You know you should be doing something for your pelvic floor. But every time you look it up you either get a list of Kegel variations or an overwhelming program that wasn’t designed for where you actually are right now.
If you’re a woman over 40 who wants to know where to genuinely start — not where a 28-year-old postpartum woman starts — this is written for you.
Why Starting Point Matters for Women Over 40
The most common advice for pelvic floor issues is to start doing Kegels. And while Kegel exercises have a legitimate role in pelvic floor rehabilitation, beginning with isolated contractions is not always the most effective first step — particularly for midlife women.
Here’s why starting point matters so much:
Your body has changed hormonally. Estrogen decline during perimenopause and menopause affects pelvic floor tissue tone, elasticity, and responsiveness. Approaches designed for younger women don’t account for this hormonal context.
Decades of habits are in play. How you breathe, hold tension in your body, and move through daily life has accumulated over decades. These patterns affect your pelvic floor function in ways that need to be addressed alongside any exercise program.
Not everyone needs more contraction. Some women have a pelvic floor that holds too much tension rather than too little. Starting with contraction-focused exercises in this case can worsen symptoms rather than improve them. Understanding your starting point matters before choosing your exercises.
Before You Start Any Pelvic Floor Exercise Program
Before jumping into exercises, it’s worth understanding a few foundational things about how your pelvic floor works:
Your pelvic floor is part of a system. It functions alongside your diaphragm, deep abdominal muscles, and the muscles along your spine. Exercises that address this system as a whole are more effective than those that isolate the pelvic floor alone.
Breathing is fundamental. How you breathe during movement directly affects the pressure in your core and how your pelvic floor responds. Learning to coordinate your breath with movement is one of the most important foundational skills — and it costs nothing.
Relaxation matters as much as strengthening. A pelvic floor that can fully relax is just as important as one that can contract. Many exercise programs focus only on strengthening and skip the relaxation component entirely.
Consistency beats intensity. Small consistent efforts over time produce more lasting change than occasional intense sessions. A realistic approach you can maintain is far more valuable than a perfect program you do twice and abandon.
If you want to skip ahead to a structured program that does this for you, you can see it here →
Foundational Pelvic Floor Exercises for Women Over 40
These are general movement principles that are widely recommended in pelvic floor physical therapy as foundational starting points. They are not a substitute for personalized guidance from a pelvic floor physical therapist.
Diaphragmatic Breathing This is the single most important foundational skill for pelvic floor support. When you breathe deeply into your diaphragm — allowing your lower ribcage and belly to expand on the inhale — your pelvic floor naturally descends and relaxes. On the exhale, it gently lifts and recoils. Practicing this breath pattern lying down, then sitting, then standing, helps re-establish the natural coordination between your breath and pelvic floor.
Practice for 5 minutes daily. It sounds simple — but for many women this alone produces noticeable changes in how their core and pelvic floor feel.
Pelvic Floor Awareness — Relax First Before working on contraction, practice noticing whether you can fully relax your pelvic floor. Many women discover they hold chronic tension there without realizing it. Lying on your back with knees bent, take a deep breath in and consciously let go of any holding in your pelvic floor on the exhale. This release is as important as any strengthening exercise.
Bridge Pose With Breath Coordination Lying on your back with knees bent and feet flat, exhale as you lift your hips into a bridge position, allowing your pelvic floor to gently lift with the exhale. Inhale as you lower back down, allowing the pelvic floor to relax. This trains the coordination between breathing, glutes, and pelvic floor — a fundamental pattern for functional stability.
Start with 8-10 repetitions. Focus on the breath coordination rather than how high you lift.
Heel Slides Lying on your back with knees bent, exhale as you slowly slide one heel along the floor until your leg is straight, then inhale as you return. This gentle movement trains deep abdominal and pelvic floor coordination with minimal pressure. It is appropriate even for women who are just beginning or returning after a long break.
Standing Hip Hinge Standing with feet hip-width apart, practice hinging forward at the hips — not bending at the waist — while keeping your spine long. Exhale as you return to standing. This trains the glutes and pelvic floor to work together during functional movement — the pattern your body uses constantly in daily life.
What to Avoid When Starting Out
Avoid high-impact exercise before building a foundation. Running, jumping, and high-intensity interval training place significant demand on the pelvic floor. If you are experiencing symptoms, building foundational coordination first before returning to high-impact activity is worth the investment of time.
Avoid holding your breath during exercise. Breath-holding significantly increases intra-abdominal pressure and places more demand on the pelvic floor. Learning to exhale during exertion is one of the most protective habits you can develop.
Avoid doing too much too soon. The pelvic floor responds to consistent, progressive training — not to volume or intensity. More is not better when it comes to pelvic floor work, particularly at the beginning.
When to Progress
Once diaphragmatic breathing feels natural, you can hold a conversation during bridge exercises without losing coordination, and foundational movements feel stable and symptom-free — that is when it makes sense to progress to more challenging exercises. Progressing before this foundation is solid is one of the most common reasons women don’t see the results they’re hoping for.
A Structured Approach Worth Considering
If you’d rather follow a structured program that takes you through pelvic floor exercises for women over 40 in a clear, progressive sequence — rather than piecing together individual exercises yourself — Pelvic Floor Strong is one I’ve come across that takes this kind of whole-body, step-by-step approach.
When to See a Professional
If you are experiencing extreme symptoms — leaking, pelvic pressure, pain, or prolapse sensations — it is best to consult your physician. Additionally, consulting a pelvic floor physical therapist before beginning a self-guided exercise program is strongly recommended. A pelvic floor PT can assess whether tension or weakness is the primary issue, which significantly affects which exercises are appropriate for your specific situation.
Sources: Mayo Clinic — Kegel Exercises · NIH — Bladder Control Problems in Women · Cleveland Clinic — Pelvic Floor Dysfunction · ACOG — Pelvic Support Problems
Why You Wake Up at Night to Pee — The Pelvic Floor Connection