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9 Pelvic Floor Exercises for Stress Incontinence

If you have stress urinary incontinence — aka you pee a little (or a lot) when you sneeze, cough, jump, or otherwise experience an increase in pressure inside your abdomen — you know that even small leaks can be a big deal. Stress incontinence impacts everything from your social life and sexual health to your mood and productivity at work. That's why it's better to treat leaks sooner, rather than later.

Pelvic floor physical therapy is a recommended treatment option for stress urinary incontinence, for a few great reasons:

  • Unlike other treatments, pelvic floor PT is very low-risk.
  • The benefits of pelvic floor PT are strongly supported by evidence.
  • Pelvic floor exercises not only lead to lasting resolution of symptoms, they also reduce their negative impact on your quality of life.

If you're dealing with stress urinary incontinence (SUI), don't hesitate to come see us at Origin. Our women's health PTs specialize in treating bladder issues and can help you ditch leaks for good. In the meantime, we're here with nine of our favorite pelvic floor exercises for SUI.

Stress urinary incontinence & your pelvic floor

Before we jump to the moves, let's quickly review some key details about SUI and the role your pelvic floor plays in preventing bladder leaks.

Stress urinary incontinence is the involuntary leakage of urine that happens during activities that cause increased pressure or stress on your bladder. SUI is the most common form of urinary incontinence and impacts approximately 38% of people born with vaginal anatomy.

When SUI occurs, it's most often because there is a glitch in what researchers call the “stress continence control system.” This system involves your pelvic floor muscles as well as the connective tissues and fascia that support your bladder. Ideally, all three of these work together in response to a sudden rise in intra-abdominal pressure — i.e. when you cough or sneeze — to prevent a bladder leak.

Basically, the pelvic floor muscles, connective tissues, and fascia exert pressure around the urethra (the bladder opening) to pinch it closed. Think: Stepping on a hose to stop the flow of water.

To do this efficiently and effectively, your pelvic floor muscles must:

  • Be strong enough to resist increased pressure
  • Be quick enough to provide extra resistance with sudden rises in pressure, like when you trip or sneeze
  • Be coordinated enough to unconsciously or consciously contract when needed, like when you lift a heavy box
  • Have enough endurance to provide constant support
  • Be flexible enough to release fully when it's time to empty your bladder

If your pelvic floor muscles are injured, underused, or otherwise not working properly, they'll fall short in one or more of these areas and you'll experience leaks.

9 pelvic floor exercises for stress urinary incontinence

The following 9 moves are great examples of exercises that are typically included in a PT treatment plan for SUI. The goal of doing exercises like these is to increase the strength, speed, coordination, endurance, and flexibility of your pelvic floor muscles to guard against leaks. The best exercise routine for you is one that's designed by a pelvic floor PT for your unique body and symptoms.

1. Kegels

We’ll start with the most basic pelvic floor exercise, aka the kegel. It’s not the most exciting exercise, but it will help you regain a foundation of control over your muscles, which you can then build on.

Even basic kegels are actually quite tricky to do, so it's important to follow the instructions carefully.

Stand with feet hip distance apart.

  1. Inhale deeply, allowing air to fill the bottom of your lungs. Feel your lower abdomen, your low back and your pelvic floor gently stretch outwards with your breath.
  2. As you exhale, contract your pelvic floor muscles into a kegel, feeling your pelvic floor lift up and in and your belly button move towards your spine. Try to avoid contracting your glutes or abdominals — really focus on moving your pelvic floor muscles.
  3. Relax your pelvic floor during the next inhale.

Not connecting with your pelvic floor? Feel like you can't move it at will. That's actually fairly normal — and a great reason to see a pelvic floor PT.

2. The Knack

If you have stress incontinence, you've likely lost some pelvic floor muscle coordination. By consciously practicing the timing of your pelvic floor contractions, you can help them synch up again.

Lie flat on your back with your legs straight and arms at your sides.

  1. Inhale and fill your belly with air, keeping your pelvic floor relaxed as you feel your belly expand outward.
  2. Contract your pelvic floor muscles in a kegel as you exhale, feeling your belly draw in towards your spine.
  3. Continue to hold the kegel and cough once. Try not to lose the strength of your kegel for the duration of the cough. In addition to a cough, you can try a loud "shh" sound.
  4. Relax your pelvic floor.

To challenge your endurance, try to hold your kegel for several coughs or "shh's" in a row.

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3. Diaphragmatic Breathing

Don't let the simplicity of this move fool you — it's another foundational exercise that can boost essential muscle coordination and flexibility, as well as improve mindfulness. To learn about all the benefits of diaphragmatic breathing, check out this article.

Lie on your back or side. You can use pillows to support your head or knees.

  1. Place your top hand on the side or front of your belly.
  2. Inhale, feeling your abdomen expand outward and into your hand, as well as your pelvis and back, as your lungs fill with air. With each inhale, imagine your pelvic floor lengthening like the bottom of a balloon as it inflates with air.
  3. Exhale, allowing your abdomen to gently release back towards your spine. Try to keep your chest still as you breathe — place a hand on your chest to help you see how much movement is happening there throughout this exercise.

