Strengthening the pelvic floor muscles: exercises and techniques

The pelvic region comprises several major muscle groups. First, there are the pelvic floor muscles, which form a "hammock" between the pubic bone and sacrum and support the pelvic organs. Second, there are the hip girdle muscles: the gluteus maximus, medius, and minimus, the deep hip rotators, the adductors and abductors, and the hip flexors and extensors. Together, they ensure pelvic stability, leg movement, and proper load transfer from the core to the lower extremities. [1]

The pelvic floor muscles are responsible for urinary and fecal continence, contribute to sexual function, and help stabilize the lumbosacral region. Weakness in these muscles is associated with increased risk of urinary incontinence, pelvic organ prolapse, and a feeling of heaviness and discomfort in the lower abdomen and back. Systematic reviews show that pelvic floor training reduces the severity of these symptoms and improves quality of life. [2]

The gluteal and hip muscles control pelvic position during walking, running, squatting, and other movements. Weakness in the gluteus medius and minimus is associated with pelvic instability, excessive knee roll, and increased stress on the knee and lumbar spine. Research has noted a link between weakness of these muscles and knee and lower back pain, as well as improvement in symptoms after strengthening them. [3]

The deep core muscles and lumbar stabilizers work together with the pelvic floor and gluteal muscles. Their job is to maintain the spine in a physiological position and distribute pressure within the abdominal cavity. When the diaphragm, abdominal muscles, and pelvic floor are well coordinated, a stable "corset" is created that protects the spine and joints from overload. When this coordination is disrupted, the risk of chronic low back pain increases. [4]

Therefore, the term "pelvic muscle strengthening" should always be understood more broadly than just Kegel exercises. It's a comprehensive approach: the pelvic floor muscles, buttocks, thighs, and core muscles should be trained together. This approach not only reduces the risk of urinary incontinence and pelvic organ prolapse, but also improves posture, reduces back pain, and increases the effectiveness of any athletic activity. [5]

Table 1. Main groups of pelvic muscles and their functions [6]

Muscle group	Where are they located?	Main functions
Pelvic floor muscles	Between the pubic bone and the sacrum	Continence of urine and feces, support of the pelvic organs, participation in sexual function
Gluteus maximus muscle	The back surface of the pelvis and thigh	Hip extension and external rotation, powerful propulsion when walking and running
Gluteus medius and minimus	Lateral surface of the pelvis	Pelvic stabilization, hip abduction, knee position control
Adductor muscles of the hip	Inner thigh	Adduction of the hip, participation in stabilization of the pelvis during walking
Hip flexors and extensors, deep rotators	Anterior and posterior surfaces of the hip joint	Control of range of motion, participation in daily activities and sports

Why Strengthen Your Pelvic Muscles: Proven Benefits

The most studied effect of pelvic floor training is the reduction of urinary incontinence in women. A large Cochrane review found that in women with stress urinary incontinence, a pelvic floor exercise program was significantly more likely to result in a reduction or resolution of symptoms compared to no training. This was true for both self-administered programs and exercises supervised by a specialist. [7]

More recent studies confirm the effectiveness of such exercises in preventing incontinence during pregnancy and after childbirth. Regular pelvic floor training during pregnancy reduces the risk of developing stress incontinence and alleviates its symptoms when they do occur. Postpartum, exercises help to more quickly regain urinary control, reduce the feeling of heaviness, and improve overall well-being. [8]

Strong pelvic floor and hip girdle muscles also impact sexual health. A 2024 systematic review found that pelvic floor training in women improves sexual function scores on standardized questionnaires, including increased satisfaction, decreased pain, and improved orgasm quality. In studies in men, pelvic floor muscle training helps reduce the severity of erectile dysfunction and premature ejaculation, especially when used as part of a comprehensive treatment. [9]

