Strengthen your pelvic floor

Key takeaways

Leaking when you sneeze, cough or laugh is common but isn't something you have to live with.
Pelvic floor exercises combine slow squeezes held up to about 10 seconds and quick squeezes, with full relaxation in between.
Many people notice improvement after around three months of regular practice.

Read the lesson

Leaking a little urine when you sneeze, cough, laugh or exercise is called stress incontinence, and it's common, especially after pregnancy and around menopause, but it isn't something you have to live with. Pelvic floor exercises, where you regularly squeeze and lift the muscles you'd use to stop yourself passing wind or urine, are an effective first treatment, and many people notice improvement after around three months of daily practice. If leaking doesn't improve, a doctor or specialist pelvic health physiotherapist can help.

Read: Pelvic floor exercises: how to do them and stop leaking when you sneeze or laugh

Or read it here

What is your pelvic floor?

Your pelvic floor is a sling of muscles stretching from your pubic bone at the front to your tailbone at the back. It supports your bladder, bowel and womb, helps you control when you pee and poo, and plays a role in sexual sensation.

These muscles can be weakened by pregnancy and childbirth, the hormonal changes of menopause, getting older, long-term constipation and straining, a chronic cough, being overweight, and repeated heavy lifting or high-impact exercise. Like any muscles, they can be strengthened.

Signs of a weak pelvic floor

Leaking urine when you cough, sneeze, laugh, jump or lift
Needing to rush to the toilet, or not quite making it in time
Passing wind without meaning to
Difficulty controlling your bowels
Reduced sensation during sex
A heavy or dragging feeling in your vagina, or a bulge, which can be a sign of prolapse

It's common, but it's not 'just part of being a woman' or a mum. It can usually be improved.

How to find the right muscles

Sit or lie comfortably with your thighs, bottom and tummy relaxed. Then:

imagine you're trying to stop yourself passing wind, and squeeze the muscles around your back passage
at the same time, imagine stopping the flow of urine and squeeze the muscles at the front
you should feel a squeeze and a gentle lift upwards and inwards

Try not to hold your breath, clench your bottom or pull your tummy in hard. Don't practise by stopping your pee mid-flow regularly, as this can affect how your bladder empties — just use the idea to find the muscles.

How to do pelvic floor exercises

There are two types of squeeze, and both matter:

Slow squeezes: squeeze and lift, hold for a few seconds, then fully relax. Gradually build up how long you can hold, up to around 10 seconds.
Quick squeezes: squeeze and lift quickly, then let go straight away.

Aim to do a set of each several times a day. Relaxing fully between squeezes is just as important as the squeeze itself.

A useful trick is to squeeze before you sneeze — tightening your pelvic floor just before you cough, sneeze, laugh or lift can help prevent leaks. Some people find reminders on their phone or a pelvic floor app helps them stick with it.

How long does it take to work?

Many people notice an improvement after around three months of regular exercises. Keep going after that to maintain the benefit — think of it as a lifelong habit, like brushing your teeth.

If you're not sure you're doing them correctly, or there's no improvement after a few months, ask for a referral to a specialist pelvic health physiotherapist. They can check your technique and tailor a programme to you. In some places you can refer yourself.

Other things that help

Avoid constipation and straining — eat plenty of fibre and drink enough fluids
Don't cut back on fluids to avoid leaks, as concentrated urine can irritate your bladder
Cut down on caffeine, fizzy drinks and alcohol, which can make bladder symptoms worse
Aim for a healthy weight, which reduces pressure on your pelvic floor
Stop smoking, which can help if you have a chronic cough
Lift with care, and tighten your pelvic floor as you lift

If exercises and lifestyle changes don't help enough, other treatments are available, including bladder training, vaginal devices, vaginal oestrogen after menopause, and surgery.

When to see a doctor or get help urgently

See a doctor if leaking affects your life, if you have a bulge or dragging feeling in your vagina, pain, blood in your urine, or frequent urinary infections.

Get emergency help if you suddenly can't control your bladder or bowel along with back pain, numbness around your bottom or genitals, or weakness in your legs, or if you can't pee at all.

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