Direct answer
A coordination programme trains the pelvic floor to contract or release at the right time with breathing, bladder or bowel function, movement, and pressure. It does not assume that more force is needed. Grading means adding one task layer only after the simpler pattern remains comfortable and clear.
This page is a planning framework, not a personalized prescription. It intentionally does not assign universal hold times, repetition counts, sets, or daily frequency.
Audience and limits
Adults with an identified timing or coordination goal and no warning signs that require medical care. Emptying disorders, pain, neurological conditions, and postoperative needs should be clinician guided.
Prerequisites before you start
Before using this programme, all of the following should be true:
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the intended function and reason for pelvic-floor practice are clear;
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a contraction-focused or coordination-focused plan is appropriate for the concern;
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you can breathe normally and avoid bearing down or whole-body clenching;
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contraction and complete release are comfortable and distinguishable;
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there is no unexplained pain, bleeding, fever, acute urinary or bowel problem, or new neurological symptom;
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any pregnancy, postpartum, catheter, surgical, cancer-treatment, or other clinical restriction has been addressed;
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you know which symptom means stop and who will review the plan if it does not help.
If one prerequisite is uncertain, use the uncertainty as a reason for assessment rather than as a challenge to overcome with harder practice.
Programme target and baseline
Match contraction and release to the intended task without unnecessary whole-body bracing.
Write down the baseline before progressing: position, effort, contraction duration or task, rest, repetitions, frequency, ease of release, symptoms during and later, and the real-life outcome. The exact numbers are less important than creating a stable comparison.
A baseline that causes pain, pressure, urgency, emptying difficulty, or lingering tension is not a starting level.
The graded programme
Phase 1: isolate the cycle
Work: Practise a gentle contraction and complete release with uninterrupted breathing.
Advance when: Advance when direction and rest are reliable.
Regress or pause when: Return to awareness work if timing is unclear.
Phase 2: coordinate with breath
Work: Place the pelvic-floor action within a normal breathing cycle without prescribing one rigid breath rule for every task.
Advance when: Advance when breathing remains natural.
Regress or pause when: Reduce effort when the breath becomes a brace.
Phase 3: add simple movement
Work: Pair the stable cycle with one low-demand movement or posture change.
Advance when: Advance when neither movement nor release deteriorates.
Regress or pause when: Remove movement if symptoms or substitutions appear.
Phase 4: practise task-specific timing
Work: Use contraction for closure or release for emptying only in the clinically relevant context.
Advance when: Maintain when function improves without constant conscious control.
Regress or pause when: Reassess if the intended task remains unchanged.
Progression and regression rules
Change one variable at a time. If technique or symptoms worsen, return to the last reliable level; seek review if the problem recurs. Do not double the next session to replace a missed one.
Outcomes and review point
Coordination progress is the right response at the right time, including the ability to do nothing when contraction is unnecessary.
Stop rules
Stop or pause for pain, burning, bleeding, new or worsening pressure or heaviness, persistent tension, increased urgency, weaker urine flow, incomplete bladder or bowel emptying, constipation, numbness, or a symptom flare that remains later. Do not complete the set for an app streak.
Seek urgent care for sudden inability to urinate, major bleeding, severe rapidly increasing pain, fever with marked illness, or new saddle or genital numbness with acute bladder, bowel, or leg changes.
Follow local maternity, surgical, oncology, or emergency instructions when they set a lower threshold.
Clinician instructions take precedence
Follow your treating clinician’s restrictions and plan. If instructions conflict, pause and ask the responsible team to reconcile them. Confirm the target, settings, progression criteria, stop rules, and review date before combining programs.
PelvicEx capability boundary
PelvicEx times an already chosen plan and stores completion records on your device. It cannot diagnose symptoms, verify contraction technique, measure muscle function, or decide whether progression is clinically safe.
Evidence boundaries
The ICS assessment report describes dyssynergia, including contraction when relaxation is required. It is a terminology report, not a prescription for these phases. Emptying problems require assessment rather than an assumption that more squeezing will improve coordination.
Related guides
Use How to coordinate pelvic-floor contraction with breathing and movement, Pelvic floor, diaphragm, breathing, and abdominal pressure, and Why the pelvic floor may not release after a contraction to check the adjacent technique, progression, or safety decision.
Sources
- Bø K, Berghmans B, Mørkved S, Van Kampen M, eds. Evidence-Based Physical Therapy for the Pelvic Floor. 3rd ed. Elsevier; 2023. Chapter 6: Pelvic Floor and Exercise Science, pp. 140-165. Official or indexed source.
- Cardozo L, Rovner E, Wagg A, Wein A, Abrams P, eds. Incontinence. 7th ed. International Consultation on Incontinence and International Continence Society; 2023. Chapter 8, section 2: Pelvic Floor Muscle Training, p. 807. 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 for Health and Care Excellence. Pelvic floor dysfunction: prevention and non-surgical management. NG210. 2021. Official or indexed source.