From a musculoskeletal perspective, strengthening the pelvic and hip muscles reduces the risk and severity of low back and pelvic pain. Meta-analyses show that stabilization exercise programs and pelvic floor training reduce the severity of chronic low back pain, and the addition of strengthening exercises for the buttocks and hips improves function and reduces stress on the spine. In pregnant women, core and pelvic training reduces the risk of low back and pelvic girdle pain. [10]

Finally, for athletes and physically active individuals, strong gluteal, adductor, and abductor muscles are important for injury prevention and improved movement efficiency. Reviews have noted a link between weak gluteal muscles and knee pain, landing instability, and an increased risk of patellar ligament syndrome. Strengthening these muscles improves limb control, jump and squat performance, and may reduce the risk of injury. [11]

Table 2. Confirmed effects of pelvic muscle strengthening [12]

Direction	What the research showed	Practical conclusion
Urinary incontinence in women	Pelvic floor exercises significantly reduce the frequency and volume of leakage.	An important part of treatment and prevention, especially for stress incontinence
Pregnancy and postpartum period	Exercise reduces the risk of incontinence and speeds up recovery	Recommended in the absence of contraindications as a preventative measure
Sexual function	Women's sexual function improves, with some men reporting improved erectile function and ejaculation control.	Exercises can be included in complex therapy for sexual disorders
Pain in the lower back and pelvic region	Strengthening the pelvic floor, core, and pelvis reduces chronic pain and improves function	A useful part of back pain treatment and prevention programs
Sports injuries and performance	Strong gluteal and hip muscles reduce the risk of knee injuries and improve motor control.	A must-have element of strength training for athletes and fitness enthusiasts

Basic types of exercises for the pelvic muscles

Pelvic floor exercises can be divided into three groups. The first group consists of specific pelvic floor exercises, including classic Kegel exercises. The second group consists of strength exercises for the buttocks and hip muscles: bridges, squats, lunges, hip abductions and adductions, and exercises with elastic bands. The third group consists of core stabilization exercises that teach the pelvis, lower back, and hip joints to work together. [13]

Pelvic floor exercises involve rhythmic contractions of the muscles a person uses to stop the flow of urine and hold in gas, but they are performed separately from actual urination. They typically use a combination of short and long contractions, performed in different body positions. Precision and consistency are important: research shows that programs performed daily for at least 8-12 weeks, under the guidance of a professional or with feedback, are most effective. [14]

Strengthening exercises for the glutes and hips create a foundation for pelvic stability. Glute bridges, hip abductions with an elastic band, side-lying shell squats, and controlled lunges engage the gluteus maximus and medius, as well as the hip adductors and abductors. Systematic reviews show that such exercises reduce knee and low back pain by improving motor control and load distribution. [15]

Core stabilization exercises, such as plank variations, dead bugs, and single-leg balance exercises, teach the muscles of the lower back, abdomen, and pelvis to work together. Recent reviews of chronic low back pain show that programs that include stabilization exercises improve function and reduce pain, especially when combined with strength exercises for the hips and glutes. [16]

For daily practice, not only the form of the exercise is important, but also its dosage. International strength training recommendations recommend performing 1 to 3 sets of 8-12 repetitions for each major muscle group at a moderate to heavy load for healthy adults. For older and weaker individuals, slightly more repetitions with lighter weights are recommended. These sets are easily adapted to the pelvic muscles, provided the technique and the principle of gradually increasing the load are followed. [17]

Table 3. Examples of exercises for different groups of pelvic muscles [18]

Target zone	Examples of exercises	Equipment	The main task
Pelvic floor	Short and long contractions in a lying, sitting, standing position	Without equipment or with feedback simulators	Improved control over urination, defecation and sexual function
Buttocks and hip joints	Glute bridge, hip abduction, shell, squats, lunges	Your own weight, elastic bands, dumbbells	Stabilizes the pelvis, reducing stress on the knees and lower back
Core muscles	Plank, side plank, dead bug, balance exercises	A mat, or a fitball if desired	Coordination of the core and pelvis, reduction of back pain

