How To Do Pelvic Floor Exercises | Physio Recommended At Home Techniques

If you have been told you have a prolapse, or you have noticed a heavy, dragging feeling low in your pelvis by the end of the day, pelvic floor exercises are usually the first thing worth trying.

A prolapse means one of the pelvic organs — the bladder, bowel or uterus — has dropped lower than it should, because the muscles and tissue supporting it have stretched or weakened.

It is far more common than most women realise, and it is not something you simply have to live with.

What the evidence actually says

Pelvic floor muscle training is recommended internationally as the first-line treatment for prolapse, before surgery is considered.

Reviews of the research have found that a properly supervised program can reduce the stage of a prolapse, ease symptoms like heaviness and bulging, increase pelvic floor muscle strength, and improve quality of life.

The benefit is clearest for mild to moderate prolapse — which is the stage most women are at when they first notice something is different.

There is also good evidence that training the pelvic floor helps prevent prolapse symptoms from worsening over the following couple of years.

Signs worth paying attention to

• A heavy, dragging or bulging feeling in the vagina, often worse late in the day or after standing
• A sensation that something is coming down, or that a tampon will not stay in place
• Needing to go back a second time to fully empty your bladder or bowel
• Low back or pelvic ache that settles when you lie down
• Symptoms that clearly worsen with lifting, coughing or running
  
  

Why “just do more Kegels” is not the answer

This is the part that catches people out.

Squeezing harder and more often only helps if your pelvic floor is genuinely weak, and if you are contracting the right muscles in the right direction.

Research going back decades has found that around one in four women still cannot perform a correct pelvic floor contraction after being given clear verbal instructions alone.

The common error is bearing down instead of lifting — which pushes in exactly the wrong direction and can make a prolapse feel worse rather than better.

Some pelvic floors are also not weak at all, but overactive and tight. That produces very similar symptoms and needs the opposite approach: learning to release rather than grip.

This is why an assessment matters more here than in almost any other area of physiotherapy. The exercises are only ever as good as the diagnosis behind them.

How you lift and load matters just as much

Day-to-day load management often makes as much difference as the exercises themselves.

Breathe out on effort. Exhale as you lift the pram, the shopping or the weight, rather than holding your breath and bearing down.

Treat constipation as part of the treatment. Repeated straining on the toilet puts more downward pressure through the pelvic floor than almost anything else you do.

Rebuild impact gradually. Return to running, jumping or heavy lifting in stages rather than picking up where you left off.

When to get assessed for a prolapse

Book an assessment if your symptoms are ongoing, if you are unsure whether you are contracting correctly, or if nothing has shifted after about three months of consistent work.

A pelvic floor physio can assess what your pelvic floor is actually doing, tell you whether it needs strengthening or releasing, and build the program around that rather than around guesswork.

You can also call the free National Continence Helpline on 1800 33 00 66 to speak with a continence nurse advisor.