The Ultimate Guide to Pelvic Floor Muscle Training (PFMT)

This article is a supportive guide, accompanying the Pelvic Floor Program created by Terri Robertson Elder for Street Parking, an at-home fitness membership and community. To see more about the Pelvic Floor Program from Street Parking, click here

The pelvic floor is an often-forgotten but critical group of muscles, connective tissues, and nerves located at the base of the pelvis in all people (yes, dudes have pelvic floors, too!). A purposeful program that addresses strength, coordination, and endurance of these muscles can help enhance and optimize their function. While each individual is likely best served by having a one-to-one assessment by a pelvic health physical or occupational therapist, not everyone wants or is able to access individualized care. 

If you begin a program of PFMT and continue to have ongoing pelvic floor symptoms, I encourage you to seek care from a pelvic health provider. Here is a directory of providers to search your area.

If you are experiencing persistent pelvic pain symptoms, have chronic constipation, or tend to have increased pelvic floor muscle tension/tone, you may have an overactive pelvic floor. Consider doing at least 4-6 weeks of daily relaxation-focused practice before adding strength work. Then, once you start a strength program, consider adding extra rest time between reps and sets, and always finish with some breathing & stretches from the relaxation-focused practice. SEE THE RELAXATION-FOCUS PROGRAM

Consider using the decision tree below to help guide you in understanding if pelvic floor muscle training is right for you at this time.

Can PFMT help with my pelvic symptoms? 

It depends! Working on strength, coordination, and endurance in your muscles is a great idea, however, no promises can be made that improving muscle function will reduce or eliminate your symptoms because of the complexity of our anatomy. If you continue to experience bothersome bladder, bowel, genital or sexual symptoms, seek care from a specialist provider. A pelvic PT or OT is often a great place to start for conservative care, and they can direct you to specific medical professionals that best suit your needs.

Here are the conditions for which Pelvic Floor Muscle Training may be most effective:

• Urinary Incontinence (UI): PFMT is effective in reducing symptoms of stress, urge, and mixed urinary incontinence. Research is strongest for the effect of PFMT improving SUI. See this article for more on navigating SUI.

  • ProTip: During PFMT, bring your focus to the “front” of your pelvic floor, thinking about the muscles that stop the flow of urine 

• Fecal Incontinence (FI): Evidence on PFMT's effectiveness for fecal incontinence is limited and of low quality. Some studies suggest potential benefits, but results are inconclusive.

  • During PFMT, bring your focus to the “back” of your pelvic floor

  • Note: there are MANY other pelvic health interventions to address a range of anal incontinence symptoms (fecal smearing, fecal urgency, gas incontinence, etc) so if PFMT doesn't work for you, here is a nudge to seek care from a pelvic pro.

• Pelvic Organ Prolapse (POP): PFMT may lead to improvements in prolapse symptoms and objective improvements in prolapse severity. However, evidence quality varies, and more high-quality RCTs are needed. See this article for more information on navigating POP and tailoring your exercise appropriately.

  • For moderate to severe prolapse, consider performing PFMT with a pessary in place, or in a laying down position.

• Female Sexual Dysfunction: PFMT has been associated with improvements in sexual function domains such as arousal, orgasm, satisfaction, and pain. However, the certainty of evidence is low, and further research is needed to definitively say whether PFMT can help. 

• Erectile Dysfunction: Some studies suggest PFMT may improve erectile function, especially post-prostatectomy. However, methodological limitations and variability among studies limit definitive conclusions.

• Overactive Bladder (OAB): PFMT may reduce OAB symptoms, including urinary frequency and urgency urinary incontinence. There are lots of other factors to consider for effective treatment of urinary urgency and frequency. Conservative management of OAB from pelvic therapists can be very effective; this is not a program to treat OAB but might be one helpful component. It is recommend to seek care from a pelvic PT/OT as able.

• Pregnancy/Birth Preparation: Studies suggest that performing PFMT during pregnancy can help with symptoms, and also build coordination (knowing when you are contracting and when you are relaxing) which can be helpful during vaginal delivery. Pelvic muscle relaxation is also super important during pregnancy, so be sure to check out the relaxation-focused practice as well.