Sample pelvic floor strengthening program

A beginner's program should be simple and achievable. A practical option is to schedule approximately three workouts per week, each including exercises for the pelvic floor, glutes, and core. During the first few weeks, the main goal is to master the technique, learn to feel the muscles involved, and avoid overloading the joints. The load is increased slowly: first, the number of repetitions is increased, then the exercise version becomes more challenging. [19]

A sample workout might look like this. First, a warm-up: light walking, gentle pelvic circles, and hip exercises. Then a pelvic floor exercise block: 10 short and 10 long contractions, twice per workout. After that, a strength block: 2-3 sets of glute bridges, squats to a comfortable depth, and hip abductions with an elastic band. The workout concludes with a stabilization block: 2 sets each of plank variations and single-leg balance exercises. [20]

As you adapt, you can increase the load. For the pelvic floor muscles, increase the duration of holds and the number of sets, and add standing exercises, including those involving everyday movements. For the gluteal and hip muscles, increase the difficulty of the exercises: move on to deeper squats, backward and side lunges, single-leg bridges, and exercises with additional weights. For the core muscles, more complex plank variations and exercises on unstable support can be used. [21]

An important principle of any such program is consistency. Most studies on pelvic floor training and stabilization exercises report noticeable improvements no earlier than 6-12 weeks. This means don't expect quick miracles: muscles strengthen gradually, and lasting results depend on how consistently the exercises are performed. If you stop training, the effects diminish over time, especially if risk factors (excess weight, heavy work, chronic cough) persist. [22]

For convenience, you can use the "small dose" principle. Instead of one large workout, some people prefer several short mini-sessions throughout the day: a block of pelvic floor contractions in the morning, a short gluteal and core workout at lunchtime, light stretching, and a couple of balance exercises in the evening. This approach increases the likelihood that exercise will become a habit rather than a one-time "feat." [23]

Table 4. Example of a weekly program for strengthening the pelvic muscles [24]

Day of the week	Training content	Brief description
Monday	Basic complex	Pelvic floor exercises, glute bridges, squats, planks
Tuesday	Active recovery	Walking, stretching, gentle breathing exercises and pelvic floor relaxation
Wednesday	Strength focus on the buttocks	Advanced bridges, hip abductions, shells, and simple stabilization exercises
Thursday	Rest or light activity	Walking, gentle stretching
Friday	Combined lesson	Kegel exercises, squats, lunges, balance exercises
Saturday	Cardio and light strength training	Walking, cycling or swimming, a small complex for the body
Sunday	Rest	Recovery, attention to posture and everyday habits

Safety, technology and common mistakes

Although pelvic floor exercises are considered safe, it's important to follow general guidelines. If you have severe pelvic pain, recent pelvic surgery, severe organ prolapse, or significant inflammation, starting a program without consulting a specialist is not recommended. In such cases, a doctor or pelvic floor physical therapist can help you choose gentle, rehabilitative exercises and determine the appropriate load. [25]

A common mistake in pelvic floor training is excessive tension without adequate relaxation. Some people already have increased tone, which manifests as pain, discomfort during intercourse, difficulty urinating, or a feeling of incomplete bladder emptying. In such cases, aggressive "strengthening" can worsen the condition. Modern recommendations emphasize the need to teach both contraction and relaxation of these muscles, especially in cases of chronic pain. [26]

Technique errors are common in strength exercises for the glutes and hips. For example, during squats and lunges, the knees can drift too far inward or forward, and the back can become excessively rounded. This reduces the load on the target muscles and increases the risk of knee and lower back pain. Research on knee pathology and instability notes the importance of controlling the position of the knee and pelvis to prevent injury and reduce pain. [27]

Another mistake is trying to suddenly increase the load: immediately adding heavy weights, advanced plank variations, or exercises on an unstable surface. The American College of Sports Medicine recommends increasing the weight gradually, by approximately 2-10% once the desired number of repetitions is reached, and adhering to the principle of "form first, then load." This is especially important for people with back pain, excess weight, or underlying medical conditions. [28]

