Do pelvic floor exercises work? For stress incontinence, the evidence is strong

Pelvic floor muscle training — the exercises often called Kegels — genuinely works for urinary incontinence, and the evidence is strongest for one specific type: stress incontinence, the leakage that happens with coughing, laughing, lifting or exercise. In a Cochrane review of 31 trials, women who did the training were about eight times more likely to report their stress incontinence cured than women who received no treatment, and the reviewers said they "can be confident" the training can cure or improve symptoms [s1]. The benefit extends, more modestly, to other types of incontinence too [s1].

The important nuance is that "pelvic floor exercises work" is a precise claim, not a universal one. What they treat, and how well, depends on the kind of incontinence and on doing the training properly.

The stress-incontinence evidence

Pelvic floor muscle training is a first-line physical therapy for stress urinary incontinence, and the review's clearest results are there [s1]. Comparing training against no treatment or an inactive control, women doing the exercises were eight times more likely to report cure of their stress incontinence: 56% versus 6%, a risk ratio of 8.38 (95% CI 3.68 to 19.07) across 4 trials and 165 women, rated moderate-quality evidence [s1].

Widen the outcome to cure or improvement, and the gap holds: 74% of women doing the training reported cure or improvement of stress incontinence, against 11% of controls, a risk ratio of 6.33 [s1]. The reviewers rated participant-perceived cure in stress incontinence as high-quality evidence — an unusually strong verdict for a non-drug intervention [s1].

Other types of incontinence: real, smaller benefit

For women with any type of incontinence — including urgency incontinence and mixed incontinence — the effect is present but smaller. Across all types, women doing the training were more than five times as likely to report cure (35% versus 6%; risk ratio 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women) [s1]. For cure or improvement across all incontinence types, training roughly doubled the odds: 67% versus 29%, a risk ratio of 2.39 (95% CI 1.64 to 3.47) [s1].

The review also found the training reduced the number of leakage episodes and improved quality-of-life measures, and its overall conclusion was that "PFMT can cure or improve symptoms of SUI and all other types of UI" [s1]. The strength of the evidence is greatest for stress incontinence and thinner for the other types, which is exactly how the results should be read: a well-supported first choice for stress incontinence, a reasonable option for the rest [s1].

What the evidence does not settle

Several practical questions remain open. The trials varied in how the training was taught and supervised, how intensively it was done and for how long, so the review cannot specify the single best regimen [s1]. Most trials were relatively short, so how durable the benefit is over years — and whether it holds without ongoing practice — is less certain. And the finding applies to the training being done correctly; the exercises depend on contracting the right muscles, which many people do not do without instruction, so results from supervised trials may overstate what happens with a leaflet alone.

Prevention, not just treatment

The exercises also appear to prevent incontinence, not only treat it — most clearly around pregnancy, when about one-third of women develop urinary incontinence [s2]. A separate Cochrane review found that continent pregnant women who did antenatal pelvic floor muscle training had a 62% lower risk of reporting urinary incontinence in late pregnancy (risk ratio 0.38, 95% CI 0.20 to 0.72; 6 trials, 624 women) and a lower risk in the mid-postnatal period (risk ratio 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women), the latter rated high-quality evidence [s2]. Aside from two women in one trial who withdrew with pelvic floor pain, no trials reported adverse effects [s2].

There is a boundary worth naming: this evidence is about urinary incontinence, not about the much broader set of claims — from "tightening" to sexual function to back pain — attached to pelvic floor work in wellness marketing. Those are separate questions with separate, generally weaker, evidence.

Within its lane, though, the answer is unusually clear for a conservative treatment. For stress urinary incontinence, pelvic floor muscle training is backed by high-quality trial evidence showing many women are cured or improved, which is why it is recommended before drugs or surgery are considered [s1].

This article is informational and is not medical advice. Anyone with bothersome incontinence should be assessed by a clinician, who can confirm the type and, where useful, refer for supervised training.

Sources

• Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women — Cochrane Database of Systematic Reviews, 2018-10-04