Pelvic Floor Exercises: A Practical Guide

What the pelvic floor is and why it matters

The pelvic floor is a group of muscles and connective tissue that closes the bottom of the pelvis, like a hammock running from the pubic bone to the tailbone. It supports the bladder, bowel and, in women, the uterus; it controls the sphincters; it plays a role in sexual function; and, together with the diaphragm, the deep abdominals and the lumbar muscles, it forms the system that manages pressure inside the abdomen. It is not an isolated muscle: it works as a team every time you breathe, move or lift something.

That is why training it is not just about "squeezing". A healthy pelvic floor can contract when needed and fully relax when not. Both a lack of strength and excess tension cause problems, and the two extremes are easily confused. Understanding this is what separates useful work from well-intentioned work that makes things worse.

Signs of weakness and hypertonia

Before prescribing exercises it helps to recognise the signs. Not to diagnose (that is not the coach's role), but to know when general work makes sense and when the prudent move is to refer. The same complaint can come from too little strength or too much tension, and the solution is the opposite.

Kegel exercises done right

Kegels are the best-known tool for strengthening the pelvic floor, but also the most poorly executed. A large share of people who believe they are doing them well are in fact bearing down, clenching their glutes or holding their breath. A correct Kegel is a subtle closing and lifting of the perineum, with the rest of the body relaxed and breathing as usual.

A sensible progression combines sustained holds (endurance) with quick contractions (the response to a sneeze or a jump), always with full relaxation between reps. If someone cannot feel the area or cannot relax it, the answer is not more volume: it is a signal to get a professional assessment.

Common mistakes

Breathing, core and hypopressives

The pelvic floor is not trained in isolation with good results. It works as the base of a piston whose lid is the diaphragm: on the inhale the diaphragm descends and the perineum yields; on the exhale both rise. Restoring this breathing coordination is usually the first step and, for many people, the most transformative. Hence the practical rule of "exhale before the effort": gently engaging the perineum on the exhale just before lifting blunts the downward pressure spike.

Hypopressive exercises combine posture, a full exhale and a breath hold with rib expansion. They have become very popular, especially postpartum, and can help some people improve postural tone and body awareness. That said, the evidence is mixed, they are not superior to well-programmed strength work and they need to be learned correctly. The reasonable view is to treat them as one more tool, introduced by someone with specific training, not as a universal fix.

Postpartum and impact athletes

Postpartum is the case that calls for the most care. Pregnancy and birth change the area, and the return to activity should ideally begin after a pelvic floor assessment. The coach has a valuable role: supporting the gradual reintroduction of load, working on breathing and basic patterns and respecting the timeline. But clearance to return to impact, and the diagnosis of conditions like abdominal diastasis or prolapse, belong to a healthcare professional.

In impact athletes (running, jumping, weightlifting, CrossFit) symptoms are more common than people admit. An athlete can be very fit and still leak during maximal efforts. Normalising it as "everyone has it" is a mistake: it is worth managing intra-abdominal pressure, reviewing breathing technique under load and, if symptoms persist, referring. Performance and caring for the area are not at odds.

When to refer to a therapist

Knowing where your scope ends is part of being a good coach. The pelvic floor has a clear clinical dimension, and there are situations where the right answer is not an exercise but a referral. Doing it in time protects the client and your professional credibility too.

In these cases, the coach adds value by collaborating with the pelvic floor therapist: respecting their guidelines, adapting strength training to the clinical plan and keeping the client motivated. A well-coordinated team gets better results than either party alone.

How to work on it with TrainerStudio

A coach can integrate breathing and pelvic floor work into a general programme without stepping onto clinical ground. In TrainerStudio you can build routines with diaphragmatic breathing, activation and core patterns, attach explainer videos so the client understands the correct action, and leave clear notes about the "exhale before the effort" rule.

You can also ask the client to log sensations and possible symptoms in their comments, review technique videos of loaded exercises, and spot when something falls outside your scope so you can recommend a referral. That way the follow-up is documented, the client feels supported, and the line between education and diagnosis stays clear.