Petal

POGP's primary cue is to imagine that you are trying to stop yourself from passing wind and urine at the same time, drawing the pelvic floor muscles upward and forward from the back passage toward the bladder. The NHS puts the same idea more plainly: imagine stopping yourself peeing and farting.

There are three ways POGP suggests to check that you have found it:

• A mirror. The area between your vagina and back passage should move up and inward, away from the mirror, when you contract. If you see any bulging, stop.
• A finger. Feel inside your vagina with your thumb or index finger and tighten. You should feel the muscles tightening around it.
• A partner. If you are having penetrative sex, you can squeeze during sex and ask whether your partner can feel it.

What you should not do is practice by stopping your urine flow. It works as a mental picture only. POGP says so directly, in the same booklet that offers the picture. Source: POGP, The Pelvic Floor Muscles: a Guide for Women and NHS.

These are the fourteen things worth hearing while you train. The first twelve cover a strengthening session, the last two belong to the relaxation track. Each one is an adaptation of a published instruction, mostly POGP's.

1. Imagine you're stopping yourself from passing wind and urine, at the same time.
2. Draw up and forward, from your back passage toward your bladder.
3. Squeeze. Lift. Hold. Then let go completely.
4. Breathe in through your nose and let your belly soften. Breathe out as you squeeze.
5. If you can count out loud while you hold, you're breathing right.
6. Keep your bottom and thighs soft. Only the inside should move.
7. Your lower belly may tighten a little. That is normal. Do not pull it in hard.
8. Letting go is half the exercise. Give the muscles a full rest before the next one.
9. Before you cough, sneeze, laugh, or lift your baby, squeeze first. It's called the Knack.
10. Work until the muscles get tired. Wherever that is today, that's your starting point.
11. Start lying down or sitting. Standing comes later, once this feels easy.
12. Don't practice by stopping your flow on the toilet. Use it as a picture in your head, not a habit.
13. This one isn't a squeeze. Let everything soften and widen, and breathe.
14. If you feel any bulging or pushing down, stop and check in with a pelvic health physio.

Holding your breath

Breathe in through your nose, letting the air reach the bottom of your lungs and your tummy relax, then breathe out through your mouth. Counting out loud is the easiest way to prove you are still breathing. Source: POGP.

Squeezing your bottom and thighs instead

Keep your buttocks and legs relaxed. If your knees move, the wrong muscles are doing the work. Source: POGP.

Pulling your tummy in hard

The NHS says not to pull your tummy in. POGP adds the nuance that your lower tummy may tighten a little, which is normal. Hard bracing is not. Source: NHS and POGP.

Bearing down instead of lifting

Use a mirror. The area between your vagina and back passage should move up and inward, away from the mirror. If you see any bulging, stop. Source: POGP.

Never fully releasing

Let the muscles relax fully after every contraction. This is why Petal rests at least as long as it holds, and never less than five seconds. Source: POGP.

Practicing by stopping your urine flow

Do not practice by stopping your urine flow. POGP also asks you to sit and relax on the toilet rather than hover, so the muscles can release while you empty your bladder. Source: POGP.

Starting too hard

You may need to start with little and often if you can only hold the squeeze briefly, or manage a few before the muscles tire. That is what the 90-second check measures. Source: POGP.

Stopping the moment symptoms improve

POGP notes how easy it is to forget the exercises once symptoms start to improve. The benefit follows the practice, not the memory of it. Source: POGP.

POGP teaches a ladder. Lying down is easiest, sitting is harder, standing is hardest, and doing it in the middle of real life is the point. Petal starts you lying or sitting and moves the default up the ladder as your step rises, but the position is only ever a default. You can pick any of them in settings, on any step.

From 20 weeks of pregnancy Petal stops suggesting flat on your back and offers side lying instead, following ACOG Committee Opinion 804.

The Knack is squeezing before the thing that makes you leak, rather than after. Cough, sneeze, laugh, lift the baby: squeeze and lift first, hold through it, then release. POGP teaches it as a habit to build rather than an exercise to count.

Petal has a session type for it, about eighty seconds long, that rehearses the four triggers in turn. It is the fastest thing in the tool to feel useful, which is why it is available from day one on the pregnancy and general tracks.

POGP is explicit that it is as important to have pelvic floor muscles that can relax as it is for them to be strong. A floor that never fully lets go is not a strong floor. That is why every rest in Petal is at least as long as the squeeze that preceded it, and never shorter than five seconds.

If squeezing hurts, if you feel pushing down, if you cannot feel a full release, if sex hurts, or if emptying your bladder or bowel is difficult, a strengthening program is the wrong starting point. Petal offers a relaxation track instead: 4-6 breathing, twelve cycles, no squeeze cues, with the ring open the whole time. That routing is Petal's own decision rather than a guideline instruction, and it comes with a reason to see a pelvic health physiotherapist, because that is the assessment neither you nor this page can do.

A caesarean does not spare the pelvic floor. Pregnancy itself is the strain, which is why NICE NG210 lists pregnancy among the risk factors regardless of how the birth went.

Pelvic floor work can start straight away and gently. Abdominal work is the part that waits: abdominal tissue has regained only about half its strength at six weeks. Petal keeps that distinction visible in the postpartum track for the first twelve weeks, so the two do not get confused for each other.

The NHS says all pregnant women should do pelvic floor exercises, symptoms or not. The Cochrane review of antenatal training found that women who were still continent and started early had a lower risk of leaking in late pregnancy, RR 0.38 (95% CI 0.20 to 0.72), which is roughly a 62% lower risk. That number is about prevention. It does not promise the same result if you are already leaking.

Two things change as pregnancy goes on. From 20 weeks, lying flat on your back comes out of the rotation. And in the third trimester the Knack matters more, because lifting a toddler and a shopping bag is where the leaking happens. Source: Cochrane Database of Systematic Reviews, 2020.

Stop and contact your provider if you have vaginal bleeding, abdominal pain, regular painful contractions, fluid leaking from the vagina, dizziness, chest pain, shortness of breath before exertion, calf pain or swelling, or muscle weakness affecting your balance. Those are ACOG's warning signs for stopping exercise in pregnancy, and they apply here.