Pelvic floor exercises for runners and lifters: the basics
Pelvic floor exercises for runners and lifters: what the research shows, how to train the muscles, what leaking means and when to see a pelvic health physio.
revns editorial · Published November 13, 2026 · 9 min read
What the pelvic floor does, how common leaking is in sport, what trials show about pelvic floor muscle training, a simple weekly routine, and the red flags that need a clinician.
Pelvic floor exercises are a set of squeezes and relaxations that train the muscles at the base of your pelvis. They are the first treatment trials support for leaking urine when you cough, run, jump or lift. A 2018 Cochrane review of 31 trials in 1,817 women found that women with stress urinary incontinence were about eight times more likely to report a cure with pelvic floor muscle training than with no treatment. If you train hard and notice leaks, heaviness or pelvic pain, the useful move is to act early, not to stop training or to hide it.
TL;DR
| Question | Short answer |
|---|---|
| Is leaking common in sport? | Yes. A systematic review of 7,507 women found 10.88% to 80% of athletes reported it, highest in jumping sports |
| Does training the pelvic floor help? | In women with stress incontinence, a Cochrane review found 56% reported cure with training against 6% without |
| How much do I do? | NHS trust leaflets give long holds of up to about 10 seconds and short fast squeezes, built up over weeks |
| Who gets it? | Women most of all, but men have a pelvic floor too |
| When is it a medical issue? | Regular leaking, heaviness, pain, or blood in urine or stool |
What is the pelvic floor, and what does it do?
The pelvic floor is a sling of muscles at the base of the pelvis. It helps hold in urine and stool, and it supports the pelvic organs. In women it also supports the uterus.
It works with your deep abdominal muscles, your back and your breathing. It needs strength to resist pressure. It also needs to relax, for example when you pass urine or stool.
That second point matters. Not every pelvic floor problem is a weak muscle. Some people hold too much tension. For them, more squeezing can make symptoms worse. This is one reason an assessment helps if exercises have not worked after a few weeks.
Is leaking when I run or lift normal?
It is common. It is not a sign that you are doing something wrong, and it is often treatable.
A 2018 systematic review in the International Urogynecology Journal by de Mattos Lourenço and colleagues searched the literature to January 2017. It included 22 studies and 7,507 women aged 12 to 69. In athletes, the prevalence of urinary incontinence ranged from 10.88% to 80%. The range was wide because the sports differed. The review reported 5.56% in low-impact activity and up to 80% in trampolining. High-impact activities showed 1.9 times the prevalence of medium-impact ones.
What this can and cannot show:
- It shows that leaking is frequent, and more so in sports with jumping, fast running and rotation.
- It cannot show that sport causes the leaking. Only five of the studies compared active women with controls.
- It could not assess hormone use, smoking or menopausal status, because most studies did not report them.
- The figures come from questionnaires. Different studies asked about leaking in different ways.
In plain terms: if you jump, sprint or lift heavy, you are in a group where leaking is more often reported. That is a reason to train the pelvic floor, not a reason to quit.
Do pelvic floor exercises work?
For stress urinary incontinence in women, yes, and the evidence is stronger than for many gym habits. Stress incontinence means leaking when pressure on the bladder rises: a cough, a sneeze, a jump or a heavy lift.
The 2018 Cochrane review by Dumoulin, Cacciari and Hay-Smith compared pelvic floor muscle training with no treatment or inactive controls (such as advice on pads). It included 31 trials and 1,817 women from 14 countries.
| Outcome | PFMT group | Control group |
|---|---|---|
| Reported cure, stress incontinence (4 trials, 165 women) | 56% | 6% |
| Reported cure, any incontinence (3 trials, 290 women) | 35% | 6% |
| Cure or improvement, stress incontinence (3 trials, 242 women) | 74% | 11% |
Women who trained also had about one fewer leakage episode in 24 hours. Side effects were rare and minor in the two trials that reported them.
The limits matter. Trials were small to moderate in size. Follow-up was generally under 12 months. The content and length of the programmes varied a lot. The review does not report results for athletes separately. The authors concluded that PFMT could be included in first-line conservative care, and that long-term effects need more research.
How do I do pelvic floor exercises?
There is no single official programme. Hospital and NHS trust leaflets agree on the basic pattern. This is general training guidance, and a pelvic health physiotherapist can tailor it.
- Find the muscles. Imagine you are stopping yourself passing wind, then lift that squeeze up and in. Do not squeeze your buttocks or hold your breath. Do not practise stopping your wee midstream. A Welsh NHS health board leaflet warns this can cause problems.
- Long holds. Breathe out, tighten and lift, and hold for up to about 10 seconds, then relax fully for a few seconds. Start with a shorter hold if 10 seconds is too hard, and build up.
- Short squeezes. Squeeze and lift quickly, then let go straight away. Leaflets suggest around 8 to 10 repeats. Start with 4 to 6 if 8 is too hard.
- Repeat daily. Leaflets commonly suggest several short sessions a day. Start lying down, then try sitting and standing.
- Be patient. Trials ran for weeks to months, so judge progress over 8 to 12 weeks, not days.
The relax half counts. After each squeeze, let go until you feel the muscles drop. If you cannot feel them let go, or you feel pain, stop and ask a clinician.
Does the pelvic floor need different training for runners and lifters?
