Eight weeks of exercises and nothing has changed. Do I stop or keep going?

Eight weeks tomorrow. I have done the sets nearly every day, I have the sheet on the fridge, I have a tick chart like a child, and as far as I can tell absolutely nothing is different.

Same on the school run, same when I sneeze, same everything. I had one appointment where it was all explained and measured and I came out feeling brilliant, and since then it has been me, the sheet and the kitchen, for two months, with nobody looking at any of it.

What I cannot work out is whether eight weeks of nothing means it is not working for me, or whether eight weeks is nothing at all and I am being impatient. And there is a small horrible voice saying I am probably doing them wrong and have been for two months. I do not have another appointment booked. Nobody mentioned one.

No review booked is the bit I would be ringing about tomorrow, not the eight weeks.

I hit the same wall and my response was to double everything, on the reasoning that if it was not working then obviously it was not enough. Three weeks of that and I felt noticeably worse, achier, and I assumed that was the muscles getting stronger. It was not.

Not saying that is what is happening to you. Just flagging that "do more" was my instinct and it turned out to be the exact wrong direction.

First time round I stopped at six weeks. Decided it was a waste of time, felt very sensible about it, and quietly went back to planning my life around toilets for another two years.

Second time round somebody put a review date in the diary in front of me and that one date is genuinely the difference between the two attempts. Not willpower, not motivation. A date, in a diary, at which somebody who was not me would measure something and tell me whether it had moved. On the bad weeks I was not doing the exercises because I believed in them. I was doing them because I did not want to turn up and admit I had not.

The short answer is that eight weeks is inside the minimum, not past it, so nothing about your situation has failed yet.

The guideline numbers, with the words they actually use, because the words carry information. NICE NG210 at recommendation 1.6.14 says to offer a programme of supervised pelvic floor muscle training of at least three months to women with stress or mixed urinary incontinence. For symptomatic prolapse that does not extend more than one centimetre beyond the hymen on straining, 1.6.13 says to consider at least four months, and NG123 puts the same thing as at least sixteen weeks and also says consider rather than offer. Offer and consider are the guideline telling you how strong the evidence underneath is, not a drafting accident. And the three months and four months are not two different opinions: NG210's own rationale explains that both come from the same evidence, because sixteen weeks and three months were the most common points at which the trials measured their results. They are measurement windows. Nobody chose them as the moment a body improves.

Which leads to the thing I most want to say to you. There is no published curve. The Cochrane review reported at trial endpoints, and the big prolapse trial measured at twelve months with an interim look at six, and nobody in between published week nine. So when you ask whether eight weeks of nothing is meaningful, the honest answer is that no source I would cite can tell you, and anybody who hands you a week number is quoting a convention.

What I see in a room, kept separate from what the trials found, is that the first thing to move is usually not whether the symptom happens but when it happens inside an activity. It arrives later, or after more effort, or it becomes predictable rather than ambushing. People measuring for a yes or no answer often miss that entirely and conclude nothing has changed. If you are keeping a tick chart already, the more useful thing to record alongside it is the point at which the symptom turns up, not just whether it turned up.

On Mo's instinct, gently, because it is the commonest wrong turn on this board. More is not the fix, and for an overactive pelvic floor conventional strengthening makes symptoms worse rather than better, which is why the treatment for that presentation runs in the opposite direction. You mostly cannot tell which you have from symptoms alone and a short guarded muscle can test as weak. The rule of thumb I use is that roughly four weeks of diligent effort making things worse is information rather than failure, and the response is reassessment rather than more repetitions. Downtraining and the overactive floor explains why the sequence matters more than the content.

And Bex is right that the missing review is the actual problem here. NG210 recommendation 1.6.18 asks for at least one review to assess progress during the programme and one at the end. A programme with nobody measuring anything is a sheet of paper with a longer delivery time, and a fair trial means three things at once: long enough, supervised, and actually done. You have the third. Ring and ask for the second. How long it takes sets out the minimums and what a fair trial is.

What I cannot say is whether your technique is right, whether your programme suits your findings, or what your eight weeks means. Only the person who assessed you can, and that is exactly the appointment you have not got booked.

Update, ten weeks after the last post. I rang, made a nuisance of myself twice, and got a review at the end of April.

The measurement had moved. Not enormously, and not in a way I had noticed at all, but it had moved, and she changed what I was doing based on it, which is the bit I could never have done from the kitchen. She also asked what I was doing on the bad days and I admitted the tick chart had a fortnight of optimistic ticks in it, which was mortifying and apparently extremely normal.

The threshold thing is real, by the way. I started writing down which sneeze rather than whether I sneezed, and there is a difference between March and June that I would have sworn was not there.