• Postpartum Recovery: PFMT may reduce urinary incontinence postpartum, particularly stress urinary incontinence. Evidence on whether it’s helpful for fecal incontinence is less clear. If you had a vaginal delivery, is suggested to wait until about 12 weeks postpartum to begin targeted PFMT, to allow for recovery time in case of undiagnosed pelvic floor injury.

The body is complex and there are often multiple things contributing to your symptoms. Even for a concern like Stress Urinary Incontinence (SUI, or leaking with cough/sneeze/exercise), someone might have a strong and coordinated pelvic floor, but they might have changes to their pelvic connective tissue (fascia, ligaments, etc) that contribute to leaking. In that case, pelvic floor training might not be as helpful for improving symptoms. This is where support garments and devices like pessaries, external support garments, or other medical interventions might be helpful. Find out more about pessaries here.

There are many other contributors to SUI, and quite often a change in HOW we are performing a movement can help reduce symptoms. Some of these “HOWs” are Pressure, Posture, Tension, Impact, and Sensitivity, to name a few. Check out this blog for more on Troubleshooting Urinary Incontinence with Exercise. 

Pelvic Floor Anatomy and Physiology

The pelvic floor is a group of muscles, nerves, and connective tissues that form a supportive, multi-layered hammock at the base of the pelvis. These structures play a vital role in everyday functions such as bladder and bowel control, sexual function, and core stability.

Anatomy The pelvic floor includes three layers of muscles:

• Superficial muscles, which help with sexual function and control of the openings.

• Deep muscles, which support pelvic organs like the bladder, uterus (in women), and rectum.

• Connective tissue and ligaments, which help keep the pelvic organs in place.

In all people, the pelvic floor surrounds and supports the urethra, rectum, and in most women, the vagina and uterus.

Fun fact: we ALL have the same pelvic floor muscles, they are just organized differently depending on your genital anatomy! See below- the first image is a pelvis with female reproductive parts looking from the top down, underneath that is the same view but a pelvis with male reproductive parts. Not too different, eh?

Images used with permission from Pelvic Guru®, LLC as a Pelvic Global Member

Function: Pelvic floor muscles contract and relax in coordination with other muscles in the body. They:

• Contract to maintain continence (prevent leaks).

• Relax to allow urination, bowel movements, and childbirth.

• Engage to support posture and stabilize the spine.

• There are, of course, very important sexual, as well as circulatory & lymphatic functions.

Just like any other muscle group, the pelvic floor can become weak or overactive (a tight, shortened muscle is not a strong one!), leading to common issues like incontinence, pelvic pain, or pelvic organ prolapse.

Let’s get nerdy: What does the Research Say?

Pelvic health complaints such as urinary incontinence are incredibly common and one of the most prominent health complaints across the lifespan. PFMT (Pelvic Floor Muscle Training) has the highest quality evidence available¹ for it’s effectiveness for treating urinary incontinence and is helpful for many other complaints. 

While many pelvic health professionals caution individuals against performing pelvic floor strengthening aka “kegels” without an individualized internal pelvic floor assessment, PFMT has also been shown to be safe, with no known serious adverse risks⁷. Mild adverse reactions include muscle soreness (yes, your pelvic floor can get DOMS), or a temporary worsening of symptoms. If a worsening of symptoms occurs, this might be a sign you are either “overdoing it,” or you have excess tension or tone in your pelvic floor. Try the Relaxation-Focused Program, and consider consulting a pelvic PT/OT for an individualized assessment and plan. 

The gold standard for improving pelvic floor muscle function is via an individualized program with one-to-one guidance from a pelvic health physical or occupational therapist. However, not everyone has the desire for or access to this type of care. Many studies have shown the benefits of group training for the treatment of urinary incontinence^2,3,4,5, which can improve convenience, availability, and reduce cost, which is important for a condition that is so prevalent and treatable. Some newer studies show the benefit of an online pelvic floor group class^6,8. While many studies benefit from scheduled sessions, participants had to perform most of the programming on their own, similar to this program. There is emerging evidence such as the systematic review from Hou et al., 2022⁹ demonstrating app-based pelvic floor training (like this very program!) shows promise for improving symptoms and exercise adherence. Improving “adherence” is important because a big road block to noticing improvement is lack of consistency with training. Consistency is 🔑!

