The Nuts and Bolts of Pelvic Floor Muscle Training (PFMT): Part 1

Andrew Siegel MD  2/3/18

I received intensive exposure to surgical aspects of pelvic health at UCLA School of Medicine, where I spent a year training in pelvic medicine and reconstructive surgery following completion of my urology residency at University of Pennsylvania School of Medicine. This background, coupled with my passion for health, fitness and the benefits of exercise, led to my interest in PFMT as a means of optimizing pelvic health and to avoid, or at times facilitate, surgical management of pelvic floor dysfunctions.  Is it traditional for a pelvic surgeon to espouse non-surgical treatments?  Not at all, but after decades in the urology/gynecology “trenches,” I have concluded that PFMT is a vastly unexploited resource that offers significant benefits.

Photo below: Yours truly on left with Dr. Shlomo Raz (UCLA professor who is “father” of female urology) on right (1988)

shlomo and andy


“Strength training improves muscle vitality and function.” These seven words embody a key principle of exercise physiology that is applicable to the PFM.


There is little to no consensus regarding the nuances and details of PFMT programs.  There is no agreement on the best position in which to do PFMT; the number of sets to perform; the number of repetitions per set; the intensity of PFM contractions; the duration of PFM contractions; the duration of PFM relaxation; and how often to do PFMT. The particulars of many PFMT routines are arbitrary at best. In fact, Campbell’s Urology—the premier textbook—concludes: “No PFMT regimen has been proven most effective and treatment should be based on the exercise physiology literature.”  

My goal is to take the arbitrary out of PFMT, providing thoughtfully designed, specifically tailored programs crafted in accordance with Dr. Arnold Kegel’s precepts, exercise physiology principles and practical concepts.

Dr. Kegel’s precepts are summarized as follows:

  • Muscle education
  • Feedback
  • Progressive intensity
  • Resistance

Exercise physiology principles as applied to PFMT include the following (note that there is some overlap with Dr. Kegel’s precepts and practical concepts):

  • Adaptation: The process by which muscle growth occurs in response to the demands placed upon the PFM, with adaptive change in proportion to the effort put into the exercises.
  • Progression: The necessity for more challenging exercises in order to continue the process of adaptive change that occurs as “new normal” levels of PFM fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of PFM repetitions and number of sets.
  • Distinguishing strength, power and endurance training: Strength is the maximum amount of force that a muscle can exert; power is a measure of this strength factoring in speed, i.e., a measure of how quickly strength can be expressed. Endurance or stamina is the ability to sustain a PFM contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in. High intensity PFM contractions build muscle strength, whereas less intensive but more sustained contractions build endurance. Power is fostered by rapidly and explosively contracting the PFM.
  • “Use it or lose it”: The “plasticity” of the PFM—the adaptation in response to the specific demands placed on the muscles—requires continued training, at minimum a “maintenance” program after completion of a course of PFMT.
  • Full range of motion: The goal of PFMT is not only to increase strength, power and endurance, but also flexibility. This is accomplished by bringing the muscle through the full range of motion, which at one extreme is full contraction (muscle shortening), and at the other, complete relaxation (muscle lengthening). The exception to this is for muscles that are already over-tensioned, which need to be relaxed through muscle lengthening exercises.

Practical concepts encompass the following:

  • Initially training the PFM in positions that remove gravity from the picture, then advancing to positions that incorporate gravity.
  • Beginning with the simplest, easiest, briefest PFM contractions, then proceeding with the more challenging, longer duration contractions.
  • Slowly and gradually increasing exercise intensity and degree of difficulty.
  • Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness, since each pelvic floor dysfunction is associated with specific deficits in strength, power and/or endurance.

To be continued….

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx



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