How to Strengthen Your Core and Pelvic Floor

Strengthening your core and pelvic floor starts with understanding that they are not two separate projects. The pelvic floor muscles, the deep abdominals, and the diaphragm form an interconnected pressure system that contracts and relaxes as a unit. Training one in isolation, like doing crunches for your abs and Kegels for your pelvic floor, misses the point. The most effective approach coordinates all of these muscles together through breathing, targeted exercises, and smart pressure management.

One System, Not Separate Parts

When your pelvic floor muscles contract, your deep abdominal muscles contract too. Research using electromyography and pressure sensors has shown that the transversus abdominis and internal oblique activate during every pelvic floor contraction, and it is not possible to effectively contract the pelvic floor while keeping those deep abdominal muscles relaxed.¹ The reverse is also true: when the pelvic floor contracts, it changes what the diaphragm can do. The resulting increase in intra-abdominal pressure limits downward movement of the diaphragm, which means pelvic floor activity directly affects your breathing mechanics.²

This interconnection exists because the core is essentially a pressurized canister. The diaphragm forms the roof, the pelvic floor forms the base, and the deep abdominal and back muscles wrap around the sides. Every breath you take, every lift, every cough changes the pressure inside that canister. All the walls of the canister have to respond together. When one part is weak or poorly coordinated, the others compensate, sometimes in ways that cause problems.

Why So Many People Get Kegels Wrong

Pelvic floor exercises have a reputation for being simple: squeeze, hold, release. In practice, the error rate is strikingly high. One study found that roughly 57% of postpartum women performed incorrect movements when attempting a pelvic floor contraction, and the chance of doing the exercise correctly was about 2.65 times higher in women who avoided those compensatory errors.³ In another study of women assessed during a clinical visit, about 71% used at least one inappropriate accessory muscle group during their attempt at a pelvic floor contraction, with up to half of those contracting two accessory groups, most commonly the abdominals.⁴

Common mistakes include bearing down instead of lifting up, holding the breath, clenching the buttocks, or gripping the inner thighs. Bearing down is the most counterproductive because it pushes the pelvic floor in exactly the wrong direction. If you are not sure whether you are doing it right, a pelvic floor physiotherapist can check with a simple internal exam or surface electrodes and give you real-time feedback. Even a single teaching session can correct the pattern for many people.

Two Core Activation Strategies and When to Use Each

You will hear two terms come up repeatedly in core training: hollowing and bracing. They target different muscles and create different pressure profiles, so neither is universally “better.”

Hollowing means drawing your lower belly inward toward your spine. It preferentially activates the transversus abdominis, the deepest abdominal muscle, and tends to keep the larger outer muscles quieter.⁵ It also minimizes unwanted motion in the lower back and pelvis during movements like hip extensions, making it a good choice for controlled rehabilitation work.⁶

Bracing means tensing the entire abdominal wall as if you were about to get punched in the stomach. It activates the internal and external obliques and rectus abdominis on top of the deeper muscles, and it generates more intra-abdominal pressure than hollowing does.⁷ Bracing is the strategy your body defaults to during heavy lifting or any task that demands spinal stability under load.

In practice, you probably need both. Hollowing works well for re-learning deep muscle control, recovering from injury, or early postpartum training. Bracing is what you need for carrying groceries, lifting weights, or getting off the floor. A good training program starts with hollowing to build awareness, then progresses to bracing and eventually to functional movements where you do not have to think about which strategy you are using.

Breathing as a Training Tool

Because the diaphragm sits at the top of the core canister and the pelvic floor sits at the bottom, learning to coordinate your breath with your pelvic floor is one of the most effective training methods available. When you inhale deeply, the diaphragm descends and the pelvic floor should gently lengthen downward. When you exhale, the diaphragm rises and the pelvic floor should recoil upward. This rhythm is automatic in a healthy system, but it can fall out of sync after pregnancy, surgery, chronic pain, or long periods of shallow chest breathing.

Coordinated retraining of diaphragmatic, deep abdominal, and pelvic floor function has been studied specifically in women with stress urinary incontinence. After a four-month training period, over 90% of participants in the training group reported cure or improvement, with both the amount and frequency of leakage dropping significantly compared to controls.⁸ Quality of life also improved on more measures in the training group than in the control group. The key takeaway is that breathing coordination training is not just a warm-up exercise or a meditation add-on. It is a genuinely effective intervention in its own right.

