5 Simple Ways To Progess Your Pelvic Floor Exercises

Progress pelvic floor exercises

Are you getting the results you want from your pelvic floor exercises?

Are you frustrated by your lack of progress?

Just like muscle strength training in the gym where increasingly heavy weights are lifted to increase the challenge, pelvic floor muscle training needs to be progressed to get the best strengthening effect.

These 5 quick tips help you progress pelvic floor exercises to get the most benefit out of your pelvic floor strengthening.

Tip 1. Progress Your Position

Woman sittingWhat position(s) do you choose for your pelvic floor exercises?

When starting out some women find that lying down is the best position. This is fine to start with but it’s not the best position long-term!

There are 2 main benefits with upright strengthening:

  1. Increased challenge to your pelvic floor as it needs to lift upwards against gravity.
  2. Train your pelvic floor muscles to work better when you need them most i.e. upright.

Upright positions for progressing pelvic floor exercises include both sitting and standing. Some women progress pelvic floor exercises from lying down to sitting and then standing as their pelvic floor muscles become stronger.

Ultimately the best position for pelvic floor exercises to maximize your strengthening is standing upright using the correct posture.

Tip 2. Increase Your Effort

Do you use your best possible effort with every exercise or are some of your attempts a little half-hearted?

Strong muscle contractions that use a lot of effort have a better strengthening effect than a weak muscle contractions.

Try to use your best possible effort with every pelvic floor exercise you do i.e. squeeze and lift your pelvic floor muscles as strongly as you can with every exercise (and don’t forget to try to lower your pelvic floor slowly rather than let it drop).

Tip 3. Progress Your Numbers Progress your numbers

You don’t need to do hundreds of daily pelvic floor exercises to strengthen your pelvic floor!

Previous recommendations to do hundreds of pelvic floor exercises (Kegels) daily are now well outdated. In fact this practice can cause pelvic floor fatigue making pelvic floor symptoms worse.

Current pelvic floor exercise guidelines recommend 8-12 pelvic floor exercises in a row. These exercises should be repeated 3 times throughout the day.

Don’t worry if you can only manage to do a few exercises in a row when starting out – this is a common problem with weak pelvic floor muscles. Try to increase your repeated exercises up to 8-12 in a row using your strongest possible pelvic floor contraction as you strengthen over time.

Tip 4. Reduce Your Rests Rest

When starting out you may need long rests between your pelvic floor exercises i.e. 45 seconds and even longer.

Reducing your resting time challenges your pelvic floor muscles making them work harder.

As your strength increases reduce the rest time between each pelvic floor exercise you repeat. You may find that over time you only need 5-10 seconds recovery time before your next exercise.

Tip 5. Resist Everyday Forces

Everyday forces on your pelvic floor include the force when you cough, sneeze, blow your nose or lift something heavy. These forces create pressure downwards on your pelvic floor.

Your challenge is to lift your pelvic floor muscles against these downward forces. In doing so, you’ll make your pelvic floor stronger and better at working for you in your everyday life. 

For example, next time you need to cough prepare by squeezing and lifting your pelvic floor muscles in preparation and try to keep them lifted up against the downward force of your cough. This technique is called ‘The Knack’ (shown right).

You may find that at first you can activate your pelvic floor against the force of a small cough. Progress this to resisting more forceful coughing as your pelvic floor gets stronger.

Key Points To Progress Pelvic Floor Exercises

Progressively increasing the challenge to your pelvic floor muscles to make them work harder is the key to getting the best strengthening effect from your pelvic floor exercises.

Maximize the effect of your pelvic floor exercises by:

  • Progressing to upright standing exercises
  • Using your strongest possible effort
  • Doing 8-12 repeated pelvic floor exercises, 3 times/day
  • Decreasing the time you spend resting to recover between exercises
  • Using your pelvic floor muscles to withstand everyday forces.

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Comments

  1. The timing of this article is perfect for me. Thank you.

    I have been diligently working on Kegels laying down. At first it was so difficult! (By the way, thank you for the article and video about how to do hem properly. You explain it very clearly.) I have been at it about four weeks now. I was getting discouraged because I didn’t feel like my prolapse symptoms were any better even though my pelvic floor is somewhat stronger. (My physio ranked me a 3 on a scale of 1-5 about 2 weeks ago.) Just a couple of days ago she had me exercise with biofeedback electrodes and said it is time to progress! I am still mostly to lie down for Kegels, but now I have been assigned bridges, clams, and hydrants in addition. I am looking forward to when I get to progress to sitting Kegels. Right now I can’t imagine standing, but I remain hopeful. I keep reminding myself this is a slow process! Patience and perseverance…

    Thank you for sharing valuable, practical information on your website. It took a long time, but I went back through all the blog archive, read every article and all the comments. I learned so much! I was way more prepared for my medical appointments because of what I learned here!

