Pelvic Floor Physical Therapy for Women

The Pelvic Floor's Important Functions:

• Support: Holds up your bladder, uterus, and rectum
• Sphincter control: Controls urination and bowel movements
• Sexual function: Contributes to arousal and orgasm
• Core stability: Works with abdominal and back muscles for posture and movement
• Lymphatic and blood flow: Helps circulation in the pelvic region

Before you can strengthen your pelvic floor, you need to identify the correct muscles. Here's how:

Method 1: Stop the Stream (for identification only)

• While urinating, try to stop or slow the flow of urine midstream
• The muscles you use to do this are your pelvic floor muscles
• Important: This is only for identification—do NOT practice Kegels while urinating regularly, as this can lead to incomplete emptying

Method 2: Vaginal Awareness

• Insert a clean finger into your vagina
• Squeeze as if trying to hold in urine or gas
• You should feel a gentle lift and squeeze around your finger

Method 3: Visualization

• Imagine picking up a marble with your vagina
• Or imagine drawing a string up from your vagina toward your belly button
• Feel the lift and squeeze sensation

Kegels are the foundation of pelvic floor strengthening. There are two types:

Tips for Effective Kegels:

• Breathe normally — don't hold your breath
• Keep other muscles relaxed — buttocks, thighs, and abdomen should stay soft
• Focus on the lift — imagine lifting up and in, not pushing down
• Be patient — results take 6-12 weeks of consistent practice
• Progress gradually — start with 3-5 second holds, work up to 10

Exercise 3: Bridge with Kegel

1. Lie on your back, knees bent, feet hip-width apart
2. Engage your pelvic floor (Kegel)
3. Lift your hips off the ground into a bridge
4. Hold for 5 seconds while maintaining the Kegel
5. Lower slowly while releasing the Kegel
6. Repeat 10-15 times

Benefit: Strengthens pelvic floor, glutes, and core together

Exercise 4: Diaphragmatic Breathing with Pelvic Floor

1. Lie on your back or sit comfortably
2. Inhale: Breathe deeply into your belly, letting your pelvic floor gently relax and descend
3. Exhale: As you breathe out, gently engage and lift your pelvic floor
4. Continue for 2-3 minutes, focusing on the coordination

Benefit: Improves coordination between breathing and pelvic floor function

Exercise 5: Squats with Pelvic Floor Engagement

1. Stand with feet shoulder-width apart
2. As you squat down, allow your pelvic floor to relax
3. As you stand up, engage your pelvic floor and squeeze
4. Repeat 10-15 times

Benefit: Functional strengthening that mimics daily movements

Exercise 6: Happy Baby Stretch (for tight pelvic floors)

1. Lie on your back
2. Bring your knees toward your armpits
3. Hold the outside of your feet
4. Gently rock side to side
5. Breathe deeply and allow your pelvic floor to fully relax
6. Hold for 1-2 minutes

Benefit: Releases tension in the pelvic floor—important for those with tightness or pain

"The Knack" is a technique where you consciously contract your pelvic floor just before and during activities that cause leakage:

How to Do It:

1. Anticipate the activity (cough, sneeze, lift, laugh)
2. Just before the activity, squeeze your pelvic floor muscles
3. Hold the contraction through the activity
4. Release after

Practice "The Knack" During:

• Coughing or sneezing
• Laughing
• Standing up from sitting
• Lifting objects
• Jumping or running

This is one of the most effective strategies for preventing stress incontinence leaks in real-life situations!

Important: Not all pelvic floor problems are due to weakness. Some women have hypertonic (overactive/tight) pelvic floors that need to learn to relax. If you have pelvic pain, pain with intercourse, or difficulty urinating, these relaxation techniques may be more important than strengthening.

Relaxation Exercise 1: Deep Belly Breathing

• Lie on your back with a pillow under your knees
• Place one hand on your belly, one on your chest
• Breathe in slowly through your nose, letting your belly rise
• As you inhale, consciously release your pelvic floor (imagine it opening like a flower)
• Exhale slowly and completely
• Practice for 5-10 minutes daily

Relaxation Exercise 2: Child's Pose

• Kneel on the floor, sit back on your heels
• Fold forward, resting forehead on the floor
• Arms extended or by your sides
• Breathe deeply into your belly and back
• Hold for 2-5 minutes, focusing on releasing the pelvic floor

Relaxation Exercise 3: Reverse Kegel

• Instead of squeezing, focus on letting go and opening
• Imagine your pelvic floor gently bulging downward (as if having a bowel movement, but gently)
• Hold the release for 5-10 seconds
• Return to neutral
• This helps those who are constantly "clenching" learn to release

Beginner Program (Weeks 1-4)

Time	Exercise
Morning	10 slow Kegels (5 sec hold), 10 quick flicks
Afternoon	10 slow Kegels (5 sec hold), 10 quick flicks
Evening	10 slow Kegels (5 sec hold), 10 quick flicks, 5 min deep breathing

Intermediate Program (Weeks 5-8)

Time	Exercise
Morning	15 slow Kegels (10 sec hold), 15 quick flicks, 10 bridges with Kegel
Throughout Day	Practice "The Knack" with all triggering activities
Evening	15 slow Kegels (10 sec hold), 10 squats with pelvic floor, relaxation stretches

While these exercises help many women, you should consider seeing a pelvic floor physical therapist if:

• You're not sure if you're doing the exercises correctly
• You have pelvic pain or pain with the exercises
• Symptoms don't improve after 8-12 weeks of consistent practice
• You have significant prolapse symptoms
• You leak during the exercises themselves
• You have difficulty relaxing your pelvic floor
• You have pain with intercourse
• You're recovering from childbirth, surgery, or radiation

A pelvic floor physical therapist can perform an internal examination, provide biofeedback, and create a customized treatment plan for your specific needs.

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