Managing Pressure During Exercise

Every physical movement changes intra-abdominal pressure. A cough produces the highest spike, and different exercises produce different profiles. Research in postpartum women found that a simple drawing-in maneuver generated the lowest abdominal pressure at about 7% below resting baseline, while a curl-up pushed pressure to about 43% above baseline. Combining a drawing-in with a curl-up brought the pressure back down to about 31% while also boosting the supportive pressure at the pelvic floor.⁹

This has practical implications for exercise selection. If you are recovering from childbirth or have pelvic floor symptoms, pairing a pelvic floor lift or drawing-in with your ab exercises can reduce the downward force on your pelvic floor while still getting a training effect. Researchers have also pointed out that absolute pressure numbers alone do not tell the whole story. The relative pressure response, meaning how much pressure increases compared to your personal maximum, may matter more for individualized exercise recommendations than raw pressure values.¹⁰ A high absolute pressure during a deadlift might be well managed by someone with a strong, coordinated system and problematic for someone who is deconditioned.

Pelvic Floor Training and Urinary Incontinence

The strongest evidence for pelvic floor muscle training is in treating stress urinary incontinence, the kind triggered by coughing, sneezing, laughing, or jumping. Multiple reviews classify pelvic floor training as first-line treatment, with the highest level of evidence supporting its effectiveness.¹¹ A separate review confirmed that the training improves incontinence symptoms as a reliable, noninvasive exercise that can be done at home with periodic professional check-ins to keep costs down.¹²

A common question is whether adding biofeedback devices makes the exercises more effective. A Cochrane review found little to no difference in incontinence quality of life between women who trained with biofeedback and women who trained without it. The biofeedback group had a slight reduction of about 0.29 fewer leakage episodes per day, but this may not be clinically meaningful. Women in the biofeedback group may report greater satisfaction with treatment, possibly because the visual or auditory feedback feels motivating.¹³ The bottom line: biofeedback devices are fine if you find them helpful, but they are not necessary for results.

Postpartum Recovery and Diastasis Recti

Diastasis recti abdominis, the separation of the left and right sides of the rectus abdominis along the midline, is common after pregnancy. It affects both core stability and appearance, and its rehabilitation overlaps heavily with pelvic floor training. A scoping review of current clinical practice found that programs combining deep and superficial muscle work, pelvic floor exercises, respiratory maneuvers, and functional movements showed promising results in reducing the gap between the muscles.¹⁴ A randomized trial of a deep core stability exercise program found a highly significant decrease in the separation along with meaningful quality-of-life improvements.¹⁵

One interesting nuance: not all exercises narrow the gap. Head lifts and twisted curl-ups were shown to decrease inter-recti distance both above and below the belly button. But an isolated pelvic floor contraction, a maximal in-drawing maneuver, or the combination of both actually increased the gap slightly.¹⁶ This does not mean pelvic floor work is harmful for diastasis. It means the exercise selection and combination matter, and that some exercises have different immediate effects than you might expect. A postpartum program should include both pelvic floor and abdominal work, but should be designed with this interplay in mind.

When Strengthening Is the Wrong Goal

Not every pelvic floor problem is a weakness problem. Some people have a pelvic floor that is too tight, a condition called pelvic floor hypertonicity. Symptoms can include chronic pelvic pain, painful intercourse, difficulty emptying the bladder or bowels, and urological or gynecological symptoms that mimic other conditions.¹⁷ For these people, doing Kegels and other strengthening exercises can make symptoms worse. Treatment focuses on relaxation, lengthening, manual therapy, and down-training rather than contracting harder. If you have pelvic pain, pain with sex, or difficulty relaxing your pelvic floor, see a pelvic floor specialist before starting a strengthening program.

Pilates, Hypopressives, and Other Approaches

Several popular exercise methods claim pelvic floor benefits. The evidence varies.

Pilates consistently uses principles that overlap with core and pelvic floor training, like deep breathing, pelvic alignment, and transversus abdominis activation. A randomized trial found that both Pilates and dedicated pelvic floor training produced similar strength gains, with no significant difference between the groups.¹⁸ In men recovering from prostate surgery, Pilates-based training produced similar continence rates to conventional pelvic floor training at four months, with about 54% of the Pilates group becoming fully continent compared to 59% in the conventional group.¹⁹ However, a systematic review and meta-analysis looking specifically at healthy women who practiced Pilates found no evidence of improved pelvic floor function as measured by perineometry.²⁰ The takeaway: Pilates can work as a pelvic floor training vehicle, especially if the instructor cues pelvic floor engagement, but just “doing Pilates” without that intention may not change your pelvic floor strength.

Hypopressive exercises involve specific postures combined with a strong exhale and rib expansion without actually inhaling, creating a vacuum effect that lifts the pelvic organs upward. An eight-week randomized trial found that women who performed hypopressives showed significantly greater pelvic floor muscle activation afterward compared to controls, with a large effect size.²¹ Lab measurements show that a single hypopressive exercise performed lying down can activate the pelvic floor muscles to roughly 75% to 87% of a maximal voluntary contraction, which is a substantial training stimulus.²² Hypopressives are worth exploring, especially if traditional Kegels are not clicking for you, but the technique requires proper coaching since the breathing pattern is counterintuitive.

