Pelvic Floor Exercises for Women

Pelvic floor exercises for women

Dr. Maureen O’Keefe, DPT | February 7, 2022

Are You Looking For Pelvic Floor Exercises For Women? Wondering where to start? Here we will give you some tips!

We are Purple Mountain Physical Therapy, located in Grand Rapids, Michigan, and we specialize in pelvic floor dysfunction for women, men, and kids. This means that every day we develop pelvic health physical therapy treatment programs, customized to each person’s unique needs & abilities.   Most of our patients have pelvic floor muscle dysfunction that needs to be addressed.  However, patients are often surprised to learn that kegels are often not part of their recommended exercise program.

Many times women come to us and ask us how to do pelvic floor exercises, not knowing what would help them the most.

There are some important things to know when embarking on improving your pelvic health, bladder incontinence and pelvic floor strengthen, so read on to get the scoop! Contact us here to speak with our staff and get your questions answered.

Should I be Doing Kegel Exercises for my Pelvic Floor?

This is the #1 question we get asked! Here’s the best answer: It depends on what’s going wrong with your muscles and your system.  Many people should not be doing kegels for a variety of reasons.  For example, if they have certain types of pelvic pain, then kegels could possibly worsen pain.  Or, if the muscles are very stiff and taut, kegels might worsen stiffness.     Our specialist pelvic floor dysfunction PTs help each patient determine what type of pelvic floor dysfunction they have and then we customize an exercise and hands-on therapy program to recover full function.   If you are confused about your pelvic floor issues, let us bring some clarity and help to you.  Contact us here for more info, or call (616) 516-4334.

At Purple Mountain PT we have a unique way to help you see your pelvic floor muscles while you do your pelvic floor exercises:  We use rehabilitative ultrasound imaging, a technology unique to our clinic that allows you to watch your pelvic floor muscles in action.

With this technology and our specialist PTs examination, we are able to determine if kegels would be helpful for you.  If so, we use the ultrasound imaging while you train your pelvic floor to ensure that you are doing the exercises correctly.  Patients absolutely love this technology because they find that by watching their pelvic floor muscles in action and being guided by our physical therapists, they finally can figure out how to engage the muscles properly.  Rehabilitative ultrasound imaging sets us apart from all other clinics in our area, no one else has invested in this.   If you wonder if you have pelvic floor dysfunction, before going ahead and doing kegels (which might be counter-productive depending on your type of dysfunction), we recommend that you get properly assessed by a pelvic health physical therapist to determine what is going on with your pelvic floor muscles. The vast majority of people we work with benefit from pelvic floor exercises, but do not need to be doing kegels.   If you would like to take the guesswork out of what’s going on with your pelvic floor, reach out to us to schedule your rehabilitative ultrasound imaging PT evaluation appointment.

How do the pelvic floor muscles work?

The pelvic floor muscles have automaticity!

The pelvic floor muscles have really good “automaticity”, meaning they turn on all by themselves with your daily activities. You shouldn’t need to be doing kegels all the time to get these muscles working well. If you are thinking you might have pelvic floor weakness, usually your problems are more complicated than Kegels.

The pelvic floor muscles are postural muscles. Therefore, if you think you need to do pelvic floor exercises, try doing some postural exercises, such as rows for your upper back. If you improve your posture, your pelvic floor muscles will improve.

For the pelvic floor muscles to operate effectively in their postural role, you need to have optimal alignment from head to toes. If you are aware that your head is forward, your shoulders slouch or your feet arches collapse, think about work on these things so that your posture improves. Your low back should have a slight curve in it, also. When the curve in your low back is ideal, your pelvic floor muscles are put in the right position to do their postural duties without being overworked. Addressing your posture is an excellent pelvic floor exercise routine for women. Seriously.

