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What helps · By area of the body

Pelvic health you can listen to.

Four short practices for leaking, urgency and a pelvic floor that won't switch off, each one spoken aloud with a pacer to follow. Then the 12-week program underneath them: the guideline dose, week by week, with a diagram for every move.

Start here

Nobody learns this from a paragraph.

Bladder leaks, urgency and heaviness are among the most common midlife symptoms and the least talked about. Falling estrogen thins the tissue of the urethra and vagina, and the muscles underneath change too. The usual advice, “do your kegels”, is both right and useless: right because pelvic floor muscle training is genuinely first-line, useless because it never says how, how many, or what to do when squeezing makes things worse.

These four are voice-guided on purpose. When your nervous system is already loud, reading a numbered list while trying to sense something internal is the fastest way to give up. Press listen, close your eyes, and let someone else keep count.

Before you squeeze anything

The pelvic floor moves with your breath.

This is the part that's almost never explained. Your diaphragm and your pelvic floor are the top and bottom of the same canister, and they move together. Breathe in and the diaphragm drops, so the floor lets go. Breathe out and the diaphragm rises, so the floor lifts with it.

Which is why “squeeze and hold” while holding your breath doesn't work. If you're going to lift, lift on the exhale. If squeezing makes things worse, urgency, heaviness, pain, the release half of this picture is the one you need, and it's what the down-training practice below trains.

Watch it for three or four breaths and let your own breathing fall in with it.

Round 1

Breathe in

Four in through your nose, hold for seven, eight out through your mouth. Three rounds is enough.

Free for everyone

Four practices, spoken aloud.

Pick the one that matches your day. The urge practice works in the moment; the other three are worth a week before you judge them.

When the urge hits

In the moment · one minute

Stop. Stand still or sit down

10

Step 1 / 5

Voice guide · 50 sec
Read it instead

Stop walking. Running to the bathroom makes the urge louder, not quieter. Stand still, or sit down on something firm. Now, five quick lifts of the pelvic floor: squeeze and let go, squeeze and let go, quickly, five times. This settles the bladder muscle. Now breathe out, long and slow. Curl your toes if it helps. The urge will rise, peak, and fall, it always does. Wait for it to fall. Now walk, don't run, and go. Every time you wait out the peak, you're teaching the bladder to hold a little longer.

Rushing to the bathroom feeds the urgency loop. Waiting out the peak, on purpose, is the core of bladder retraining — and it's the one thing you can do the very first day.

Try this week: Next time the urge arrives away from a bathroom, run this once instead of hurrying.

Finding it with your breath

Before anything else · two minutes

Hand on the lower belly, knees bent

15

Step 1 / 4

Voice guide · 1 min
Read it instead

Lie down with your knees bent, or sit if that's easier. One hand on your lower belly. We're not squeezing anything yet. Breathe in through your nose and let the belly rise into your hand. As you breathe in, the pelvic floor lengthens and drops, quietly, on its own. You may not feel it. That's normal. Now breathe out, slowly, through your mouth, and notice whether anything gently lifts underneath you. In: it softens. Out: it lifts. Five more breaths, at your own speed, just watching. If you feel nothing at all, you haven't failed. It means the connection is worth building with a pelvic floor physiotherapist rather than guessing at it on your own.

The pelvic floor moves with the diaphragm. Feeling that before you start squeezing anything is what stops months of well-meant but wrongly-aimed effort.

Try this week: If you genuinely feel nothing, that's information, not failure. It's the cue to see a pelvic floor physiotherapist.

Letting it go

For urgency, pain and holding · two minutes

Unclench the jaw, soften the tongue

20

Step 1 / 4

Voice guide · 1 min 15 sec
Read it instead

This one is the opposite of what you've been told. A pelvic floor that never switches off can cause urgency, pain and leaking just as much as a weak one. So today we let go. Get comfortable, knees supported, feet apart. Unclench your jaw. Let your tongue fall away from the roof of your mouth. The jaw and the pelvic floor tend to travel together. Now breathe in and imagine widening, from sit bone to sit bone. Wide, and soft, and heavy. Breathe out without pulling anything up. Again. Wide on the way in. Nothing to do on the way out. If your mind reaches for a squeeze, let it pass. Six more breaths of doing less on purpose.

A pelvic floor that never switches off causes urgency, pain and leaking too. Down-training is half the work, and it's the half almost nobody is taught.

Try this week: If kegels have ever made you feel worse, start here instead and take it to a physiotherapist.