One popular claim that does not hold up: squeezing a ball between your knees or pressing your knees apart during pelvic floor exercises to boost the contraction. A study in healthy women found that isometric hip adduction or abduction combined with a pelvic floor contraction did not increase the force generated by the pelvic floor muscles.²³ Those cues might help some people find their pelvic floor initially, but they do not appear to make the muscles contract harder.

Heavy Lifting and the Pelvic Floor

Strength training can coexist with pelvic floor health, but it requires attention. Reports suggest that symptoms of pelvic floor dysfunction may affect up to half of women who do resistance training, with symptoms most common when lifting close to maximum capacity and when performing the Valsalva maneuver, the breath-hold that happens reflexively during heavy lifts.²⁴ Above about 80% of your one-rep max, most people automatically perform a transient Valsalva whether they intend to or not, because the spike in intra-abdominal pressure stabilizes the spine.

This does not mean you should avoid heavy lifting. It means managing how you create that pressure. Exhaling on the effort instead of holding your breath at lighter loads, coordinating a pelvic floor lift before the hardest part of a rep, and building up load gradually all help. If you leak during deadlifts or squats, that is a signal to address your pelvic floor coordination, not to abandon the movements. Working with a coach who understands pelvic floor considerations, or with a pelvic floor physiotherapist who understands lifting, can make a real difference.

Sexual Function

Pelvic floor training affects more than continence. A meta-analysis of studies in postmenopausal women found that pelvic floor muscle training produced significant improvements in sexual function scores, with particularly large effects on arousal, orgasm, and satisfaction.²⁵ A randomized trial in women of reproductive age found that sexual function scores increased significantly by the third month of training, with a large effect size.²⁶ Adding vaginal training devices such as weighted spheres to pelvic floor exercises may offer some specific additional benefits for desire and lubrication, though overall outcomes tend to be similar to exercises alone.²⁷

How Posture Affects Your Pelvic Floor All Day

Your pelvic floor is not only active during exercise. It responds to how you sit. Electromyographic studies have found that pelvic floor muscle activity increases significantly as you move from a slouched, supported sitting position to an upright, unsupported one, and increases further in a tall, actively extended posture.²⁸ Women with stress urinary incontinence showed lower pelvic floor activity across all postures compared to continent women, suggesting that the automatic postural engagement of the pelvic floor is part of what keeps things working.

This has a practical implication that goes beyond “sit up straight.” If you spend hours slumped in a chair, your pelvic floor is getting almost no passive engagement. Varying your posture throughout the day, alternating between sitting and standing, and occasionally sitting without back support can provide a low-level training stimulus. It will not replace dedicated exercise, but it sets the stage for better function.

Men and Pelvic Floor Training

Pelvic floor training is not a women-only concern. Men have the same deep core canister and the same need for pelvic floor coordination, and the most common scenario driving men to pelvic floor training is recovery after prostate surgery. In one randomized trial, both the group that received pre-surgery pelvic floor physiotherapy and the control group had similar continence rates three months after radical prostatectomy, with incontinence around 70-73% in both groups.²⁹ The Pilates-based trial mentioned earlier, by contrast, showed more encouraging results, with over half the men in the Pilates group becoming fully continent by four months. The evidence for men is more mixed than for women, but the general principles of coordination, breathing, and progressive loading still apply.

Hormonal Changes and Tissue Integrity

Core and pelvic floor strength do not exist in a vacuum. The tissues themselves change over time, especially around menopause. The pelvic organs and their surrounding muscular and connective tissue support are estrogen-responsive. Research has shown that estrogen helps suppress enzymes that break down collagen in pelvic floor connective tissue. As estrogen declines, collagen degradation increases, and the structural support for the pelvic organs weakens.³⁰ This is one reason why pelvic floor symptoms often appear or worsen after menopause even in women who were asymptomatic earlier.

Exercise can counteract some of this decline by maintaining muscle mass and coordination, but it cannot fully replace what the tissue changes take away. For some women, local estrogen therapy prescribed by a doctor works alongside pelvic floor training to address both the muscular and the connective tissue components. Understanding that both muscle strength and tissue quality contribute to pelvic floor function helps explain why the same exercise program can work beautifully for one person and fall short for another.

Why Bipedal Humans Are Uniquely Vulnerable

Pelvic floor problems are not a modern invention or a consequence of sedentary lifestyles alone. Walking upright puts unique mechanical demands on the human pelvis that quadrupedal animals simply do not face. Comparative analysis has shown that bipedal evolution reshaped pelvic morphology and load transmission, increasing the mechanical stress on the pelvic floor.³¹ Across mammals, pelvic canal shape and size vary with posture and gravitational loading, and the human pelvic floor bears a uniquely heavy load because it supports the weight of the abdominal organs against gravity all day.³² The human pelvic floor is, in a sense, evolutionarily over-tasked, which is part of why it needs active maintenance in a way that, say, a hamstring does not.