. When you feel an urge, use your pelvic floor contraction to suppress it, wait a few minutes, then go. Over weeks, you gradually increase the waiting period.

Fluid management: Drink enough to stay hydrated (pale yellow urine is the goal), but consider timing. Reducing fluids in the evening may help with nocturia.

Weight management: Excess weight puts constant pressure on the pelvic floor. Studies show that even modest weight loss can improve incontinence symptoms.

Avoiding bladder irritants: Caffeine, alcohol, and acidic foods bother some people’s bladders. Keeping a diary to identify personal triggers can help.

9. Technology and Biofeedback Options

Various devices claim to help with pelvic floor training. Some are genuinely useful; others are marketing more than medicine.

Biofeedback devices use sensors to detect pelvic floor muscle activity and provide visual or auditory feedback. These can help confirm you’re contracting the right muscles and track your progress over time. A 2024 study found that app-based pelvic floor training with feedback significantly reduced incontinence symptoms 10.

Vaginal weights or cones provide resistance training for the pelvic floor. You insert a weighted cone and try to keep it in place by contracting your muscles. The evidence for these is mixed, and they’re not suitable for everyone.

Electrical stimulation devices use mild current to activate pelvic floor muscles automatically. These may help people who have difficulty voluntarily contracting their muscles. They’re sometimes used alongside active exercises.

My honest assessment: Technology can be helpful, particularly for confirming technique and maintaining motivation. But it’s not essential. Plenty of people improve with basic exercises alone. If you’re considering purchasing a device, look for ones with clinical studies supporting their use, not just marketing testimonials.

When to See a Doctor

Pelvic floor exercises are generally safe, but they’re not appropriate for everyone and shouldn’t delay medical evaluation when it’s needed.

See your doctor if:

You have blood in your urine (hematuria)
You experience pain when urinating (dysuria)
Your symptoms started suddenly
You have complete inability to urinate
Incontinence significantly affects your quality of life
You’ve tried pelvic floor exercises for 3 months without improvement
You have symptoms suggesting a hypertonic pelvic floor (difficulty emptying, pelvic pain)

A pelvic floor physiotherapist can assess your specific situation and create an individualised programme. They can determine whether you need strengthening, relaxation, or a combination of both. This is particularly valuable if you’ve been trying exercises on your own without success.

For persistent or severe symptoms, medical treatments beyond exercises may be appropriate. These include medications for overactive bladder, pessaries for stress incontinence, or in some cases, surgery.

Summary

Pelvic floor exercises remain one of the most effective conservative treatments for urinary incontinence. They’re safe, free, and you can do them anywhere. But effectiveness depends on doing them correctly, consistently, and for the right indication.

Key points to remember:

Find the right muscles first, and verify you’re not engaging your buttocks, thighs, or abdomen
Both contraction and relaxation matter: don’t skip the rest phase
Results take time: expect 6 to 12 weeks for initial improvement
Not everyone needs strengthening; some people need relaxation exercises instead
The “knack” technique provides immediate protection during activities that trigger leakage
Professional guidance improves outcomes, especially if self-directed exercises haven’t worked

If you’ve been told to “just do your Kegels” but haven’t seen results, don’t assume pelvic floor exercises don’t work for you. More likely, you need better guidance on technique, or you may have a condition that requires a different approach entirely.

References

Overactive bladder inhibition in response to pelvic floor muscle exercises - BJU International (2003)
Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women - Cochrane Database of Systematic Reviews (2024)
Correct performance of pelvic muscle exercises in women reporting prior knowledge - Female Pelvic Medicine & Reconstructive Surgery (2014)
Kegel Exercises - StatPearls, NCBI Bookshelf (2024)
Effectiveness of Pelvic Floor Muscle Training and Abdominal Training - Neurourology and Urodynamics (1999)
Effectiveness of supervised Kegel exercises using biofeedback versus unsupervised Kegel exercises on stress urinary incontinence - BMC Women’s Health (2022)
Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback - International Urogynecology Journal (2022)
Pelvic Floor Exercises - Physiopedia
Kegel Exercise Training Program among Women with Urinary Incontinence - Healthcare (2022)
Pelvic Floor Muscle Training Using the Perifit Device for Urinary Incontinence - International Urogynecology Journal (2024)