4. Diaphragm Release

If coordinating your breath with your pelvic floor movement feels difficult, try this gentle diaphragm release first.

Sit in a chair with feet planted greater than hip distance apart.

  1. Place your palms against the front of your ribs so that your fingertips are able to curl around the bottom edge of your ribcage a few inches away from your sternum on either side.
  2. Take a deep breath into your chest, as you feel your chest lift, bring your palms away from your ribs and your wrists forward, pressing your fingertips into the space just beneath your ribs.
  3. Keep your fingers in this position and, as you exhale, lean your torso forward until the backs of your hands can rest on your thighs. Your hands should be able to relax in this position but continue to keep your fingers firmly positioned towards the inside of your ribcage.
  4. Take a deep breath, feeling your diaphragm push into your fingertips.
  5. As you exhale, relax and lower your torso even further towards your lap, allowing your abdomen to soften and lean into your fingers.
  6. Repeat this breathing pattern for several breaths before returning to an upright seated position.

5. Kneeling Hip Extensions

You’ll definitely feel this move in your abdominals and glutes but don’t forget about your pelvic floor. This exercise hits all of the muscles involved in your core in a way that is super functional — and similar to how you would be using them during everyday activities.

Sit on the floor with both knees bent and feet flat on the ground hip distance apart.

  1. Move both feet so they are greater than hip-width apart while keeping your knees bent at 90 degrees. If using a yoga mat, bring your feet to the outside edges of the mat.
  2. Keep your feet in this position as you slowly lower one knee down and out, towards the floor.
  3. Allow your other knee to fall in the same direction, lowering to the floor in front of you. Both knees should still form a 90-degree angle in this pose, reposition your feet as needed to keep this angle.
  4. As you lower your legs, turn your hips and chest to face the same direction as your leading leg.
  5. Squeeze your glutes to lift your hips off of the floor into a kneeling position. Avoid using your arms throughout this exercise, consider holding a weight for added difficulty.
  6. Slowly and with control, lower your hips back to the floor.
  7. Repeat this motion towards the opposite direction.

Where you'll feel it: In your legs and core as you move back and forth from sitting to standing.

6. Suitcase Walking

You’d be surprised how often you find yourself needing the strength built in this exercise during everyday life, like when you’re trying to take the groceries in the house in just one trip, or struggling with a mid-tantrum toddler on your way out of Target. This exercise will not only help you gain deep core stability, but it will teach you how to control intrabdominal pressure during similar tasks.

Start by standing with your feet hip distance apart and a weight or kettlebell placed on the ground by the outside of your foot.

  1. Bend your knees and sit back into your hips to grab the weight with the hand that is closest to it, like a suitcase.
  2. Exhale as you lift the weight, squeezing your glutes to return to standing.
  3. Holding the weight by your side like a suitcase, begin to walk forward, keeping your body tall and shoulders level. Avoid holding your breath or leaning despite the added weight.
  4. Exhale as you sit back into your hips and bend your knees to place the weight back on the floor.

7. Hopping

As your pelvic floor gains some strength back, it can help to add some impact to your exercise routine to mimic some of the exercises that may cause your stress incontinence.

Begin in a standing position with both feet flat on the ground.

  1. Bend your knees and jump, lifting both feet off the ground.
  2. Land softly on just one foot.
  3. Continue to jump up and down on one foot for several repetitions. Try to land softly and quietly, with a slight bend in your knee.

8. Squat

Next, it's time to slow things down a bit. A squat allows you to practice coordinating your muscle engagement with your breath and an increase in intra-abdominal pressure. It also improves strength and endurance in your hips and legs.

Stand with your feet hip distance apart.

  1. Pull your belly button in towards your spine to activate your core.
  2. Keeping your core engaged, push your hips back and bend your knees as though lowering into a chair. Try to keep your knees directly above your ankles and feel your weight shift into your heels.
  3. Squeeze your glutes as you straighten your legs to return to standing.

Where you'll feel it: Your glutes and thighs.

9. Stepping Lunge

Another great exercise that is super practical for many every day scenarios that ma cause stress incontinence is this stepping lunge, but it is definitely one that you won’t likely see until you are further along in pelvic floor rehabilitation.

Stand with feet flat on the ground and hip-width apart.

  1. Take a large step forward, falling into a forward lunge position with your shoulders, hips, and the knee and foot of your back leg forming a straight line. Do not allow your front knee to move forward past your toes.
  2. Push off of your front foot to bring your leg back to its starting position.

How to get individualized PT for your pelvic floor

At Origin, we don’t mess around with stress incontinence. We know it is much more than just a bladder issue and are dedicated to quickly helping you ease your symptoms and reducing the toll it can take on your quality of life.

After thoroughly reviewing your health history and completing a pelvic floor muscle exam (we have the details on that for you here), your pelvic floor physical therapist will be able to help you build a program that is individualized to your needs. And to make it even easier — and more affordable — we offer nationwide virtual care, have 20 in-person locations throughout 8 states, and accept major insurance plans.

Ashley Rawlins Headshot
Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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