As a Physiotherapist and Pilates Instructor, the pelvic floor is one of the areas I teach most and the one I get asked about more than almost anything else. Most of those questions are about strength: how to activate it, how to build it and how to get it back after a baby or through menopause. Strength matters. But there is another aspect of pelvic floor training that gets far less attention and I was reminded of it recently.

I spent a week doing every health and longevity test I could, from body composition and grip strength to stress regulation. Every result came back better than I had hoped and my pelvic floor and core strength were where I would want them to be. What a session with a pelvic health Physiotherapist did pick up was tension. A stressful period had been showing up in my body as holding, with my pelvic floor bracing when it should have been resting. It was a clear reminder of something I teach every day. A strong pelvic floor is one that can contract and one that can let go. Strength without release is only half of the work, so I want to take you through both.

What your pelvic floor does

Your pelvic floor is a group of muscles that sits like a sling at the base of your pelvis. It supports your bladder, bowel and internal organs, gives you control over when you go to the toilet and works with your diaphragm, your deep abdominals and the small muscles along your spine as part of your deep core. Every time you lift, jump, cough or laugh, it responds. Healthy pelvic floor muscles need to be strong enough to support you and flexible enough to stretch and relax. 

Why strength and release work together

Most pelvic floor advice stops at squeezing. But these muscles can also become overactive, holding tension when they should be resting. Stress and anxiety are among the factors linked to a pelvic floor that struggles to relax and for some people, a pelvic floor that feels weak is one that is too tight to contract fully. Strength alone does not tell the whole story. Even a strong pelvic floor can hold tension when life is stressful.

This is why I always cue your breath with pelvic floor work. As you exhale, gently draw your pelvic floor up and in. As you inhale, let it fully release. That release is not a rest between reps. It is half of the exercise. If you have any pain, or you are unsure whether your pelvic floor is weak or holding tension, a pelvic health Physiotherapist is the right person to see.

Your pelvic floor responds to training

Pelvic floor training is one of the most researched areas in my field. A Cochrane review of 31 trials found that most people with stress urinary incontinence who trained their pelvic floor reported improvement or cure, compared with far fewer of those who did not. Leaking when you cough, sneeze or jump is common, but it is not something you have to accept. Like any muscle, your pelvic floor gets stronger with consistent, progressive work done with control.

Postpartum: rebuild from the inside out

Pregnancy and birth place a huge load on your pelvic floor and deep core. Training the pelvic floor early in pregnancy has been shown to reduce the risk of leaking later in pregnancy and after birth. After a straightforward birth, gentle pelvic floor exercises can start as soon as you feel ready. Higher impact training is a different conversation. Get advice at your 6 week postnatal check before you return to running, jumping or anything high-impact. If you notice a gap down the middle of your stomach, known as diastasis recti, have it checked before you load your core. Rebuilding starts with your breath, your pelvic floor and your deep core. Strength is layered on top of that foundation.

Perimenopause and menopause: train for the years ahead

As oestrogen falls, the tissues that support your bladder and pelvic floor change too. This is why bladder weakness becomes more common through menopause and why daily pelvic floor training is recommended to reduce the risk of leaks. It is the same message I shared about muscle and bone in my perimenopause article. You are not waiting for something to go wrong. You are training for the years ahead. Pelvic floor work belongs alongside your Strength and Cardio, not instead of them, because your muscle, your bones and your deep core all respond to the right challenge.

How to do a pelvic floor exercise

This is how I teach it. Start lying down or sitting with your knees bent, then build up to standing once the movement feels familiar.

1. Find the right muscles. Imagine you are stopping yourself from passing wind and stopping the flow of urine at the same time. You should feel a squeeze and a gentle lift inside. Keep your glutes, thighs and stomach relaxed.
2. Breathe with it. Inhale to prepare and let everything soften. Exhale as you squeeze and lift. Never hold your breath.
3. Hold, then fully release. Hold the squeeze and lift for up to 10 seconds, then let it go completely and rest for the same amount of time. Repeat up to 10 times. If you can hold for 3 seconds today, start there.
4. Add quick squeezes. Squeeze and lift quickly, then release straight away. Repeat up to 10 times, letting the muscles fully relax between each one. This trains your pelvic floor to respond when you cough, sneeze or jump.
5. Make it consistent. Do the full set 3 to 4 times a day. It can take around 6 weeks to notice a difference and you will keep improving for months after that.

One thing to avoid: do not practise by stopping your urine flow midway, as this can affect how your bladder works. If you are unsure of your technique, a pelvic health Physiotherapist can check it for you.

Structure is what makes it work

Your pelvic floor needs what every muscle needs: the right exercises, done with control, built up over time and balanced with release and rest. That balance is hard to find in one-off workouts. It comes from a Program built to progress, where strength, breath and recovery are planned together week by week.

That is why I have created a new 4 week Women’s Health Program. It is specifically designed for Perimenopause, Menopause and postpartum. It combines Pilates, Strength and Cardio with pelvic floor, deep core work and breath awareness built in. We start together on Monday 9 November.