Sixteen Weeks of Pelvic Floor Exercises: What It Actually Felt Like

This is a record of one supervised sixteen week programme for stress urinary incontinence, written to show the shape of a course rather than to be copied: it contains no dose, no hold length and no repetition count, because those are set against an assessment and mine would be the wrong ones for you. NICE puts the supervised minimum at 3 months for stress or mixed urinary incontinence and at least 16 weeks for symptomatic prolapse¹, and what follows is what sixteen weeks of it felt like from the inside.

I am the person this happened to, which makes this the most useful page on the site and the least generalisable one. Everything else here is sourced. This is a single case, and the honest reason to publish it is that the week-by-week experience of a course is the one thing no guideline describes and every person starting one wants to know. Read red flags and when to stop and get checked first.

Where I was starting from

Stress urinary incontinence from about six months after my second child, first noticed on a hill sprint during a PE lesson, ignored for a term, mentioned to three clinicians over three years and told each time that it was normal after two babies. By the time somebody assessed it I had rearranged my running routes around toilets, stopped the Tuesday club session, and had a drawer of clothing I no longer wore.

I had also been doing pelvic floor exercises, on and off, for eleven years. That detail matters more than the rest of the paragraph. I was not somebody who had never tried. I was somebody who had been trying without ever having been checked, which turned out to be a different thing entirely. The full picture of the condition is in stress urinary incontinence.

Week 1: the assessment, and finding out I had been wrong for a decade

The first appointment was almost entirely questions. History, births, bowels, fluids, what I ran and how often, what I lifted at work, what had already been tried. Then a three-day bladder diary I had filled in beforehand, which she read for about forty seconds and then asked a completely different set of questions from any I had been asked before.

The examination was offered rather than announced, and I said yes. What she told me afterwards reorganised my understanding of eleven years: I was gripping my glutes, bracing my breath, and pushing down at the same time as squeezing. I had been diligent about the wrong movement. That is not an unusual finding in people with symptoms; in 47 women referred for urodynamic evaluation of urinary incontinence, only 49% achieved an ideal contraction after brief standardised verbal instruction and 25% did something that could potentially promote incontinence². It is also not a statement about women in general, because in 779 women attending community primary care practices between 68.6% and 85.8% got it right on the first attempt and 78% of the rest learned after brief instruction³. I was in the symptomatic group, which is exactly where the error rate concentrates.

I left with a dose, a diary, and a date. What happens at a pelvic health physio assessment describes the appointment in general terms, and internal pelvic examination what to expect covers the examination, including declining it.

Weeks 2 to 3: it is harder than it sounds and easier than it looks

The exercises took less time than I had expected and more attention than I had budgeted for. Getting three sessions into a teaching day was a logistics problem, not a fitness problem. I did them in the car before the school run, at my desk in a free period, and lying down before bed, which is the only part of my routine I would recommend to anyone: attaching each session to something that already happens is worth more than any amount of resolve.

Week 3 was the first time I got bored. Nothing had changed, and there was no reason for anything to have changed. I did not know that at the time.

Weeks 4 to 8: the part nobody writes about

Nothing. For five weeks.

I was doing the work, my diary was complete, and I could detect no difference in anything. This is the stretch where I would have stopped if I had been doing it alone, and it is the honest reason this article exists, because every account of pelvic floor rehabilitation I read at the time went from assessment to improvement in a paragraph.

Two things kept me going and neither was willpower. The first was that my physiotherapist had told me in week 1 to expect roughly this, which converted an alarming silence into an expected one. The second was that the six week review was booked. I am not proud of it, but the strongest adherence mechanism I encountered in four months was not wanting to turn up to an appointment having nothing to say.

The literature is unsentimental about this. A systematic review of 19 studies following 1,141 women for between 1 and 15 years found long-term adherence to training varying between 10% and 70%⁴. That range is not a moral failing, it is what happens to any daily task with a delayed payoff, and keeping it up after discharge treats it as a design problem rather than a character one.

