Some conditions may feel too embarrassing to discuss with your doctor. Weak pelvic floor muscles can cause such conditions.

You may have trouble with bladder or bowel control. Urine can leak out when you cough, sneeze, laugh, or exert yourself in any way. You might need to urinate often or urgently.

Weak muscles can also affect the vagina and uterus. You may feel discomfort inside your vagina. Telling your doctor about these conditions can help you get the right treatment.

Your bladder, bowel, vagina, and uterus are held in place by a hammock of muscles called the pelvic floor. Weak muscles can’t hold up these organs. That can cause your bladder to leak and other embarrassing conditions called pelvic floor disorders.

Pelvic floor disorders affect women of all ages. Experts estimate that 1 of every 3 women in the United States has a pelvic floor condition. But because so many women don’t tell their doctor, they’re probably much more common.

Many factors—including family history, pregnancy, menopause, weight, and smoking history—can affect your risk for developing a pelvic floor disorder. Dr. Donna Mazloomdoost, a pelvic floor specialist at NIH, says, “Some women are just going to be very prone to these sort of conditions, and others are not.”

Depending on the condition, treatment options may include dietary changes, physical therapy, medications, medical devices, or surgery. NIH is funding studies to develop new and improved treatments.

“Most of the game-changing recommendations have come from studies that the Pelvic Floor Disorders Network has done,” says Mazloomdoost, who is the director of this NIH program. It funds some of the largest, multicenter pelvic health studies across the country.

A recent study from the network showed that women who urinate too often or leak urine may be treated successfully with Botox (botulinum toxin) injections. Another treatment that helps with bladder control uses a surgical implant to electrically stimulate the pelvic muscle nerves. Stimulating the nerves appears to help the bladder relax more.

“My first advice to all women with symptoms would be to see a pelvic floor specialist,” Mazloomdoost says. “Often times, physical therapy is the first treatment recommended because just about every pelvic floor condition will benefit from it. Some conditions, however, may need more than just physical therapy to get better.”

Pelvic floor physical therapy often begins with simple pelvic floor exercises. Some of these are known as Kegel exercises. They make the pelvic muscles stronger. Any woman can benefit from these exercises. Ask your health care provider how to do them correctly.

Mazloomdoost explains that Kegels performed at home may not work for some women with a pelvic floor condition. This may be because women don’t hold the exercises long enough, and they don’t do enough of them during the day.

“Physical therapy involves monitoring and measuring the amount of strength that the muscles are using and making sure that the correct muscles are being used—and for often enough and long enough,” she says.

Women who have a pelvic floor condition don’t have to suffer. Treatments are available. “If you have any problem with your bladder function or what your vagina feels like, then I think it’s absolutely important to speak with your doctor about it,” Mazloomdoost advises.

Lower Your Risk of Pelvic Floor Issues

• Maintain a healthy weight.
• Avoid constipation and straining by getting enough fiber and fluids in your diet.
• Avoid tobacco smoke and triggers of a long-term cough, which weaken the pelvic floor.
• Do Kegel exercises regularly to keep pelvic floor muscles toned. Ask your health care provider how to do them correctly.

Kegel exercises, also called pelvic floor muscle training, are simple exercises you can do to treat bladder problems and improve bowel control. The exercises strengthen the pelvic floor muscles that support the bladder, rectum, and uterus. These muscles—which stretch like a hammock from the front to the back of your pelvis—can help you avoid releasing urine, stool, or gas at the wrong times.

Many factors, including pregnancy and childbirth, surgery, and getting older, can weaken pelvic floor muscles. If these muscles are weak, you may start to leak small amounts of urine, stool, or gas.

Kegel exercises strengthen these muscles, helping you to stop these leaks. Studies suggest that pelvic floor muscle training may also improve sexual function.

Pelvic floor muscle training can help both women and men. But in some cases, practicing these exercises may not be a good option. Check with your health care professional before you begin.

During Kegel exercises, you squeeze, hold, and relax your pelvic floor muscles. Sounds simple, but you may need a little practice before you learn to exercise the right muscles.

Find the right muscles

Find your pelvic floor muscles. Try one of the following ways to find the right muscles to squeeze.

• Imagine you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling in your vaginal or rectal area, you are squeezing the right muscles.
• While urinating, try to stop your urine midstream. The muscles you squeeze to stop the urine flow are your pelvic floor muscles. Though this is an easy way to find the muscles at first, don’t do Kegel exercises while urinating on a regular basis. Stopping your bladder from emptying completely could increase your risk for a bladder infection.
• Women: Insert your finger into your vagina. Squeeze as if you were trying to hold in your urine. If you feel tightness on your finger, you are squeezing the right muscles.
• Men: Insert your finger into your anus. Squeeze as if you were trying to hold in your urine. If you feel tightness on your finger, you are squeezing the right muscles.

Let your health care professional help you. Many people have trouble finding the right muscles. Your doctor, nurse, or pelvic floor therapist can let you know if you are doing the exercises correctly. They can examine you while you do the exercises to verify you are squeezing the right muscles. They can also recommend exercise aids, such as biofeedback, electrical stimulation, or special weights.

Practice the exercise

Learn the method. Here’s an easy way to start.

• Find and squeeze your pelvic floor muscles.
• Try to hold the squeeze for 3 seconds.
• Release the muscles and fully relax your pelvic floor.

Then repeat! Try to work up to 10 to 15 repetitions each time you exercise.

Follow your health care professional’s advice. Kegel exercises can be done in different ways—in terms of how many seconds to hold the squeeze and how many repetitions to do per session. Ask your health care professional for an exercise plan that meets your unique needs.

Don't squeeze other muscles at the same time. Be careful not to tighten your stomach, thighs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder, making it easier to leak urine. Try to squeeze only your pelvic floor muscles.

Add to your daily routine

Do your pelvic exercises at least three times a day. Every day, try to do the exercises in three positions: lying down, sitting, and standing. Using all three positions makes the muscles strongest. Keep a daily journal or exercise log to record each time you do the exercises.

Here’s a sample daily exercise schedule.

• Do a set of exercises in the morning, while making breakfast.
• Fit in another set in the afternoon, while sitting at your desk or driving.
• End with a third set in the evening, while lying in bed.

Be patient. Don't give up. It's just 5 minutes, three times a day. Like any exercise routine, it can take a little time to build up muscle strength and conditioning. You may not feel your bladder control improve until after 3 to 6 weeks.

Don’t overdo it. Keep doing the exercises, but don’t increase how many you do. Overdoing the exercises can lead to straining when you urinate or move your bowels.

Kegel exercises strengthen the muscles that support the pelvic floor and tighten the urethra, which can help reduce UI in women. They can benefit women with stress or urge incontinence. Like any type of exercise, Kegel exercises only work as long as a woman does them. Once a woman stops the exercises, the muscles will become weak again and UI might return to its previous level.