Countering Common Anti-Kegel Arguing Points

Many professionals who caution against doing PFMT (kegels) without the guidance of an internal pelvic health therapist cite the study that shows that ~50% of people do not correctly perform pelvic floor muscle contractions, but that study is over 20 years old. There has been a huge increase in awareness of the pelvic floor in the general population over the last twenty years (yay!). More recent studies have shown that only about a quarter of individuals  incorrectly perform pelvic floor muscle contractions (Kandadai et al. 2015, Thompson et al. 2023). For those who were performing the contraction incorrectly, the errors cited in the studies were: using abdominal, gluteal, or adductor muscles instead of PFMs, breath holding and, rarely, bearing down. 

Stay with me now… 

For those who perform PFM contractions incorrectly or ineffectively, does that mean it’s harmful, or simply less-than-ideal? If someone is performing a contraction and the glutes and core is kicking in as well, or breathing is not “perfect,” they might not get the full intended benefits of the exercise, but it’s not harmful per se. For the rare case that someone is forcefully, repeatedly bearing down as if to pass gas or have a bowel movement, perhaps that could lead to excessive strain on pelvic floor support structures. So, don’t do that. 😁

If you are unsure if you are “doing it right,” refer to the troubleshooting section and/or see a pelvic PT/OT for an individualized assessment. Rest assured, it is generally safe to train your pelvic floor muscles, even if you aren’t “doing it exactly right” (there are a lot of different “right ways”).

This article is a supportive guide, accompanying the Pelvic Floor Program created by Terri Robertson Elder for Street Parking, an at-home fitness membership and community. To see more about the Pelvic Floor Program from Street Parking, click here

Training Tips

Isolated PF strength work can be performed most days of the week with a “More Than Nothing” mindset for 12 weeks. 

Strength work for the hips can be a very helpful adjunct for this program, because the pelvic floor and hips & core work together! Consider movements like squats, deadlifts, and lunges to strengthen the hips.

Following completion of a 12-week program of muscle training, consider a maintenance plan of 2 days/week.

Troubleshooting 

If you are having a hard time “feeling it,” or are just unsure if you are “doing it right,” there are many different things to try. You might try different positions such as the elevated posture noted above. Also, feel externally by placing the palm of your hand over the genitals (over or under your clothing, it’s up to you!) and try some contractions. Contract and then relax the muscles that help you to hold in gas and/or stop the flow of urine. You might also try some contraction/relaxation while sitting on a rolled towel, as this pressure can act as an input to help you connect with the pelvic floor muscles.

Another strategy you may try is a more gentle contraction. Try a 50% contraction (or 75%, or even 25%) and see how that feels. There are many folks who are overzealous with muscle contractions (I’m looking at you, those who peacock!) and then can’t feel anything because everything is working at once!

Finally, understand that there are many reasons for why you may not be able to feel a contraction such as sensory changes, overactive/shortened pelvic floor, weakness, coordination differences, to name a few. If you are still unable to feel contractions after a lot of trial and error, consider an “overflow practice,” and/or getting help from a professional (pelvic physical or occupational therapists are particularly well-suited to help). 

Overflow practice is using the muscles that functionally work with the pelvic floor, to try to get “overflow” into the pelvic floor. These muscle groups are namely the inner thigh aka adductor muscles, and/or the gluteal (butt!) muscles. Test different things to see if anything feels like it may be better in terms of “feeling” your pelvic floor working, and understand that your muscles are likely contracting even if you might not feel it. 

Some options for overflow practice are: 

• Perform a bridge movement (on your back with knees bent, lift your hips while you try to contract your PF) 

• Try a bridge as noted above, with a band around your thighs just above your knees 

• Try a bridge while squeezing a yoga block, pillow, or rolled towel between your knees. 

You might now actually “feel” your PF muscles working, or you might not. If it has been a long time, or you have never performed this type of training, it might take some time to “connect” with these muscles- keep trying! Training the muscles of the glutes and inner thighs may be helpful even without being able to perceive whether or not you are doing a contraction. Consider working through the Street Parking Butts & Guts Extra Program, adding some of this “Overflow Practice” to your warm-ups, and some Relaxation-Focused Programming to your cool downs. 

