Can you train the pelvic floor muscles by contracting other related muscles?

Key points

1. 01A direct pelvic floor contraction raised pressure at the pelvic floor more than abdominal, hip, gluteal, breathing, or curl-up exercises.
2. 02Accessory-muscle exercises produced only about 30 percent of a pelvic floor contraction's pressure, and curl-ups about 50 percent, likely too low to drive a strength gain.
3. 03A new intra-vaginal sensor array (FemFit) could measure pelvic floor pressure and abdominal pressure at the same time, separating the two.
4. 04Curl-ups and cough raised pressure too, but mostly from abdominal pressure rather than true pelvic floor activation, so they are not recommended as training.
5. 05Surprisingly, nearly half of these trained pelvic floor physiotherapists had a weak pelvic floor contraction, underscoring the need for targeted training.

How it was conducted

Design

Cross-sectional experimental study using a prototype intra-vaginal pressure sensor array (FemFit), all activities in supine position

Participants

Convenience sample of experienced pelvic floor and women's health physiotherapists; 19 of 21 had usable data; mean age 43.7 years, mean BMI 22.4 kg/m2

Exercises

Three maximal pelvic floor contractions plus randomized hip rotation/abduction/adduction, gluteals, pelvic tilt, indrawing, abdominal crunch, deep inspiration and expiration, and a double cough

Measurement

Maximum pressure per sensor per exercise, averaged over three repetitions; highest pelvic floor sensor versus sensor 8 for abdominal (intra-abdominal) pressure

Analysis

Wilcoxon paired tests comparing pelvic floor pressure between exercises and against abdominal pressure, with Bonferroni correction (alpha = 0.005)

What they found

• Mean pelvic floor muscle pressure during a targeted contraction was 16.3 mmHg (SD 12.2, range 4.2 to 40.7 mmHg); only nine women had an increase greater than 10 mmHg from baseline.
• Pelvic floor pressure was significantly higher during a targeted contraction than during all other exercises except curl-ups (P = 0.009) and cough (P = 0.013).
• Estimated pressure difference from a pelvic floor contraction: TrA -10.0 mmHg, gluteals -8.7, external rotators -13.7, internal rotators -9.1, pelvic tilt -13.0, inspiration -10.8, expiration -10.1 (all P < 0.001).
• Pelvic floor pressure was significantly higher than abdominal pressure for pelvic floor contraction, internal rotators, and gluteals (P < 0.001).
• On average, curl-ups reached about 50 percent and other contractions about 30 percent of a pelvic floor contraction's pressure; for curl-ups, pressure exceeded a pelvic floor contraction in only 5 participants and was lower in 14.
• Intra-abdominal pressure was low during a pelvic floor contraction (3.4 mmHg, SD 2.2) but high during curl-up (8.8 mmHg, SD 7.33), expiration (6.12 mmHg, SD 4.91), and cough (40.99 mmHg, SD 7.33).

Limitations

• Very small sample of only 19 analyzable participants.
• Participants were a purposefully selected group of pelvic floor physiotherapists, so results may not generalize to the public.
• Cross-sectional pressure measurements only, with no actual training intervention or strength outcome over time, so the training effect is inferred not tested.
• The FemFit device was a prototype and the inferred strength thresholds rely on general resistance-training literature, not pelvic floor specific trials.

Why it matters

For patients

Doing abdominal, hip, or gluteal exercises is unlikely to substitute for learning a proper, targeted pelvic floor contraction if you want to strengthen the pelvic floor.

For clinicians

This supports continuing to teach specific pelvic floor muscle contractions rather than relying on functional or accessory-muscle co-contraction, and highlights that even trained clinicians may have weak contractions worth assessing.

For readers

A new sensor array can tell pelvic floor pressure apart from abdominal pressure, helping clarify which exercises genuinely activate the pelvic floor.