Pelvic Floor Strengthening & Smart Tools: Your First Steps for Stress Urinary Incontinence

Leaking with coughing, sneezing, laughing, or exercise, sound familiar? This is called stress urinary incontinence (SUI), and while it’s common, it doesn’t have to be permanent.

Many women feel overwhelmed when deciding where to start. Should you try Kegels? Do you need a device? Is physical therapy worth it? As a urogynecologist, I want to walk you through the very first steps—what really works, what’s optional, and how to choose the right path for you.

Why Start with the Pelvic Floor to treat your Stress Incontinence?

Your pelvic floor muscles form a supportive bowl that runs from hip to hip, pubic bone to tailbone. These muscles:

• Support your bladder, uterus, and rectum

• Help your sphincters (the muscles that keep you dry)

• Automatically contract during daily activities

When you contract them intentionally, that’s a Kegel exercise. And strengthening these muscles is the gold standard first step for stress incontinence.

Pelvic Floor Strengthening: The Gold Standard

With a Physical Therapist

Seeing a pelvic floor physical therapist is the most effective way to strengthen your muscles. Why? Because they can:

• Check if you’re doing Kegels correctly

• Teach you exercises that go beyond simple contractions

• Hold you accountable to keep practicing

Studies show that pelvic floor PT helps 70% of women improve or even resolve their leaking.

On Your Own

If you want to strengthen on your own, it can still work—if you meet two big requirements:

1. You must know how to do a correct contraction.

2. You must keep it up for 3–6 months before expecting results.

Many women stop too soon or don’t realize they’re doing contractions incorrectly, which is why guidance (or even biofeedback tools) can make such a difference.

Helpful Tools to Boost Your Progress

Vaginal Weights

Like hand weights at the gym, vaginal weights add resistance and help you feel the muscles working. Many sets come with increasing sizes so you can progress over time.

Peri-Trainers (App-Based Devices)

These small devices fit into the vagina, measure pressure, and connect to apps or games on your phone. They track progress and make training more engaging. Just remember—they can’t always tell if you’re pushing instead of squeezing, so form still matters.

Urethral Seals

Placed over the urethra (pee hole), these seals block leakage during high-pressure moments like exercise. They’re best for low-volume leaks and short-term use.

Pessaries for Stress Incontinence

Pessaries aren’t just for prolapse. Devices like Impressa (Poise) and Revive are available over the counter. They fit into the vagina, press gently on the urethra, and prevent leaks during activity. Think of them as athletic support for your bladder.

The “Squeeze Before You Sneeze” Technique

Once your muscles are stronger, you can use the KNACK (nicknamed squeeze before you sneeze).
Contract your pelvic floor right before you cough, laugh, or jump. Over time, this becomes automatic and can stop leaks in their tracks.

What About DevicesThat Do the Work for You

Electrical or magnetic stimulation (like the Emsella chair) can make your pelvic floor contract without effort. While they work, they don’t teach you timing, which is crucial for daily life. They also tend to be more expensive.

Getting Started Today

If you’re struggling with stress urinary incontinence:

1. Learn how to do a proper Kegel (download my guide in the show notes).

2. Commit to 3–6 months of consistent practice.

3. Explore supportive tools like weights, peri-trainers, urethral seals, or pessaries if you need extra help.

4. Work with a pelvic floor PT if possible, it’s the gold standard.

Leaking may feel isolating, but it’s not inevitable. With the right starting steps, you can rebuild strength, regain control, and live without the constant worry of accidents.