A proper lift and release

Most days · two minutes

Sit tall or lie down, keep breathing

15

Step 1 / 5

Voice guide · 1 min
Read it instead

Sit tall, feet flat, or lie down if sitting is uncomfortable. The lift is not a clench of the buttocks and it is not holding your breath. It's a gentle drawing up and in, as if stopping wind and then lifting a little further forward. Ready. Lift, and hold it, two, three, four, five. Now fully let go. That letting go matters as much as the lift, so give it a couple of seconds. Again. Lift, two, three, four, five, and release completely. Keep breathing throughout. If you can't hold for five, hold for two, that's your honest starting point, and it will change. Ten of these, most days, for three months is the dose that has trials behind it. Not one heroic session.

Supervised pelvic floor muscle training is first-line for stress and mixed urinary incontinence in the guidelines. The release matters as much as the squeeze, and consistency beats intensity.

Try this week: Ten, most days, for three months. Pair it with something you already do daily so you don't have to remember.

The 12-week program

The practices above are the pieces. This is the dose.

Guidelines ask for a properly run three-month trial of pelvic floor muscle training, eight contractions three times a day, before surgery is on the table for leaking or prolapse. Almost nobody is ever told what those three months should look like. This is that missing detail: twelve weeks, three short sessions a day, the release half nobody teaches, the pre-emptive lift that changes daily life fastest, and checkpoints at weeks 1, 4, 8 and 12 so you can see whether it worked rather than guess.

Pick your pattern

The program is the same. The emphasis isn’t.

Choose the one that sounds most like you and the weekly notes adjust. You can change it at any point, and if you have more than one, pick the one that bothers you most.

Free · no login

Week 1 is open to everyone.

The first week is the connection and the baseline. It is the week that decides whether the other eleven will do anything, so it should not sit behind anything.

Week 1

Baseline and breath

Find the muscle with your breath, and write down where you're starting so week 12 has something to compare to.

The dose

  • Connection breath, five minutes, once a day.
  • Lift and release: hold for as long as you can up to five seconds, rest the same length, five in a row. Three times a day.
  • Baseline test, once: how many seconds can you hold, and how many clean holds in a row before quality drops? Write both down.

New this week

The honest baseline

Two seconds is a real starting point. So is zero. What matters is that the number is yours, measured, and written down, because the change over 12 weeks is the thing that tells you it's working.

Finding the pelvic floor with your breath

Voice guide · 1 min

A proper lift and release

Voice guide · 1 min
Breathe in, ribs widen

Inside

Breathing in. Lengthens and widens

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Connection breath

Also called Diaphragmatic breathing, 360 breathing

The diaphragm and the pelvic floor are the top and bottom of the same canister. Feeling them move together is what stops months of well-meant effort aimed at the wrong muscle.

  • Lie on your back, knees bent, one hand on your lower belly.
  • Breathe in through your nose and let the belly and ribs widen. The floor lengthens and drops.
  • Breathe out slowly through your mouth and feel the floor come quietly back up on its own.

Most common mistake. Chest-only breathing with the belly held in. Sucking the stomach in raises pressure downwards, which is the opposite of what you want.

Easier. Sit in a chair or lie on your side. Position matters less than actually feeling the movement.

You know it’s working when. The hand on your belly moves before your chest does, and the exhale is longer than the inhale.

Rest, fully released

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Lift and release

Also called Long-hold pelvic floor contraction, kegel

The long hold is the strength half of pelvic floor muscle training. The full release afterwards is the half almost nobody is taught, and skipping it is why some people feel worse.

  • Breathe out, then lift from back to front, as if stopping wind and then slowing a stream of urine.
  • Hold while you keep talking or counting out loud. Breath keeps moving.
  • Let go completely and wait as long as you held. The release is a rep too.

Most common mistake. Clenching the buttocks, the inner thighs and the jaw, holding the breath, and never fully letting go between reps.

Easier. Two-second holds lying down. Build the hold before you build the number.

You know it’s working when. You can hold and count out loud at the same time, and you feel a distinct drop when you release.

What to expect. Nothing yet. This week is measurement and accuracy, and finding out you feel almost nothing is common and fixable.

Log this. Hold seconds, clean reps, and your symptom count for two days.

Free · no login

Every move, drawn.

Eight positions, each with the movement animated, three cues, the mistake almost everyone makes, and an easier version that still counts.

Breathe in, ribs widen

Inside

Breathing in. Lengthens and widens

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Connection breath

Also called Diaphragmatic breathing, 360 breathing

The diaphragm and the pelvic floor are the top and bottom of the same canister. Feeling them move together is what stops months of well-meant effort aimed at the wrong muscle.

