A Clinical Approach to Pelvic Floor Exercises. The Essential Guide to Technique (Part 1)

When I started writing this blog post, I noticed that it became too long. As you can see, there is quite a lot to take in on 'just do your Kegels' (and I quite like a bit of detail). So, I decided to divide it into three parts. Today, we will learn about anatomy and how the muscle works.

In my clinical practice, I often debate the utility of publishing generalised guides on "how to do pelvic floor exercises." As a specialist physiotherapist, my core clinical philosophy is that true pelvic floor restoration extends far beyond the repetitive, isolated "squeezes" we have been historically taught to perform.

If you are looking to truly engage your pelvic floor, we must shift the focus from forceful exertion to mindful, sensory awareness. Here is my clinical approach to re-establishing that vital brain-body connection.

First Things First

Before we can effectively train these muscles, we must understand precisely where they are situated. Visualise the bony structure of your pelvis as a basin or bowl. The pelvic floor forms the muscular foundation of this bowl. If you were to sit upright on a firm chair, these muscles span the entire area between your points of contact. They attach to the pubic bone at the front, sweep backwards to connect to the tailbone (coccyx), and stretch side-to-side between your 'sit bones' (ischial tuberosities). Rather than a flat, rigid surface, they create a dynamic, hammock-like sling that physically supports your bladder, uterus, and bowel from the bottom up. (1,2)

The video below from Continence Health Australia can show you where the pelvic floor is and how it works:

To understand how the pelvic floor works, we must first understand basic muscle physiology. While the pelvic floor is made up of multiple distinct muscles, they all share a crucial characteristic: they are skeletal muscles(1). This means that, much like the biceps or glutes you might train in the gym, the pelvic floor responds directly to targeted strengthening. Crucially, they are under our voluntary control, same as your biceps and glutes (1,2).

Like all skeletal muscles, these fibres function optimally when they have a full range of motion. They have a maximum point of lengthening and a maximum point of contraction. The more effectively you can relax and stretch a muscle, the more powerfully and functionally you can contract it to build true strength. These muscles also contain different types of fibres: fast-twitch and slow-twitch fibres (3). The slow-twitch fibres act as your continuous postural support, maintaining resting tone throughout the day and keeping your pelvic organs secure. Conversely, the fast-twitch fibres are designed for rapid, powerful reactions. They engage instantly to prevent leakage during sudden spikes in intra-abdominal pressure, such as when you cough, sneeze, jump, or laugh. (3,5)

Anatomically, the pelvic floor muscles are not long. They form a relatively small, dynamic sling that loops from the pubic bone to the tailbone and back again. When engaged, they contract inwards and upwards. Because of their size and their continuous daily workload, they can get tired quite quickly. This is why targeted training is key. In fact, NHS national guidance frequently highlights the phrase '2 and 8 is great', referencing an ideal foundational goal of performing 2 sets of 8-second holds to build this vital muscular endurance (3). I do agree with it (to some extent), but is it really enough?

I have just mentioned that we have 2 types of muscle fibres. 2 and 8 is great for the slow-twitch fibres and building baseline tone. What about the fast-twitch ones?

To train these reactive fibres, we execute the same inward and upward contraction, but we do not hold it for long. Instead, we focus on a rapid sequence: simply squeeze, release, and fully relax. Training this dynamic, explosive strength is a crucial piece of the puzzle, which we will explore in much greater detail in Part 3.

What Is The Pelvic Floor Role?

Once we understand its location and structure, we can truly appreciate the pelvic floor’s multifaceted role in our daily lives. In the clinic, I often explain that this muscular sling performs five critical, dynamic functions:

• Support: It provides vital structural support for your pelvic organs (the bladder, uterus, bowel, and your baby during pregnancy), resisting the constant downward pull of gravity and it is also there for childbirth (1,2).

• Continence: It acts as a sphincter, contracting to maintain continence when you cough or laugh, and fully relaxing to allow for healthy voiding. It means it allows us to use the toilet when it is socially acceptable (1,2).

• Sexual: It plays a significant role in sexual function, arousal, and sensation (2,3).

• Stability: It provides foundational lumbo-pelvic stability, operating alongside your diaphragm and deep abdominal muscles to manage intra-abdominal pressure and support your lower back (1,5).

• Sump-Pump: It acts as a physiological pump, aiding in local blood and lymphatic circulation to keep the pelvic tissues healthy and well-oxygenated (1).

When even one of these functions is compromised, it can profoundly impact your overall quality of life.

Now that we have mapped out the precise anatomy and the five core functions of the pelvic floor, the next crucial step is understanding how to actually engage these muscles in daily life. As we will discover, you cannot have a fully functional pelvic floor without a functional diaphragm. (1,4)

Join me next week for Part 2 of this series, where we will dive into the absolute foundation of pelvic health: your breath. We will explore the vital, continuous relationship between your breathing and your pelvic floor, and why mastering this lumbo-pelvic connection is the mandatory first step before you ever attempt a single contraction.

Understanding your anatomy is the foundation of recovery, but true healing requires specialised, individualised care. If you are experiencing pelvic floor dysfunction and are ready to move beyond generic advice, we are here to support you.

You can click below and start your journey at Flor.

References

[1] StatPearls Publishing. (2026). Anatomy, Abdomen and Pelvis: Pelvic Floor. National Center for Biotechnology Information (NCBI). https://www.ncbi.nlm.nih.gov/books/NBK482200/

[2] Cleveland Clinic. (2025). Pelvic Floor Muscles: Anatomy, Function & Conditions. Cleveland Clinic Health Library.https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles

[3] Midlands Partnership University NHS Foundation Trust. (2026). Pelvic Floor Exercises for Women. Specialist Pelvic Health Team Patient Information. https://www.mpft.nhs.uk/services/specialist-pelvic-health-team/specialist-pelvic-health-team-patient-information/pelvic-floor-exercises-women

[4] Royal United Hospitals Bath NHS Foundation Trust. (2021). Breath and Pelvic Floor Strengthening: Physiotherapy Patient Information.https://www.ruh.nhs.uk/patients/patient_information/PHY043_breath_and_pelvic_floor_strengthening.pdf

[5] Frontiers Editorial Office. (2026). Optimizing women's health: Pelvic floor considerations in sports and physical activity. Frontiers in Sports and Active Living, 8. https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2026.1707274/full