Pelvic floor exercises after menopause: Kegels, trainers and physical therapy

Name: Pelvic floor exercises after menopause: Kegels, trainers and physical therapy
Creator: MenoWoman

Pelvic floor exercises can help at any age, including after menopause: in trials, about three in four women with stress incontinence improved or were cured. Many women do them wrongly at first, so learning them from a pelvic health physical therapist gives the best chance of success.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if you have blood in your urine, pain or burning when you pass urine, a bulge or dragging feeling in the vagina, bowel leakage, or any bleeding after menopause. Get urgent help for new leakage with numbness or weakness in the legs or around the genitals.

How menopause affects the pelvic floor

The pelvic floor is a sling of muscles that supports the bladder, bowel and uterus. It helps you hold in urine and wind.

Lower estrogen around menopause can thin the tissues of the vagina and urethra. This is linked to burning, needing to pass urine more often and more urinary infections.³ The pelvic floor muscles may also weaken, which can cause leaks, urgency and trouble controlling wind.³ Weaker muscles can raise the chance of prolapse, where a pelvic organ drops down.³

Leaks are common. About 1 in 5 women have stress incontinence, leaking with coughs, sneezes or exercise. By age 70, about 1 in 2 women have some form of leakage.²

What pelvic floor exercises (Kegels) are

Pelvic floor exercises, often called Kegels, involve squeezing and lifting the muscles you would use to stop passing wind. You then let them fully relax. Some exercises use slow, held squeezes and others use quick ones.

Getting the right muscles matters. About half of women cannot tighten the pelvic floor correctly at first.² A common mistake is tightening the stomach, thigh or buttock muscles instead. These should stay relaxed while you breathe normally.⁷

Stopping your urine flow can help you find the right muscles, but it should not be used as a regular exercise.⁷ Squeezing too hard is not better either, and it can cause problems such as pain during sex.⁷

Results take time. Many women notice fewer symptoms after four to six weeks, but it can take several months. Leaks can return if you stop, so most women need to keep going long term.⁷

A specialist can also teach "the knack". This means tightening the pelvic floor just before you cough, sneeze or lift.²

Kegels for women over 50 are just as relevant as for younger women. Trials include women of all ages, though results are rarely reported by age.⁶

What the research shows

A Cochrane review pooled 31 trials with 1,817 women from 14 countries.⁶ About two in three women with any type of leakage improved or were cured with pelvic floor muscle training. In comparison, about three in ten improved with no treatment.⁶

For stress incontinence, about three in four women improved or were cured, compared with about one in ten without training. They also had about one fewer leak a day.⁶ Side effects were rare and minor in the trials that reported them.⁶ Most evidence was moderate quality, and follow-up was usually under a year, so long-term results are less clear.⁶

The UK's NICE advises a supervised program of at least three months as the first treatment for stress or mixed incontinence.¹ For urgency, training is usually combined with bladder retraining.² Vaginal estrogen may also modestly help urge symptoms after menopause.²

Pelvic floor physical therapy and trainers

A pelvic health physical therapist (physiotherapist in the UK and Australia) or continence nurse can check you are using the right muscles. They can design a program that suits you.^2,3 Some women have muscles that are too tight rather than weak, and need a different approach.³ Ask your doctor about a referral, or check whether you can book directly where you live.

In clinics, therapists sometimes use biofeedback, where a sensor shows how well you are squeezing. A Cochrane review of 24 trials found women given feedback or biofeedback with their training were more likely to report improvement.⁸ But these women often had more contact with a therapist, so it is unclear whether the feedback itself made the difference.⁸

Home pelvic floor trainers are devices placed in the vagina that link to an app and show how hard you squeeze. Brands such as Elvie and Perifit say they make training easier to track and stick to. These are brand claims. The biofeedback trials tested clinic methods, not these consumer devices. A physical therapist can tell you whether a device suits you. See our pelvic floor products page.

If you have pelvic floor problems, high-impact or high-intensity exercise that pushes down on the pelvic floor may need adjusting.⁴ See strength training and Pilates.

Pregnancy is still possible in perimenopause.⁵ If you are or might be pregnant, ask your doctor or midwife before using an insertable trainer.

What it is used for: evidence rated

Option	Evidence	What the research shows
Pelvic floor muscle training for stress incontinence	Strong evidence	A Cochrane review of 31 trials found about three in four women with stress incontinence improved or were cured.⁶ NICE recommends it as first-line treatment.¹
Supervised training with a pelvic health physical therapist	Strong evidence	NICE advises a supervised program of at least three months. Supervision helps because many women contract the wrong muscles at first.^2,7
Pelvic floor training for urge or mixed incontinence	Some evidence	Benefits are seen across types of leakage, but only one trial each studied urge-only or mixed incontinence alone.⁶ Usually combined with bladder retraining.²
Vaginal estrogen (for urge symptoms and dryness)	Some evidence	May modestly improve urge symptoms after menopause, and benefits fade when it is stopped. Prescription-only in many countries.^2,3
Pelvic floor exercises to help prevent prolapse	Weak evidence	Strengthening the pelvic floor may lower the risk of prolapse and leaks, but this is expert advice rather than strong trial evidence.³
App-connected pelvic floor trainers	Weak evidence	Brands claim better tracking and motivation. Clinic biofeedback may add some benefit, but it has not been shown for specific consumer devices. Best used with professional guidance.⁸

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.