  • Lie on your back, knees bent, one hand on your lower belly.
  • Breathe in through your nose and let the belly and ribs widen. The floor lengthens and drops.
  • Breathe out slowly through your mouth and feel the floor come quietly back up on its own.

Most common mistake. Chest-only breathing with the belly held in. Sucking the stomach in raises pressure downwards, which is the opposite of what you want.

Easier. Sit in a chair or lie on your side. Position matters less than actually feeling the movement.

You know it’s working when. The hand on your belly moves before your chest does, and the exhale is longer than the inhale.

Rest, fully released

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Lift and release

Also called Long-hold pelvic floor contraction, kegel

The long hold is the strength half of pelvic floor muscle training. The full release afterwards is the half almost nobody is taught, and skipping it is why some people feel worse.

  • Breathe out, then lift from back to front, as if stopping wind and then slowing a stream of urine.
  • Hold while you keep talking or counting out loud. Breath keeps moving.
  • Let go completely and wait as long as you held. The release is a rep too.

Most common mistake. Clenching the buttocks, the inner thighs and the jaw, holding the breath, and never fully letting go between reps.

Easier. Two-second holds lying down. Build the hold before you build the number.

You know it’s working when. You can hold and count out loud at the same time, and you feel a distinct drop when you release.

Off

Inside

Breath keeps moving. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Quick flicks

Also called Fast-twitch contractions

A cough or a sneeze arrives faster than a slow squeeze can answer it. Fast contractions train the reflex speed that catches the leak.

  • One second on, one second fully off.
  • Sharp up, complete let go. The let go is what makes the next one work.
  • Ten in a row, then stop. Quality dies quickly here.

Most common mistake. Turning it into ten half-contractions stacked on top of each other, never returning to zero.

Easier. Five flicks lying down, twice a day.

You know it’s working when. The tenth flick feels as crisp as the first. If it doesn't, you've found your number.

Standing, about to cough

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

The knack

Also called Pre-contraction, counter-bracing

Lifting before the pressure arrives, rather than after, is the single most transferable thing in this program. It is what turns practice into no longer leaking.

  • Just before the cough, sneeze, laugh or lift: lift.
  • Do the thing.
  • Let go straight afterwards. You are not meant to hold it all day.

Most common mistake. Remembering afterwards. Practise it deliberately with a fake cough so the timing becomes automatic.

Easier. Practise sitting first, then standing, then with a real cough.

You know it’s working when. You catch yourself lifting before you pick up the shopping without deciding to.

Lying, knees supported

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Letting go

Also called Down-training, reverse kegel, diaphragmatic release

A pelvic floor that never switches off leaks, aches and rushes to the bathroom too. If kegels have ever made you feel worse, this is the half you were missing.

  • Knees wide over a pillow, jaw unclenched, tongue soft on the roof of the mouth.
  • Breathe in and imagine widening from sit bone to sit bone.
  • Breathe out with nothing to lift. There is no squeeze in this one at all.

Most common mistake. Sneaking a little lift in anyway. Doing less is the exercise.

Easier. Child's pose or side-lying with a pillow between the knees.

You know it’s working when. You yawn, sigh, or your shoulders drop. That is the nervous system letting go with you.

Down

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Glute bridge with breath

Glutes and pelvic floor work as a team. Loading the hips while the breath keeps moving is how the floor learns to work under real effort.

  • Feet flat, heels a hand's width from your bottom.
  • Breathe out, lift the pelvic floor, then lift the hips.
  • Lower slowly and let everything release at the bottom.

Most common mistake. Holding the breath on the way up and squeezing the buttocks so hard the ribs flare.

Easier. Lift halfway, hold for three breaths, lower. Or do it with feet on the sofa.

You know it’s working when. Your glutes are what's tired, and you were able to talk the whole way through.

Standing at rest

Inside

Breathing in. Fully released

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Standing lifts

Gravity is the point. Nobody leaks lying down, so at some stage the training has to happen upright, which is where the symptoms live.

  • Stand tall, feet hip width, weight even through both feet.
  • Breathe out, lift, hold for your current count while you keep talking.
  • Release fully and shake the legs out between sets.

Most common mistake. Gripping the buttocks and tipping the pelvis under. Everything above the hips stays quiet.

Easier. Do them leaning back against a wall, or sitting on a firm chair.

You know it’s working when. Standing holds feel about two seconds shorter than lying-down holds. That's normal, and it's the honest number.