    • Michelle Kenway Physiotherapist says:

      Hi Susan
      Thanks for your comments and kind feedback. it’s great that you’re improving and yes it does take time and diligence!
      Susan what’s to stop you trying your exercises upright now? Often women with pelvic floor weakness and prolapse issues can actually contract their pelvic floor upright. Sometimes the only problem is that they’ve never thought to try it. Upright really is the most effective training position and the most functional – see if you can contract in upright even for a second or two and progress form there. This will be much more beneficial for your than any lying down exercises you do especially now that you know how to do your pelvic floor exercises correctly.Always keen to hear how you go!
      Cheers
      Michelle

      • Thank you for the encouragement. I am on a learning curve! I wish there was someone, like you, I could take out for coffee for a long, long, talk. That said, your website and these comment threads are the BEST source for Q&A I have found. Doctors do the best they can in their short appointment, I’m sure, but appointments feel so rushed. So, thank you for your time here!

        Can I ask about my progression so far?
        Background –
        This is how it began. Starting 8/13 I was to do the following 3 times a day on my back: 10 repetitions of long Kegels (10 second contractions, 10 seconds rest between) and 10 short Kegels (contract with exhale, relax with inhale to slow, steady breathing). 8/31, I was “finger tested” for strength, and ranked 3 on a scale of 1-5, and to keep going with the Kegels, which were getting stronger. 9/16, my physio put biofeedback electrodes on my perineum, and had me do a strong Kegel contraction to hold as I did each repetition of the exercises I mentioned in my original message above, relaxing between repetitions. These hip exercises are to be done this way every other day in place of one of my Kegel sets those days. These last few days I decided to try a few of my first morning set of Kegels, sitting. I was surprised they were not as hard as I expected. Thank you for encouraging me to try. That’s where I am today.

        Question –
        I have been instinctively spacing the sets out for maximum rest, but I am beginning to wonder if I am wrong to do that. I do my first set at about 10am, second set late afternoon, and last set during my bath before bed. Then I use a warm pack in bed because sometimes I feel a spasm in my pelvic floor under my vulva. I used to feel spasms every night, but that has gone almost completely away as I have gotten stronger and have learned to fully relax (something I also learned here – thanks). Do you think I would progress better if I did my sets closer together, earlier in the day?

        I cannot thank you enough for letting us ask questions and giving us encouraging, informative responses!

  2. Hi Michelle, I have heard that taking the pill (birth control) is a good thing with prolapse as it has estrogen which helps maintain muscle strength?? Is this true. I am thinking of going off the pill and don’t want my prolapse to worsen. Would appreciate your comments please.
    Regards
    Theresa

    • Michelle Kenway Physiotherapist says:

      Hi Theresa
      Best to talk to your doctor about changing your medications. Going off the pill is unlikely to change prolapse symptoms or severity – the key is to really working to maintain optimal pelvic floor muscle strength long-term.
      All the best

      • Thank you Michele always appreciate your kindness

      • I have wondered about hormones, too, since I developed POP symptoms 2 years post menopause, almost to the day! I probably had dropped organs before, but developed vaginal atrophy from low estrogen. My pelvic floor was weak, too, but I am working on that diligently! I have both of your books and your DVD. They are really good!

        My Gyn immediately put me on Estrace cream, but after a month, I had horrible side effects and stopped. He said hormone therapy doesn’t really help much, but it was worth a try. My 2nd opinion this week said hormone replacement is very important and wanted me to resume immediately! It also came out that perhaps my reaction was due to incorrect dosage. The Rx says 1/4-1/2 applicator (1-2 grams), but the new Gyn says it should be 1/4-1/2 gram! I am calling the pharmacy today to see if a mistake was made with the original Rx. (This upsets me because the reaction was awful: severe headache, dizziness, nausea, depressed feelings, painful breasts, raw vaginal skin. Ugh. I hope no permanent damage was done. A few days after stopping, my sunny disposition returned, I felt way better.)

