Pelvic floor muscle training

The pelvic floor is a sheet of muscle spanning the base of the pelvis. It supports the bladder, bowel and, in women, the uterus, and it contributes to closing the urethra during coughing, lifting or laughing. Pelvic floor muscle training is the deliberate, repeated contraction and relaxation of these muscles, usually taught by a physiotherapist so that the correct muscles are recruited rather than the abdominals, buttocks or thighs.

It matters because weakness or poor coordination of these muscles is a common contributor to stress urinary incontinence, where urine leaks under sudden abdominal pressure, and to mixed incontinence, which combines stress leakage with urgency. Training is generally regarded as the first-line conservative approach before any consideration of devices or surgery.

Progress is tracked in several ways. A perineometer measures the pressure generated by a contraction, the Oxford Grading Scale gives a clinician-assigned score from a manual examination, and surface or intravaginal EMG records the muscles' electrical activity. Symptom and quality-of-life questionnaires are used alongside these, because a change in measured force does not always match how much a person's daily life improves.

Biofeedback is often added so the person can see or hear their own contraction in real time, which helps when the muscles are hard to sense. Adjuncts studied in research settings include electrical stimulation and exercises for neighbouring muscle groups such as the hip rotators.