Standing

Inside

Breathing out. Floor lifts

The body barely moves here — the work is internal. The bowl below shows what the pelvic floor is doing, against the dotted resting line.

Squat with exhale

The last block is about real life: getting off the floor, picking up a grandchild, carrying shopping. Load with a breath strategy, and the floor comes with you.

  • Sit back to a chair, chest tall, breathe in on the way down.
  • Breathe out and lift the pelvic floor as you stand up.
  • Belly stays soft the whole time. Never suck in.

Most common mistake. Holding the breath and bearing down at the hardest point, which pushes pressure straight onto the floor.

Easier. Sit-to-stand from a higher chair, hands on the thighs.

You know it’s working when. No leaking, no heaviness, and you can say a full sentence at the bottom of the squat.

The other half

Bladders are nervous systems too.

Urgency gets louder when you're braced. If your days are spent scanning for the next bathroom, the pelvic floor rarely gets the chance to let go, and the practices above will keep sliding off. The mindfulness library has the same voice-guided treatment for breath, grounding and somatic work, and the nervous system guide explains why midlife makes all of it jumpier.

Bladder leaks, in fullProlapse and heavinessPessariesPelvic floor chairs

When to bring in a person

Training is first-line for most people, and it is not the right first move for everyone. Please get seen rather than starting here if any of these apply.

  • Blood in your urine, or urine that keeps testing positive for infection.
  • Continuous leaking that you can't stop or control at all.
  • A lump or bulge you can see or feel outside the vaginal opening, especially if it's sore or bleeding.
  • Not being able to empty your bladder, or a bladder that feels full straight after going.
  • New numbness around the saddle area, new weakness in the legs, or loss of bowel control. That's same-day medical care.
  • Pain as the main symptom, rather than leaking or heaviness. Squeezing is usually the wrong first move here.

Supervised training beats solo training in the trials, and an internal assessment is the part no app can do. If you can get to a pelvic floor physiotherapist, this program works alongside them rather than instead of them. Also get checked promptly for blood in your urine, pain when you pee, or a sudden change in bladder habits.

Find a pelvic health practitioner Log the twelve weeks The full treatment menu

Beyond Nila · pelvic health

Where else to read, listen and learn about your pelvic floor

Free patient education from professional bodies, plus the two general-audience books we keep recommending. None of it replaces an internal assessment, and all of it makes that appointment easier.

  • Tool

    Patient information booklets

    by Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), UK

    Free downloadable booklets written by pelvic health physiotherapists — pelvic floor training, prolapse, bowel and bladder habits. Plain, printable and not selling anything.

  • Tool

    Your Pelvic Floor

    by International Urogynecological Association (IUGA)

    Patient leaflets on prolapse, incontinence, pessaries and surgery, translated into many languages. Useful before a urogynaecology appointment.

  • Tool

    The Canadian Continence Foundation

    by The Canadian Continence Foundation

    Canadian bladder and bowel resources, including what to expect from continence care and how to raise it with your doctor.

  • Book

    Floored: A Woman's Guide to Pelvic Floor Health at Every Age and Stage

    by Sara Reardon, DPT

    General-audience pelvic floor book from a physiotherapist who spends much of her time undoing bad kegel advice. Good on what changes at menopause.

  • Book

    The Pelvic Floor Bible

    by Jane Simpson

    Short and blunt on bladder and bowel symptoms — the ones people live with for a decade before mentioning them.

No affiliate links. No paid placement. We update this shelf roughly every quarter.

Sources

The evidence behind this page.

Pelvic floor muscle training is one of the few midlife interventions with first-line guideline backing — and the guidelines are equally clear about when self-directed practice isn't enough. See how we grade evidence.

Why the lifts, and why supervised beats solo

3 sources

Show

Training the pelvic floor is first-line for stress and mixed urinary incontinence. It works better with a physiotherapist checking what you're actually doing.

Pelvic floor muscle training is recommended as first-line conservative management for stress and mixed urinary incontinence in women, before surgical options are considered.

Clinical guidelineAmerican Urological Association / SUFU — Stress Urinary Incontinence Guideline · 2023
Read the source

Pelvic floor muscle training is part of standard first-line management for pelvic organ prolapse symptoms, alongside pessaries, with surgery reserved for those it doesn't help.

Clinical guidelineACOG Practice Bulletin No. 214 — Pelvic Organ Prolapse · 2019
Read the source

Urinary symptoms, prolapse-adjacent change and pelvic floor considerations after menopause are addressed together in Canada's national menopause guideline, including local estrogen for genitourinary symptoms.

