Pelvic Floor (Kegel) Exercises for Bladder Control: How to Do Them Right

Your pelvic floor is the sling of muscles at the base of your pelvis that supports the bladder and bowel and helps keep the urethra closed. When those muscles are weak, or you do not know how to use them at the right moment, a cough, a laugh or a sudden urge can mean a leak.

Pelvic floor muscle training, often called Kegel exercises, is one of the best-supported treatments in the whole of bladder care. It costs nothing, but it has to be done correctly and for long enough, and that is where most people go wrong.

What the evidence shows

Stress incontinence in women

This is where the evidence is strongest. In a Cochrane review of randomized trials, women with stress incontinence who did pelvic floor training were eight times more likely to report being cured than those who did not (56% versus 6%), and 74% reported being cured or improved, against 11%. Across all types of incontinence, 67% improved or were cured, against 29%. Side effects were rare. Most trials followed women for less than a year.

NICE recommends a trial of supervised pelvic floor training lasting at least 3 months as the first-line treatment for stress or mixed incontinence, and notes that it is as effective as surgery for around half of women with stress incontinence.

Urgency and overactive bladder

For urgency, bladder training is the main first-line treatment, but the pelvic floor has a role too. The AUA/SUFU guideline recommends pelvic floor training, including urge suppression techniques, for overactive bladder and urge incontinence. In a trial of 197 women aged 55 to 92 with urge incontinence, eight weeks of behavioral treatment cut incontinence episodes by 81% on average, compared with 69% for medication and 39% for placebo.

Men after prostate surgery

NICE recommends supervised pelvic floor training for men with stress incontinence after prostatectomy, continued for at least 3 months before considering other options. US guidelines recommend offering it straight after surgery. The honest summary is that it helps men become dry sooner: over time, symptoms improve whether or not men do the exercises.

How to find the right muscles

• Imagine you are trying to stop passing gas, and squeeze the muscles you would use. You should feel a squeeze and a gentle lift up and in.
• Keep everything else relaxed: your stomach, thighs and buttocks.
• Breathe normally rather than holding your breath.
• Stopping your urine stream once can confirm you have found the muscles, but do not make it a habit. Repeatedly stopping your bladder from emptying fully could increase the risk of a bladder infection.

A simple daily routine

Using your pelvic floor to calm an urge

A sudden, strong urge does not have to mean a rush to the toilet. Quick, strong squeezes of the pelvic floor can help suppress it, and relaxation helps it pass. When an urge starts:

1. Stop and stay still. Sit down if you can.
2. Do several quick, strong pelvic floor squeezes.
3. Relax the rest of your body and breathe slowly, focusing on something else.
4. When the urge has faded, walk calmly to the toilet, or wait if it has gone.

This is a core part of bladder training, where you gradually lengthen the time between voids.

Why pelvic floor exercises often do not work

• The wrong muscles. In one study of 47 women given verbal instructions, only 49% performed an ideal contraction, and 25% used a technique that could actually promote leaks. Written or verbal instructions alone are often not enough.
• Doing it alone. Women who had regular supervision, for example weekly, were more likely to report improvement. NICE recommends checking the contraction before training starts, and biofeedback or electrical stimulation for women who cannot contract the muscles on their own.
• Stopping too soon. Real change takes around 3 months of regular practice.
• A pelvic floor that is too tight. Sometimes the muscles are overactive and need to learn to relax. If they are already tense, strengthening exercises will not make much difference.

A pelvic floor physiotherapist can check your technique in one appointment and tailor the program to you. It is worth asking your doctor for a referral, especially after childbirth or prostate surgery, or if you are not sure you can feel the muscles working.

Track whether it is working

Progress is slow enough that it is hard to notice day to day. The honest way to judge it is to count: leaks per week, pad changes, how strong your urges are, and how long you can wait. A few days of bladder diary before you start, then again every few weeks, shows whether the exercises are working and gives your physiotherapist or doctor something concrete to adjust.

Sources: NICE NG123 (2019), recommendations 1.3.4, 1.4.4, 1.4.5, 1.4.10 and 1.4.11; NICE CG97, recommendation 1.3.6; Dumoulin C et al., Cochrane Database Syst Rev 2018; Hay-Smith EJ et al., Cochrane Database Syst Rev 2011; Anderson CA et al., Cochrane Database Syst Rev 2015; Cameron AP et al., AUA/SUFU overactive bladder guideline, J Urol 2024; Sandhu JS et al., AUA/SUFU incontinence after prostate treatment guideline, J Urol 2019; Burgio KL et al., JAMA 1998; Burgio KL et al., JAMA Intern Med 2020; Bump RC et al., Am J Obstet Gynecol 1991; NIDDK; NHS; Continence Health Australia.

This article is educational and does not provide medical advice, diagnosis or treatment.