Equally important is monitoring daily habits. Chronic straining due to constipation, lifting heavy objects without preparation, prolonged urinary retention, and persistent coughing due to respiratory conditions create constant increased pressure on the pelvic floor and ligaments. In such cases, exercise alone won't solve the problem: a comprehensive approach is needed, including dietary adjustments, treatment of lung conditions, weight management, and learning proper breathing under stress. [29]

Table 5. Common mistakes in strengthening the pelvic muscles and their correction [30]

Error	Possible consequences	How to adjust
Severe pelvic floor tension without relaxation	Pain, cramping, difficulty urinating	Add relaxation exercises, reduce volume, and consult a specialist if necessary.
Intermittent urination as a training method	Disruption of normal reflex, risk of infection	Use the flow stop only once to identify muscles, train separately
Squats and lunges with knees inward	Knee pain, ligament strain	Make sure your knee follows the line of your foot, decrease the depth, use mirror control
A sharp increase in weight and exercise difficulty	Back and joint pain, risk of injury	Increase the load gradually, first practicing the technique
Ignoring constipation, cough and excess weight	Chronic pelvic floor strain	Combine exercise with nutritional adjustments, treatments, and weight management

Special groups: pregnancy, postpartum period, elderly and athletes

During pregnancy, the pelvic position changes, pressure on the pelvic floor increases, and hormonal levels fluctuate. Systematic reviews show that pelvic floor strengthening programs during pregnancy reduce the risk of stress urinary incontinence and help women better cope with the increasing load. However, any exercises should be discussed with an obstetrician/gynecologist, especially if there is a risk of preterm labor, pain, or complications. [31]

After childbirth, the pelvic muscles require recovery. Pelvic floor exercises and gentle core stabilizing exercises help regain control over urination and bowel movements and reduce feelings of heaviness and discomfort. The start and intensity of the program depend on the type of birth, the presence of tears, and overall well-being. If prolapse is severe, pain occurs, or complications arise, follow-up with a pelvic floor specialist is recommended. [32]

Older adults especially benefit from strengthening their pelvic muscles. This group has a higher risk of urinary incontinence, prolapse, and falls. Strengthening the gluteal and hip muscles improves balance and reduces the likelihood of falls, while pelvic floor exercises reduce the frequency of incontinence episodes. However, programs should be tailored in intensity, taking into account comorbidities and cognitive characteristics. [33]

For athletes and physically active individuals, the focus shifts to injury prevention and improving movement efficiency. Programs include powerful gluteal exercises, core stabilization exercises, and specific pelvic floor exercises for those with stress incontinence or discomfort. Systematic reviews of pelvic floor and hip training show that incorporating these elements into an overall program improves function and reduces the risk of overuse injuries. [34]

A special approach is required for patients with chronic pelvic pain, neurological diseases, and after pelvic surgery. In these cases, pelvic muscle strengthening exercises should be part of an individualized rehabilitation program coordinated by a neurologist, urologist or gynecologist, and a physiotherapist. Systematic reviews show that such programs can reduce pain and improve function, but require longer duration and precise load selection. [35]

Table 6. Features of strengthening the pelvic muscles in different groups [36]

Group	Main objectives	Features of the program
Pregnant women	Prevention of incontinence and prolapse, reduction of back pain	Gentle exercises for the pelvic floor and core, as advised by your doctor
Postpartum period	Restore control, reduce heaviness and pain	Gradual onset, taking into account the type of labor and ruptures, possible specialist supervision
Elderly	Reduce incontinence, improve balance and prevent falls	Moderate load, emphasis on safe exercises, simple schemes
Athletes	Injury prevention, increased stability and power	Intensive exercises for the buttocks and core, with specific pelvic floor exercises if needed
Patients with chronic pelvic pain and neurological diseases	Reduced pain, improved function	Individual programs supervised by doctors and a physiotherapist, with a slow increase in load