The trials above did not test athletes in particular, so any sport-specific advice is informed opinion and not proven. These ideas fit the evidence and are low-risk.
- Run. Treat leaking as information. If it shows up at a certain pace, distance or fatigue point, note it and lower the load for a few weeks while you train the muscles. A walk-run mix is a fair step down.
- Jumping and skipping. These are high-impact. The review above found more leaking in high-impact activities than in medium-impact ones. Cut volume first, not the whole session.
- Lift. The sources used for this guide give no safe load or best breathing method. If you leak at a heavy set, test a lighter weight, add reps in reserve and keep breathing. Do not hold your breath for long. See strength training for beginners for how to build load gradually.
- Bracing. Pelvic floor work is not a replacement for normal strength training. The pelvic floor is one part of a system that includes your core and breathing.
Treat leaks like any other training signal. Write down when symptoms appear next to your sessions, in any log you keep, so you and a clinician can see patterns, such as "only after long runs" or "only on heavy squat days". An AI fitness coach that reads your training history can then plan load changes around what you record.
What about pregnancy, postpartum and returning to running?
Pelvic floor training in pregnancy may help prevent leaking. A 2020 Cochrane review by Woodley and colleagues (46 trials, about 10,800 women, mostly small) looked at this. In women who were continent, antenatal training probably lowered the risk of urinary incontinence in late pregnancy (risk ratio 0.38; 6 trials, 624 women; moderate-quality evidence). It also slightly lowered the risk in the mid-postnatal period, three to six months after birth (risk ratio 0.71; 5 trials, 673 women; high-quality evidence). For the late postnatal period (6 to 12 months) the information was too thin to tell (1 trial, 44 women). In women who already leaked, there was no evidence that antenatal training helped. The authors said the effects of training as a treatment in pregnant and postnatal women remain uncertain. Pain from training led to two withdrawals in a study of 43 women; no other trial reported harms.
For returning to running, a 2024 international Delphi consensus in the British Journal of Sports Medicine (Deering and colleagues) reached agreement on 42 of 47 statements. The panel favoured an individual exercise plan, gradual increases, walk-run protocols and targeted strengthening. They said training should change when you have muscle, joint or pelvic symptoms, or concerns about sleep, mood, breastfeeding or energy intake. A consensus is expert opinion. It is not a trial.
For a first return, a pelvic health physiotherapist assessment is a sensible step, especially if you leak, feel heaviness or have pain. See also training around your menstrual cycle for how symptoms vary across the month.
What about midlife and menopause?
The review of athletes could not separate out menopausal status. Leaking and pelvic symptoms can change around menopause, so it is a good time to ask about them. Our guide on menopause exercise covers strength, sleep and bone health in that stage.
What about men?
Men have a pelvic floor, and the muscles are trained in the same way. Most of the trial evidence here is in women. After prostate surgery, a 2023 Cochrane review of 25 trials concluded that the value of conservative treatments for leaking, alone or together, remains uncertain. That does not mean exercises are useless. It means the best plan depends on you and your surgical team. See the 2026 ACS prostate screening guidance for another men's health topic.
What can I do this week?
If you have no symptoms: Learn to find the muscles. Do one short session a day for two weeks. Add it to a habit you already have, such as brushing your teeth.
If you leak sometimes:
- Do daily long holds and short squeezes for 8 to 12 weeks.
- Note when leaks happen in your training log.
- Lower the impact for a few sessions if needed, then build back.
- Book a pelvic health physiotherapist if there is no change after 8 to 12 weeks, or sooner if you are unsure you are doing it right.
Food and habits. Constipation and straining add pressure on the pelvic floor. Fibre from lentils, oats, fruit, vegetables, nuts and seeds, and enough fluid, help whether you eat meat, eggs, dairy or a fully plant-based diet. The gut health tracker can help you spot patterns.
When should I see a professional?
See a clinician, ideally a pelvic health physiotherapist or your doctor, if you have:
- leaking that is regular or getting worse
- a feeling of heaviness, dragging or a bulge in the vagina
- pelvic, back or vaginal pain, or pain during sex
- trouble emptying your bladder or bowel, or a weak or stopping stream
- blood in your urine or stool, or any new symptom after surgery or childbirth
- leaking with fever, or a sudden loss of bladder or bowel control with numbness or back pain, which needs urgent care
Pelvic symptoms are a routine topic for these clinicians. You do not need to wait for them to get worse.
Related
- Menopause exercise: what to do for strength, sleep and bone health
- Training around your menstrual cycle: what the evidence supports
- Strength training for beginners: the first eight weeks
- Rest days: how many you need and what to do on them
This is general training guidance, not medical advice. It does not diagnose or treat any condition. If you have symptoms, see a qualified clinician.
Sources
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018
- de Mattos Lourenço TR et al. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J 2018
- Woodley SJ et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020
- Deering RE et al. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. Br J Sports Med 2024
- Cochrane. Conservative interventions for managing urinary incontinence after prostate surgery, 2023
- Somerset NHS Foundation Trust. Pelvic floor exercises
- Betsi Cadwaladr University Health Board (NHS Wales). Pelvic floor exercises
Terms in this post
revns publishes training and nutrition guidance, not medical advice. See a clinician for symptoms, injury or a medical condition. Accurate as of November 13, 2026.