Common “errors” when it comes to optimizing pelvic floor muscle contractions:

• Bearing down: if you are taking a breath and pushing out as if you are having a bowel movement, try some of the other cues noted in the “troubleshooting” section. 

•  🦚 Contracting everything: many will contract the glutes, abdominals, legs muscles, etc to try to feel a contraction. Ideally, we can learn to isolate the pelvic floor muscles, which means to be able to contract them on their own. It’s ok (and normal!) to feel a very gentle deep core muscle contraction along with a pelvic floor contraction because these muscles functionally work together.  

Final Thoughts

Pelvic floor health is a foundational part of how we move, function, and feel in our bodies across the lifespan. Pelvic Floor Muscle Training can be a valuable, evidence-supported tool for improving strength, coordination, and endurance—particularly for conditions like urinary incontinence—while also supporting pregnancy, postpartum recovery, sexual health, and overall core stability. At the same time, it is not a one-size-fits-all solution. Symptoms are often multifactorial, and knowing when to prioritize relaxation, adjust how you move, or seek individualized care is just as important as strengthening itself. This guide, alongside the Street Parking Pelvic Floor Program, is intended to empower you with education, realistic expectations, and practical strategies so you can train with confidence, consistency, and compassion for your body—while recognizing that pelvic health professionals remain an invaluable resource when symptoms persist or questions arise.

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References

1. Abrams P., Anderson K.E., Apostolidis A., Birder I., Bliss D., Brubaker L., Cardozo L., Castro D., Cottenden A., O’Connell R., et al. Recommendations of the international Scientific Committee: Evaluation and treatment of UI, bladder pain syndrome, POP and fecal incontinence. In: Abrams P., Cardozo L., Khoury A.E., Wein A., editors. International Consultation on Urinary Incontinence. 6th ed. Volume 2. Health Publication Ltd.; Plymbridge, UK: 2017. pp. 2549–2619. [Google Scholar] [Ref list]

2. Weber-Rajek M., Radzimińska A., Strączyńska A., Strojek K., Piekorz Z., Kozakiewicz M., Styczyńska H. A randomized-controlled trial pilot study examining the effect of pelvic floor muscle training on the irisin concentration in overweight or obese elderly women with stress urinary incontinence. BioMed Res. Int. 2019;2019:7356187. doi: 10.1155/2019/7356187. 

3. Dumoulin C., Morin M., Mayrand M.-H., Tousignant M., Abrahamowicz M. Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: Study protocol for a randomized controlled trial. Trials. 2017;18:544. doi: 10.1186/s13063-017-2261-4. 

4. Dumoulin C., Morin M., Danieli C., Cacciari L., Mayrand M.-H., Tousignant M., Abrahamowicz M. Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Intern. Med. 2020;180:1284–1293. doi: 10.1001/jamainternmed.2020.2993.

5. Cacciari L., Vale L., Morin M., Tousignant M., Mayrand M., Abrahamowicz M., Dumoulin C. Economic Evaluation of Group-Based vs. Individual Pelvic Floor Physiotherapy for Urinary Incontinence in Older Women. Gothenburg, Sweden. 2019.

6. Le Berre, M., Filiatrault, J., Reichetzer, B., & Dumoulin, C. (2023). Group-Based Pelvic Floor Telerehabilitation to Treat Urinary Incontinence in Older Women: A Feasibility Study. International journal of environmental research and public health, 20(10), 5791.

7. Bernards, A. T., Berghmans, B. C., Slieker-Ten Hove, M. C., Staal, J. B., de Bie, R. A., & Hendriks, E. J. (2014). Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. International urogynecology journal, 25(2), 171–179.

8. Santiago M., Cardoso-Teixeira P., Pereira S., Firmino-Machado J., Moreira S. A Hybrid-Telerehabilitation Versus a Conventional Program for Urinary Incontinence: A Randomized Trial during COVID-19 Pandemic. Int. Urogynecol. J. 2022;34:717–727. doi: 10.1007/s00192-022-05108-6.

9. Hou, Y., Feng, S., Tong, B. et al. Effect of pelvic floor muscle training using mobile health applications for stress urinary incontinence in women: a systematic review. BMC Women's Health 22, 400 (2022).