The pelvic floor muscles are working in tandem with your bowel, bladder and intimacy needs

These muscles also respond to your bladder, bowel and intimacy circumstances, so they are “at the ready” all day long. If you want to do pelvic floor exercises, start by simply paying attention to your urge to have a bowel movement. Don’t ignore it. Be certain to go to the bathroom when duty calls. And when you need to defecate or urinate, you should be able to do so in a relaxed manner, without pushing or straining. Doing this relaxed is an important part of your pelvic floor exercises for women. Seriously. We cannot emphasize this enough: you should pee and defecate in a relaxed manner. You should not push your pee out. If you do push, you are straining your pelvic floor muscles. Contact us to learn more about our treatment plans.

Why the pelvic floor muscles are more complicated than simply doing kegels. And what pelvic floor exercises for women are most effective?

The pelvic floor muscles have several things that go wrong when they are not working. These include

  1.  Delayed Timing: The muscles do not turn on quickly enough. They are late to the party. They missed the boat. They forgot to set their alarm. In all seriousness, these muscles have been found to fire after they are actually needed. And what happens when they fire late? You lose urine. Not a happy circumstance. Doing kegels will not translate to improving the timing.
  2. Miscoordination with the Diaphragm and Abdominals: The pelvic floor muscles need to synchronize with your diaphragm and you abdominals. We know that often the pelvic floor or the breathing muscles or the deep abdominals are not working effectively. If this is the case, then the pelvic floor is not able to generate optimal strength and timing when needed. Doing kegels will not improve this coordination problem.
  3. Loss of Fast Twitch fibers: 30% of the fibers of the pelvic floor are supposed to be fast twitch fibers, meaning they come on really quickly, on demand. There have been studies of identical twins completed where one of the twins has an exercise routine that focuses on endurance. Turns on that twin has lost some of their fast twitch fibers, because their fitness routine does not train fast twitch muscles. We believe the same happens with pelvic floor muscles. We see patients who just cannot get their muscles to operate fast. Doing kegels where you are working on a ten second hold of the kegel is not going to bring back you fast twitch fibers.
  4. The pelvic floor are asleep at the wheel: We see our patients often have issues with the pelvic floor muscles simply not knowing how to effectively contract and relax. We ask our patients to use their muscles and there’s very little happening. In this case, the person will be wasting their time if they are doing kegels, because nothing is happening.
  5. The pelvic floor muscles get stiff: This is a very common problem. These muscles have a tendency towards becoming stiff and tense. If you layer on a bunch of kegels onto a stiff and tense muscles, what do you think will happen? The muscles will become more stiff and tense. If this is the problem, then kegels worsen the situation and people can develop more pelvic pain, urinary incontinence or urgency and frequency. This is why pelvic floor exercises for women are much more complicated than doing kegels.
  6. Pelvic Floor Spasms and Pain: Quite often the pelvic floor muscles spasm and you experience pain or bladder problems. This commonly happens during intercourse when a person experiences vaginismus or pain with penetration. This also happens often with SI joint pain, chronic LBP, symphysis pubis pain, tailbone (coccydynia) pain. This also happens with urinary incontinence, frequency, urgency and retention. If you have pelvic floor spasms, then doing kegels is a bad idea. This is why our custom-designed pelvic floor exercise program for women is particularly helpful for our patients. We take the guesswork out of your circumstances and help you know how to do pelvic floor exercises in a way that won’t worsen your symptoms. Call (616) 516-4334 or contact us here to get your questions answered.

OK, so you’re telling me to not do kegels, but what should I do for my pelvic floor exercises?

The best place to start is to find a qualified pelvic health physical therapist who can properly assess you and advise on the specifics of what is going on with your pelvic floor. We cannot tell you how often our patients are so grateful to have been properly assessed and to learn what to do for themselves. That said, if you really want a few suggestions to help your pelvic floor timing, automaticity, spasms, stiffness, incontinence and pain, here are some basics that can help.

Diaphragmatic Breathing for the win!

