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The pelvic floor programme
Eight questions first, then a timer that does the counting. Built from NHS, NICE and specialist pelvic health physiotherapy guidance, with the sources named. No product is mentioned anywhere inside it — that is deliberate.
This programme strengthens the pelvic floor. If your pelvic floor is already overactive and cannot relax, strengthening it can make things worse rather than better — so these eight questions come first.
Do you have pelvic, abdominal or genital pain — either generally, or during or after these exercises?
Have you been told you have an overactive, tight or non-relaxing pelvic floor, chronic pelvic pain, prostatitis, vaginismus or vulvodynia?
Do you have pain during sex?
Have you had pelvic, prostate or gynaecological surgery?
Have you been told you have a pelvic organ prolapse?
Are you pregnant, or less than six weeks post-birth?
Do you have difficulty emptying your bladder or bowel completely, or a constant dribble?
Do you have new or unexplained symptoms you have not discussed with a doctor?
Answer all eight to continue.
Most people do these wrong
Not through lack of effort — through doing a different movement than the one intended. These are the six that matter.
Pulling your tummy in
Keep your abdomen relaxed. A little tightening is normal; actively bracing is not.
Clenching your buttocks
Don't actively squeeze them. Feeling some tightening there is normal.
Holding your breath
Breathe out as you lift. Breath-holding leads to straining, and straining pushes the pelvic floor down — the opposite of what you want.
Bearing down instead of lifting
If you can see bulging, stop. This is the one mistake that can make things worse rather than just being ineffective.
Not releasing fully between holds
Let the muscle relax completely each time. The release is prescribed, not dead time.
Practising by stopping your urine mid-flow
UK pelvic health physiotherapists say not to train this way. At most it is an occasional check.
What the evidence actually says
We would rather give you the real picture than a flattering one.
The strongest evidence is for urinary continence
A Cochrane review of 31 trials in 1,817 women found women doing pelvic floor muscle training were around eight times more likely to report cure of stress urinary incontinence than controls, with adverse events rare and minor. That is the most solid finding in this field, and it is about continence rather than sex.
For men and erections
A UK randomised trial in 55 men found that after six months about four in ten regained normal erectile function and about a third improved. Worth knowing: that was supervised physiotherapy with biofeedback and lifestyle change, not unsupervised home exercises, and systematic reviews since have concluded the direction of effect is positive but the certainty is low and no optimal protocol has been established.
For women and sexual function
A 2024 review of 21 randomised trials found improvements in arousal, orgasm, satisfaction and pain — but graded the certainty as very low, with confidence intervals ranging from trivial to large. Notably, lubrication and desire were not among the domains with a significant pooled effect. Anyone telling you otherwise is going beyond the evidence.
How long it takes
Three to six months, not weeks. NICE asks for a programme of at least 3 months before judging it. Pelvic floor exercises are not a quick fix, and it is worth continuing even when they do not seem to be helping.
Where this came from
NHS pelvic floor guidance; NICE NG123 and NG210; the Pelvic, Obstetric and Gynaecological Physiotherapy network’s patient leaflets for men and for women; and the Cochrane and journal reviews described above.