Quick Answer
If pelvic floor exercises have not helped after several months, the exercises themselves are not automatically the problem. Technique, consistency and whether the muscles are actually contracting and relaxing correctly all affect the result, and for some women the underlying issue is tension or poor coordination rather than weakness, which more squeezing will not resolve.
This guide cannot tell you which of these applies to you. A pelvic health physiotherapist can usually clarify this within one appointment, and that assessment, not doing more repetitions, is the most reliable next step if Kegels alone have not worked.
Something I hear often from women who come to see me is a version of the same sentence: “I’ve been doing my Kegels for months and nothing has changed.” Almost always, they say it as though the fault must be theirs, not enough discipline, not enough repetitions. That is rarely the real explanation, and I want to walk through what is worth checking before you simply do more.
Check Your Technique Before Anything Else
A correct pelvic floor contraction is a lift, drawing the muscles up and inward as though stopping the flow of urine and holding in wind at the same time, not a downward bearing or straining sensation. NHS physiotherapy guidance is specific about this distinction, and about avoiding common substitutions, holding your breath, clenching your buttocks or inner thighs, or pulling your stomach in hard, since these can mimic the sensation of “doing something” without the pelvic floor muscles doing the actual work.
If you have never had someone check this directly, that gap matters. Many women practise a technique they were never shown clearly, often from a leaflet or an app, and repeat it faithfully for months without it being the movement it was meant to be.
Give It Long Enough, But Not Indefinitely
Pelvic floor muscle training is slow by nature. NHS guidance describes needing to continue a routine consistently for around four to six months before expecting the full benefit, with improvement building gradually as the muscles adapt. If you have only been doing this for a few weeks, it may simply be early.
But there is a point where “give it more time” stops being useful advice. NICE quality standards recommend at least one review during a supervised training programme and one at the end, specifically so that a lack of progress gets picked up and addressed, rather than assumed to be a matter of trying harder for longer.
Could This Be a Tension or Coordination Problem Rather Than a Weakness Problem?
NICE guidance on pelvic floor dysfunction (NG210) defines pelvic floor muscle training as work on strength, endurance, power, relaxation, or a combination of these, tailored to what an individual actually needs, not strength by default. Relaxation is treated as being just as clinically relevant as squeezing.
For some women, the pelvic floor is already working hard, gripping through the day without enough opportunity to fully release. NHS guidance on this pattern describes it developing when the pelvic floor and surrounding muscles are repeatedly overused without adequate relaxation in between, and notes that ongoing symptoms can increase anxiety, which can increase tension further, a cycle rather than a straightforward strength deficit.
If a pelvic floor is already struggling to relax, adding more deliberate contraction can be a bit like doing extra reps on an arm that is already clenched and tired. The muscle does not get more capable in a useful way, it just stays busy. This can be a useful way to picture why more effort does not automatically help, but it cannot tell you on its own whether tension, weakness or something else is the more relevant explanation for you. I go into this in more depth in re-centre’s guide to whether a tight pelvic floor can cause leaking, including why it can look identical to weakness from the outside.
Could This Be a Different Type of Incontinence?
Not all urinary leakage responds to pelvic floor muscle training in the same way. NICE guidance on urinary incontinence (NG123) advises identifying the type involved, since stress incontinence, urge incontinence and mixed incontinence are not managed identically, and the evidence for pelvic floor exercises alone is strongest for stress and mixed presentations. Symptoms alone, tracked at home, cannot reliably tell you which pattern you have.
This is not something to work out from a symptom checklist. It is exactly the kind of distinction an assessment is designed to make.
What a Pelvic Health Assessment Actually Checks
A pelvic health physiotherapy assessment usually starts with a conversation about your symptoms, history, daily activities and goals. NICE guidance recommends a direct assessment of the ability to both contract and relax the pelvic floor muscles before supervised training begins, which is a level of detail home practice cannot replicate. Depending on what is relevant, the physiotherapist may also assess posture, breathing and abdominal function alongside the pelvic floor itself.
Where progress has genuinely stalled despite correct technique and consistent practice, NICE guidance also notes that additional approaches such as biofeedback or electrical stimulation may be offered to a subgroup of women who make little progress with exercise alone, which is a clinical decision, not something to self-select.
Questions to Ask at Your Appointment
Taking a short, specific list can make the appointment more useful, particularly if you feel unsure how to describe months of trying something that has not worked.
- “Can you check whether I’m contracting and relaxing my pelvic floor correctly?”
- “Based on what you’re finding, does this look more like weakness, tension, or a coordination issue?”
- “Is my type of leakage one that pelvic floor exercises alone are likely to help?”
- “Would biofeedback, electrical stimulation or a different approach be worth considering for me specifically?”
- “What should I actually be doing differently between now and my next review?”
When to Seek Assessment
This guide is educational and cannot diagnose the cause of your symptoms. Arrange assessment with a GP or pelvic health physiotherapist if pelvic floor exercises have not improved things after several months of consistent, correctly performed practice, or sooner if you have pelvic pain, a vaginal bulge or heaviness, difficulty emptying your bladder or bowels, unusual bleeding, or symptoms that are affecting your daily life.
If symptoms are severe, sudden or rapidly worsening, seek advice from an appropriate NHS service rather than continuing to manage them through a home exercise routine. Learn more in re-centre’s guide to urinary incontinence and when individual assessment is the right next step.
Sources
- NICE: Pelvic Floor Dysfunction: Prevention and Non-Surgical Management (NG210)
- NICE: Urinary Incontinence and Pelvic Organ Prolapse in Women: Management (NG123)
- NICE: Urinary Incontinence in Women Quality Standard (QS77), Statement 4
- North Bristol NHS Trust: Pelvic Floor Exercises for Women
- University Hospitals Plymouth NHS Trust: Pelvic Floor Relaxation