Week 6: the first review, and the sentence that changed the course

NICE requires at least one review to assess progress during a programme and one at the end⁵. Mine was at six weeks and it changed the programme in two specific ways: the emphasis moved, and something was added that I would not have thought to do.

What she did not do was open with a strength measurement, which I had been quietly waiting for. She asked what I could do in May that I could not do in March. I found that irritating at the time and entirely right afterwards, because the answer turned out to contain the first real signal in the whole course. I had run the club session once. I had not noticed that I had noticed.

The other thing that happened at that review was disproof. I watched a number fail to move while being absolutely certain I was doing something. What the sensor gave me was not motivation, it was evidence that my internal sense of effort was unreliable, which is precisely why the guideline word is supervised. A review of the field puts it plainly: supervised and more intensive training is more effective than unsupervised training, and the training needs proper instruction and close follow-up to be effective⁶.

Weeks 9 to 12: the change arrives sideways

At about week 9 something shifted, and it was not what I had been watching for.

I had been waiting for the leaking to stop. What actually happened was that it moved. It used to start on the third hill repetition; it started on the sixth. The total was smaller, the trigger threshold was higher, and the event became predictable rather than ambushing. Nobody had told me that improvement would arrive in that shape, and I nearly filed it as no change.

If I could put one sentence into every waiting room it would be that one. The first thing to change is often the point within an activity at which the symptom appears, not whether it appears. Returning to running and lifting is the article I wish had existed then, because the temptation at that point is to celebrate by doing far too much.

Weeks 10 to 12 were the easiest of the course, for an unglamorous reason: it had started working, so doing it stopped feeling speculative.

Weeks 13 to 16: progression, and the end of the guideline window

The last month was mostly load. Position changed, the work moved from lying to standing to standing under effort, and the timing element came forward, because a cough or a landing is over in a fraction of a second and a contraction that arrives late has missed the event. How that progression is built in general is in pelvic floor exercise programmes explained and the mechanism is in how pelvic floor muscle training works.

The final review was at sixteen weeks, matching the longer of the two guideline windows¹. She measured, we compared the diaries, and we had the conversation about what happens next. That conversation is the one nobody prepares you for, because after four months of structure you are handed the structure back.

What sixteen weeks actually bought

Substantially better, not cured.

The specifics: the club run is back, I have stopped mapping routes around public toilets, and the drawer of clothing is in use. It still happens, occasionally, usually when I am tired, on a heavy cough, or at the end of a hard session. I would put it at a fraction of what it was and I am not going to convert that into a percentage, because a number I have estimated retrospectively about myself is not a measurement.

Set against the evidence, that is an ordinary result rather than a poor one. In the Cochrane review, 56% of women with stress urinary incontinence were cured with training against 6% of controls, and 74% were cured or improved against 11%⁷. Cure is real and it is common and it was not what happened to me, and both halves of that need saying on the same page.

What I would tell somebody at week 1

Four things, and none of them is a dose.

• Expect the flat stretch. Weeks 3 to 8 produced nothing detectable, and it was the normal part rather than the failing part.
• Watch the threshold, not the event. The first change is likely to be when the symptom starts within an activity rather than whether it starts at all.
• Book the reviews and treat them as part of the treatment. They are where the programme changed, and NICE requires two of them for a reason⁵.
• Do not copy anyone’s numbers, including mine. NICE’s stated floor of at least 8 contractions three times a day is tagged 2006 in the guideline, carried forward unchanged rather than re-reviewed in 2019, and is a minimum for a programme rather than a personal prescription¹.

And the thing I would say loudest is not about the sixteen weeks at all. The exercises were unremarkable. The three years I spent before them being told this was normal after babies are the part that cost me something, and NHS information said throughout that period that urinary incontinence is a common problem that can be treated⁸. If you are still in that stretch, why symptoms get dismissed and how to be heard is the page to read before this one, and pelvic floor physiotherapy is what you would be asking for.