Remember that the pelvic floor muscles respond to and work in coordination with the diaphragm! Therefore, if you work on diaphragmatic breathing you will be working your pelvic floor muscles in a way that optimizes their firing. You can do this in sitting, standing or lying down. The important thing to do is to breathe in a relaxed manner, with your mouth closed, gently inflating your lower ribs upon inhale. As you exhale the lower ribs should deflate. 5 minutes of breathing calms the nervous system and is beneficial to the pelvic floor

Train the automaticity of the muscles!

Remember, the pelvic floor muscles are supposed to be turning on automatically during daily movements. Therefore, let’s get you active and doing these movements; general movement may be the most effective pelvic floor exercise a woman can do! Basic movements like walking, squats and stair climbing all invite the pelvic floor to automatically respond. If you do these things, you will be helping your pelvic floor (as long as you don’t experience pain or incontinence). If you have pain or urinary problems, then you should see a pelvic health PT to get advised on the specifics of your muscles.

Strengthen your Deep Core Muscles, they work in tandem with your pelvic floor!

With our rehabilitative ultrasound imaging, we are able to look at your abdominal and low back muscles while you exercise.  The deepest abdominal layer, the transverse abdominus, is a muscle that works in coordination with your pelvic floor.  Thus, to optimize the pelvic floor performance, get this deep abdominal muscle group working well.   Usually, on ultrasound we see deficiencies with this deep abdominal muscle and we can help you train that muscle when working out and watching the ultrasound.  The deep core are inhibited when you have back pain, following surgery and are deficient with pregnancy and postpartum months.   When the deep core don’t work well, other muscles that are not meant to be working, will take over and compensate.  Usually we end up with pain and tightness.   Work on the abdominals doing things like planks and side planks. There are so many fun ways to work on the abdominals and in physical therapy we use a huge variety of core exercises to get the abs engaged. Recall that the pelvic floor muscles and the abdominals work together, so if you work your abs you are always completing pelvic floor exercises, also!

Get your hips and thighs stronger!

Your glutes need to be operating in top form if you expect your pelvic floor muscles to be strong. If you are not having good, strong hips then work on these and you will find that your pelvic floor symptoms will improve. Things like squats, lunges, deadlifts, Bulgarian split squats and single leg kickbacks all help your hips and thighs and your pelvic floor muscles are exercised also.

Work on flexibility!

Keep your hips, spine and thighs flexible if you want to improve the common issue of pelvic floor spasms and stiffness. For this, consider basic stretches like touching your toes, calf stretches, inner thigh stretches, figure 4 stretches for the hips or runner stretch. Anything you can do to optimize the hip, spine and thigh range of motion will help your pelvic floor to also be less stiff and tense. Connect with us here to learn more about our model of care.

Coming up with a routine for pelvic floor dysfunction is our specialty!

We work with individuals who have pelvic floor dysfunction and offer a higher level of customization and expertise for you when we assess and treat you. We use hands-on manual therapy targeted to your low back, hips & glutes, abdominal wall, inner thighs and pelvic floor muscles. Plus, exercise based re-training designed to recover the automaticity of the muscles, as well as the timing and flexibility of the pelvic floor, our patients resolve their pelvic pain and urinary control problems. All appointments are private and one-on-one with your licensed physical therapist. Our patients tell us that they never knew how to correctly exercise their pelvic floor muscles and are so grateful to finally have gotten our help so they don’t have pain or incontinence anymore.

Purple Mountain PT is a specialty pelvic health, spine, neck and TM joint disorder clinic located in Grand Rapids, MI. We treat women, men and kids who have pelvic floor dysfunction or TM joint disorders. Many of our patients come to us with no understanding of what is going on with their pelvic floor muscles and find that our treatment brings clarity to their circumstance and direction forward to resolve their symptoms. If you are interested in learning more, contact us here or submit this online inquiry and we will be in touch. We offer in-person treatment at our Grand Rapids, Michigan location or telehealth. To read more about the benefits of Physical Therapy check out this blog we wrote on the topic.


Dr. Maureen O’Keefe, DPT

Founder of Purple Mountain Physical Therapy

Specialist pelvic health, spine and TMJ disorder PT for more than two decades.

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