Quick Answer
Your pelvic floor is a muscle group, and it responds to training. What most women are never told is that squeezing is not the only way to train it. Hypopressives works through posture and a specific rib-breathing pattern, lifting the pelvic floor reflexively rather than forcing it, and a randomised controlled trial found improved pelvic floor muscle contractility after eight weeks. For women who have squeezed diligently and got nowhere, this is usually the thing that finally shifts it.
Almost every woman I teach arrives having been told to “do your pelvic floor exercises” and little else. Nobody showed her what a correct contraction feels like, how many to do, or what to try when squeezing harder stops helping. Plenty have been squeezing for years, in good faith, and concluded their body is the problem. It usually is not.
What your pelvic floor does all day
Your pelvic floor is a sling of muscle running from your pubic bone to your tailbone, supporting your bladder, bowel and uterus from below. It holds those organs in position, keeps you continent, and manages the pressure travelling down through your abdomen every time you cough, lift or laugh.
Picturing it as a hammock helps with the idea of support. The image has limits though, because a hammock is passive and your pelvic floor is not. It works constantly with your diaphragm and deep abdominal muscles as one pressure system. That is the crucial point, and it is exactly what the squeeze-only approach misses: symptoms alone cannot establish what is happening in your own pelvic floor, and training one muscle in isolation ignores the system it belongs to.
Why squeezing alone leaves so many women stuck
Direct contraction work has real evidence behind it, and it helps plenty of people. But three things go wrong often enough to explain most of the women who tell me it did nothing for them.
The contraction never reaches the muscle. A surprising number of women are bearing down very slightly instead of lifting, adding downward pressure rather than resisting it.
The muscle is already too tight. An overactive pelvic floor cannot contract well because it never fully releases. More squeezing makes it worse, which is why it is worth knowing the signs of a hypertonic pelvic floor before adding repetitions.
The timing is off, not the strength. The muscle may be strong enough but too slow to meet a sneeze.
None of those are solved by doing more of the same.
How Hypopressives trains your pelvic floor
Hypopressives takes the opposite route. Instead of isolating the pelvic floor and squeezing, you set up a tall, specific posture, breathe laterally into your ribs, then exhale fully and open the rib cage without breathing in. That creates a drop in pressure inside the abdomen, and the pelvic floor and deep abdominal muscles respond by lifting on their own.
You are not forcing the muscle. You are creating the conditions where it does what it is designed to do, as part of the pressure system it actually belongs to.
The evidence is encouraging. A randomised controlled trial in Neurourology and Urodynamics found that after eight weeks of Hypopressive exercises, women showed improved pelvic floor muscle contractility alongside reduced severity of urinary incontinence symptoms. A systematic review in Healthcare found hypopressive techniques had positive effects across the core complex, including the pelvic floor, transverse abdominis and diaphragm.
In my own experience teaching Hypopressives, the women who improve most dramatically are often the ones who arrived most discouraged. People who had written off pelvic floor training entirely, after years of Kegels that changed nothing, frequently find that a breath-led approach gives back control they had assumed was gone for good. For some it has been genuinely life-changing.
There is usually a reason.
If you want to do the contractions too
Hypopressives and direct contraction work are not in competition, and many of the women I teach do both.
If you are doing contractions, do them properly. The NHS describes the action as squeezing and lifting, as though stopping yourself passing wind and holding in urine at once. Lift inward and upward rather than clenching your buttocks, keep breathing throughout, and release completely between repetitions. The release matters as much as the squeeze, and it is the step almost everyone skips.
NICE sets a specific dose: at least eight contractions, three times a day. Mix long holds of up to ten seconds for endurance with short sharp lifts for the fast response you need when you sneeze.
How long it takes
Be realistic in the right direction. NICE recommends a trial of at least three months for stress or mixed urinary incontinence, and at least sixteen weeks where pelvic organ prolapse is involved. Most women feel something changing well inside that, often around four to six weeks, but the full picture takes a season rather than a fortnight.
Pelvic floor training in general has some of the strongest evidence in women’s health. A Cochrane review concluded that we can be confident training can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence. That is an unusually confident conclusion, and it is why training sits at the front of the clinical recommendations rather than being offered last.
What to track before your appointment
If you are seeing a GP or pelvic health physiotherapist, a week of notes makes the appointment far more useful:
- How often you leak, and what you were doing each time
- Any heaviness or dragging, and when it is worst
- How much you drink and how often you empty your bladder
- Whether you can feel a contraction at all, and where
- What you have already tried, and for how long
Questions worth asking:
- “Can you check whether I am contracting the right muscles?”
- “Is my pelvic floor weak, too tight, or both?”
- “How long should I give this before we try something different?”
When to Seek Assessment
This guide is educational and cannot diagnose the cause of your symptoms. Arrange an assessment with a GP or pelvic health physiotherapist if you have persistent leaking, a feeling of heaviness or bulging, pain during exercise or sex, or if you have trained consistently for three months with no change. Seek prompt medical advice for blood in your urine, sudden or severe pelvic pain, or difficulty passing urine at all.
If years of squeezing have not helped, it is worth reading why Kegels may not have worked for you before doing another set.
without squeezing harder.
Sources
- NICE guideline NG123: Urinary incontinence and pelvic organ prolapse in women: management
- NHS: What are pelvic floor exercises?
- Molina-Torres G et al. The effects of an 8-week hypopressive exercise training program on urinary incontinence and pelvic floor muscle activation: a randomized controlled trial. Neurourology and Urodynamics, 2023
- Hernandez-Lucas P, Escobio-Prieto I, Moro Lopez-Menchero P. Effects of Hypopressive Techniques on the CORE Complex: A Systematic Review. Healthcare, 2025
- 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 of Systematic Reviews, 2018