Clinical guidelineSOGC Clinical Practice Guideline No. 422b — Menopause and Genitourinary Health · 2024
Read the source

The nervous-system half

1 sources

Show

Urgency and holding patterns don't respond to squeezing alone. Slow-breathing practice has trial evidence for arousal, which is the part these practices borrow.

Five minutes a day of structured slow breathing with an extended exhale reduced physiological arousal and improved mood over 28 days, outperforming mindfulness meditation on both.

Randomised trialBalban et al · Cell Reports Medicine · 2023

Stanford RCT, n=108.

Read the source

Why three sessions a day, and why twelve weeks

3 sources

Show

The dose is not arbitrary. It is the trial dose, and it is the length of trial guidelines ask for before surgery is considered.

A supervised trial of pelvic floor muscle training of at least three months, including at least eight contractions performed three times a day, is recommended as first-line treatment for stress or mixed urinary incontinence before surgery is considered.

Clinical guidelineNICE NG123 — Urinary incontinence and pelvic organ prolapse in women: management · 2019
Read the source

Pelvic floor muscle training is first-line conservative treatment for stress and mixed urinary incontinence, and intensive, individually taught, supervised programs produce larger effects than brief written or verbal advice.

Systematic reviewDumoulin, Cacciari & Hay-Smith · Cochrane Database of Systematic Reviews CD005654 · 2018

Cochrane review, updated 2018.

Read the source

Supervised pelvic floor muscle training should be offered for at least sixteen weeks as first-line treatment for stage 1 to 3 pelvic organ prolapse, and continued as maintenance if it helps.

Clinical guidelineNICE NG123 — Pelvic organ prolapse recommendations · 2019
Read the source

The knack, and why it lands in week 3

3 sources

Show

A lift timed just before the cough reduces leakage immediately, before any strength has been built. That's why it comes early rather than at the end.

A voluntary pelvic floor contraction performed just before a cough significantly reduced cough-related urine loss in women with mild stress incontinence.

Randomised trialMiller, Ashton-Miller & DeLancey · Journal of the American Geriatrics Society · 1998
Read the source

The effect was confirmed in a later controlled study, with a substantial reduction in urine loss volume during coughing when the manoeuvre was cued in advance compared with no pre-contraction.

Randomised trialMiller et al · International Urogynecology Journal · 2008
Read the source

Mechanistically, a voluntary pre-cough contraction reduces downward movement of the bladder neck during a cough, which supports training fast pre-emptive contractions alongside strength work.

Mechanism / basic scienceMiller et al · Obstetrics & Gynecology · 2001
Read the source

Bladder training, and the release half

2 sources

Show

Urgency responds to interval training rather than to squeezing harder, and a pelvic floor that never switches off gets worse with strengthening alone.

Bladder training with progressively lengthened voiding intervals should be trialled for a minimum of six weeks as first-line treatment for urgency or mixed urinary incontinence.

Clinical guidelineNICE NG123 — Non-surgical management recommendations · 2019
Read the source

Evidence for pelvic floor relaxation training in non-relaxing pelvic floor is limited but emerging, and women with a non-relaxing or overactive pelvic floor should not simply be prescribed strengthening exercises.

Narrative reviewVoss et al · Neurourology and Urodynamics · 2024

Narrative review; high-quality trials are still scarce.

Read the source

Tissue, and whether app-supported training actually works

3 sources

Show

Training does nothing for tissue that has thinned, and the biggest predictor of whether any of this holds is whether you keep doing it.

Low-dose vaginal estrogen is effective first-line treatment for genitourinary syndrome of menopause, including urinary symptoms such as urgency and discomfort.

Clinical guidelineAUA / SUFU / AUGS — Genitourinary Syndrome of Menopause Guideline · 2025
Read the source

Vaginal, but not oral, estrogen reduces recurrent urinary tract infections in postmenopausal women.

Systematic reviewPerrotta et al · Cochrane Database of Systematic Reviews CD005131 · 2008
Read the source

A structured three-month app-delivered pelvic floor training program significantly improved stress incontinence symptoms and reduced leakage episodes compared with an information-only control.

Randomised trialSjöström et al · BJU International · 2013

Conducted by the team that went on to commercialize the app tested. Treat the effect size as promising rather than independent.

Read the source

Where to next

A note on practice

Ten lifts most days for three months is the dose with trials behind it, and it is far less impressive than it sounds. Small, dull and repeated beats one determined afternoon.

Take this with you

Read: the genitourinary doorway