To do postpartum pelvic floor exercises (Kegels), squeeze the muscles you would use to stop yourself passing wind and stop the flow of wee, then lift and let go fully. The NHS advises long squeezes held for up to 10 seconds and short, quick squeezes, building up to 10 of each at least 3 times a day. After a vaginal birth you can usually start within the first few hours, and after a caesarean once your catheter is out.
This guide covers how to find the right muscles, the exact routine, how long it takes to work, the mistakes that hold people back, whether squats help, and when to see a pelvic health physiotherapist.
If you are already past your postnatal check and want coached strength work, you can book a class in Angel.
What is the pelvic floor?
Your pelvic floor is a layer of muscles that runs from your pubic bone at the front to your tailbone at the back. It supports your bladder, bowel and womb, and helps you control wee, poo and wind.
Pregnancy and birth stretch and load these muscles, whether you gave birth vaginally or by caesarean. That is why NICE guidance on pelvic floor dysfunction says women who have recently given birth should be encouraged to do pelvic floor muscle training.
How to find the muscles
Sit or lie comfortably with your thighs, bottom and tummy relaxed. POGP’s postnatal booklet puts it simply: imagine you are trying to stop yourself passing wind at the same time as trying to stop passing urine. You should feel a squeeze and a lift inside, with no movement in your legs or bottom.
Not sure you have it? A Gloucestershire Hospitals NHS leaflet suggests watching with a mirror for a gentle inward movement, or feeling for a tightening with a clean finger inside the vagina. You can try stopping your wee once to identify the muscles, but the same leaflet is clear that this is not an exercise. Empty your bladder fully afterwards and do not repeat it as practice.
How to do slow and fast squeezes
| Squeeze | How to do it | Build up to |
|---|---|---|
| Slow (long) | Squeeze and lift, hold for as long as you can up to 10 seconds, breathing normally, then relax fully | 10 holds, resting a few seconds between each |
| Fast (short) | Squeeze and lift quickly, then let go straight away | 10 quick squeezes |
Do both, at least 3 times a day. Start lying down or sitting, which is easier, and progress to standing as you get stronger, as POGP suggests. If you can only hold for 3 seconds at first, that is your starting point. Add a second or a repetition when it feels easy.
The relax matters as much as the squeeze. Let the muscles drop back fully before the next one. If you cannot feel them letting go, rest longer between holds.
Once you have the basics, use what physios call “the knack”. A Berkshire Healthcare NHS leaflet describes tightening your pelvic floor before you cough, sneeze or lift. It is a useful habit when you are picking up a car seat or a toddler.
How often, and how long before it works
Little and often beats long sessions. Many people link a set to something they already do several times a day, such as feeding the baby or boiling the kettle.
You will not feel a difference in a week. POGP says that if your muscles were weak you should notice an improvement in 3 to 5 months. The Gloucestershire leaflet says you will probably not notice an improvement for several weeks, and the best results come after 3 to 6 months. The NHS urinary incontinence treatment page says a programme should last at least 3 months, and you can keep going if it helps.
So give it at least three months of daily practice before judging it, and carry on afterwards. Your pelvic floor needs ongoing training like any other muscle.
The Squeezy app is built for pelvic floor exercise programmes, with input from pelvic health physiotherapists, and sends reminders so you do not forget.
Common mistakes
- Holding your breath. Breathe normally through each hold.
- Using the wrong muscles. The Gloucestershire leaflet lists pulling in your tummy, squeezing your legs together and clenching your buttocks as things to avoid.
- Pushing down instead of lifting. The feeling should be up and in, never bearing down.
- Practising by stopping your wee. Do it once to find the muscles, not as a routine.
- Not relaxing between squeezes. A muscle that cannot let go is not working well either.
- Only ever doing them lying down. Progress to sitting and standing, then use the knack in daily life.
- Stopping too soon. Changes take months, not days.
Do squats help the pelvic floor?
Squats are a good exercise for your legs and glutes, and strong hips help with everyday lifting and carrying. But squats are not a substitute for pelvic floor training. NICE recommends supervised pelvic floor muscle training for pelvic floor problems, and it also says there is no evidence that unsupervised physical activity, such as walking or swimming, will improve or worsen symptoms. There is no good reason to think squats are different.
The honest answer: do your pelvic floor exercises for your pelvic floor, and squat for your legs. If you squat, breathe out as you stand up, use the knack on the way up, and start with bodyweight or a shallow range. If squats cause leaking, heaviness or pain, reduce the depth or load and get assessed. Our guide to building your glutes has more on lower-body strength.
When to see a pelvic health physiotherapist
See your GP, or a pelvic health physiotherapist if you can refer yourself locally, if you notice any of the symptoms below. Most of them are also on the list Royal Berkshire NHS physiotherapists give as reasons not to step up exercise.
- Leaking wee or poo, or not being able to control wind
- Urgency, where you have to rush to the toilet
- A feeling of heaviness, dragging or a bulge in your vagina
- Pain in your pelvis or during sex
- That you cannot feel a definite squeeze and lift
- Little or no change after 3 months of regular exercises
POGP says you can refer yourself to a physiotherapist where self-referral is available, or ask to be referred, and its website lists pelvic health physios. NICE says pelvic floor muscle training programmes should be supervised by a physiotherapist or another healthcare professional with the right expertise, so an assessment is worth having if things are not improving. You can also raise any of these at your 6 to 8 week postnatal check.
How this fits with returning to exercise
Pelvic floor work is the base for everything else. Once your squeezes feel strong and you have been cleared at your postnatal check, you can build up to fuller strength work, as set out in our beginner postpartum workout plan. Gentle moves such as the postpartum glute bridge are a good next step, with a pelvic floor squeeze as you lift. If you have symptoms, get them assessed before adding intensity. For the wider question of timing, see when you can work out after giving birth.
FAQs
How soon after birth can I start pelvic floor exercises?
POGP says you can start breathing and pelvic floor exercises within the first few hours after a vaginal birth. After a caesarean, start once your catheter has been removed.
Can you do too many Kegels?
More is not always better. The Gloucestershire leaflet suggests doing no more than 8 holds at a time, with at least 5 seconds of rest between each, to avoid tiring the muscles. If you get pelvic pain or cannot relax the muscles, stop and get advice.
Are Kegels the same as pelvic floor exercises?
Yes. Kegels is another name for pelvic floor exercises, named after the doctor who popularised them.
Do I need pelvic floor exercises after a caesarean?
Yes. Pregnancy itself puts load on the pelvic floor, and NICE says women who have recently given birth should be encouraged to do pelvic floor muscle training.
Try Lagree in Angel
Lagree classes at Blood, Sweat & Tears are 45 minutes on the Megaformer: full body, low impact and high intensity, built on slow, controlled movement. They suit the stage after your postnatal check, once your pelvic floor feels reliable. New clients can try two weeks unlimited for £139. Book a class here.
