What this resource is
This page is a free, print-ready session-configuration sheet that a clinician and patient can share. PelvicEx also includes a working timed trainer with pacing cues and local completion recording. It does not send workout reminders or verify that an exercise was performed correctly.
Print this page from the browser when a paper copy is useful. Navigation, advertising spaces, and promotional calls to action are hidden in print, while the instructions, blank fields, related context, and sources remain.
Review the on-screen version again if the page shows a newer update date.
How to use the handout
A clinician can write an individualized sequence below, and the patient can keep the printed copy near any separate timer they already use. The sheet intentionally supplies no default hold, rest, repetition, or daily-frequency values. Empty fields prevent the interface from silently turning a generic template into a prescription.
Read every safety boundary before completing the fields. Keep a completed copy private because bladder, bowel, sexual-health, pregnancy, surgery, or symptom notes can be sensitive. This resource is educational and does not establish a clinician–patient relationship.
What a timer can represent
A timer can represent phases such as prepare, contract, release, rest, repeat, and finish. It may provide visual, sound, or vibration cues if those features exist. A cue only marks time: it cannot determine whether the pelvic floor contracted, whether other muscles substituted, whether pressure went downward, or whether full relaxation occurred.
Specify every variable
Record the position, movement cue, effort, contraction time, release time, between-repetition rest, repetition count, set rest, set count, session frequency, and progression rule. ICS assessment terminology distinguishes several aspects of pelvic-floor function; collapsing all of them into one “difficulty” number can hide what is actually being trained.
Make cues accessible
Choose at least two usable cue channels when possible—for example visible text plus sound, or visible text plus vibration—so the sequence does not depend on one sensory channel. Note whether sound or vibration must be disabled, whether extra preparation time is needed, and how the person will pause immediately. A clinician should not assume the eventual digital interface has passed an accessibility audit.
Define completion honestly
Finishing a timed sequence means only that the timer reached the end. It does not prove that each contraction happened, that technique was correct, or that the programme was tolerated. Record symptoms and perceived effort separately. If pain, pressure, urgency, emptying difficulty, or worsening symptoms appears, stop and follow the written review rule instead of pursuing a streak.
Personal or clinician-supplied fields
Leave any item blank when it has not been assessed or agreed. Blank space means “not supplied”; it is not an invitation to invent a dose, diagnosis, treatment date, or clearance decision.
Clinician or service name and plan date
Position, cue, and effort level
Contract, release, rest, repetitions, sets, and frequency
Cue preferences, stop rules, progression, and review date
Safety and review boundaries
Pause an exercise that causes pain or clearly worsens symptoms.
Seek a qualified pelvic-health physiotherapist or other appropriate clinician when technique is uncertain, symptoms are complex, emptying is difficult, a programme is not helping, or treatment and recovery affect exercise choice.
New or severe symptoms may require medical assessment rather than an exercise review.
The page cannot examine tissue healing, muscle activity, sensation, coordination, prolapse, retention, infection, neurological function, or the reason for leakage. A completed form records observations and instructions; it does not convert them into a diagnosis or prove that the exercise was performed correctly.
Review before reusing
Date the printed copy and replace it when professional instructions, symptoms, medicines, pregnancy stage, catheter status, treatment, or functional goals change. Do not keep progressing an old plan because it is convenient.
If the resource is shared by a clinician, that clinician remains responsible for checking that the written variables and safety route fit the individual.
Related guides
Continue with Kegel timer vs full Kegel training app, Pelvic-floor workout prescription worksheet, and When a healthcare professional’s exercise instructions should override an app.
Sources
- Bø K, Berghmans B, Mørkved S, Van Kampen M, eds. Evidence-Based Physical Therapy for the Pelvic Floor. 3rd ed. Elsevier; 2023. Chapter 5: Measurement of Pelvic Floor Muscle Function and Strength. Official or indexed source.
- Frawley H, Shelly B, Morin M, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021;40(5):1217-1260. doi:10.1002/nau.24658. Official or indexed source.
- National Institute of Diabetes and Digestive and Kidney Diseases. Kegel Exercises. National Institutes of Health. Official or indexed source.