        I tried 1/4 gram twice now this week, and the rawness has returned a little. So, my hope is to find a new cream that contains estradiol without all the chemical ingredients in the delivery cream. Are there any cleaner estradiol creams? My doctor did not seem to have time or interest in discussing this, but I want to explore other options.

        Thank you. (My kind and extremely patient husband thanks you, too!)

        • Michelle Kenway Physiotherapist says:

          Hi Susan & Theresa (again)

          Ok here’s a bit more on hormones and prolapse …Yes hormones do play a part in pelvic floor strength and support. They influence the collagen elasticity in the supportive tissues that wrap around and hold up the pelvic organs. There are also oestrogen receptors in the pelvic floor muscles. Despite this hormone treatment isn’t usually prescribed for prolapse; with prolapse the tissues are already stretched and hormone treatment won’t repair these stretched tissues. Does hormone treatment prevent prolapse? I don’t know of any studies investigating this possibility, it’s an interesting area.

          Hope this makes things a little clearer
          Michelle

  3. Elizabeth says:

    Just wanted to say thank you for these news letters and information. They are easy to understand, informative and keep me on track with my pelvic floor exercises.
    They are an extremely useful resource for all women and not just those with pelvic floor problems.
    Thank you.
    Lizzie

    • Michelle Kenway Physiotherapist says:

      Many thanks for your feedback Lizzie, it’s rewarding to hear that the information is helping you stay on track with your pelvic floor exercises – this is always a challenge isn’t it!
      All the best
      Michelle

  4. Hi Michelle
    I’ve recently had a pessary fitted – which has improved my life no end – but I’m wondering if you have any information on how long these would normally last before the need for surgery
    Also would it be safe to weight- train with a pessary on seated equipment ?

    I just want to say a big thank you for your book “inside out ” I keep it in my bedside table and refer to it many times and also your wonderful newsletter , it makes me feel I’m not battling this alone

    • Michelle Kenway Physiotherapist says:

      Hi Pearl

      Thanks for your question – some women use pessaries long-term and avoid surgery whereas others find that pessary doesn’t suit them or they have issues with using or fitting the right pessary. It’s definitely not set in stone that all women who use a pessary proceed to surgery.

      Hope this helps Pearl & so glad Inside Out & the newsletter helps you too

      Best wishes
      Michelle

  5. I’d like to echo the others to say thank you for all this information. You are the first one I’ve come across who seems to be more realistic about the time it takes to rebuild your pelvic floor. Most sites say within a month. When I read that, it’s tempting to give up. A month may be true for someone young or whose pelvic floor is not that bad but it’s taking me a lot, lot longer.

    I’m 67. Six months ago my pelvic floor was at a 1. It’s taken me this long to get it to just a 2. I have a few questions – should I expect it to take another 6 months, doing my daily exercises, to get it to a 3, and is it possible to get it even higher than that if I press on?

    Thanks.

    • Michelle Kenway Physiotherapist says:

      Hi Lee

      I think it’s really like any muscle strengthening in the gym in that there’s no set time frame & the rate and upper limit of strengthening are indeed very individual. Some women strengthen quickly and others don’t. Many factors can influence the rate of strengthening and indeed the ultimate strength you achieve with your training i.e. progression, practice, technique, position in which you exercise, voluntary strength used with your exercises etc

      I think the key is to commit to lifelong progressive strengthening to achieve your own personal best and to maintain that level long-term.

      Stick with it Lee!

      All the best
      Michelle

  6. Hi Michelle, Are you able to give an opinion on how soon it is safe to restart pelvic floor exercises following a hysterectomy with anterior and posterior repair? Is it best to give the tissues a chance to settle down first or restart straight away?
    Many thanks

    • Michelle Kenway Physiotherapist says:

      Hi Jacqui

      This depends on the preferences of your surgeon according to your particular surgery. Some women are given approval to recommence pelvic floor exercises 4 weeks after surgery, others are advised to wait for 6-8 weeks.

      The best idea is to phone the doctors rooms and ask for his/her preference if you weren’t advised at discharge from hospital. Remember the importance of correct technique so that you’re lifting not bearing down as many women mistakenly do as well as the need to start gradually as shown in this video for pelvic floor exercises after surgery

      All the best
      Michelle