Lift & Let Go

A practical guide to pelvic health
A free companion to your care. Choose your starting point, work through the lessons you need, use the tools that help, and access our full guide library—everything to understand what's happening and move forward with confidence.

Pelvic health, plainly

Lift & Let Go

A short guide to your pelvic floor. Six lessons and tools that actually work. It's free, it's private, and wherever you're starting from is a fine place to start.

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short lessons
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printable guides

Get seen promptly, not later, if you have any of these: you can't pass urine at all, heavy or unexplained bleeding, fever with pelvic or back pain, sudden severe pain, new numbness around the saddle area or in both legs, or any pregnancy concern. Contact your clinician, or in an emergency call 911.

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Your journey

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What brought you here?

Tap anything that sounds like you and we'll add the lessons, tools and guides that fit. Nobody sees this but you, and you can skip it entirely.

Choose none and you'll get the six core lessons everyone needs.

The lessons

Tap any lesson to begin

Each one takes a couple of minutes. Read the short version, or open "tell me more" if you want the detail. Your place is saved on this device.

1
Lesson 1 · 2 min
You're not the only one
Common, treatable, and worth talking about.

Plenty of people are dealing with this. It can be a hard thing to bring up, so you rarely hear about it, which makes it very easy to feel like the only one.

The short version

  • Pelvic floor problems are common at every age, in every kind of body, and in people who are otherwise fit and healthy.
  • With the right help, change is possible.
  • Pelvic health physio is mostly talking, teaching and movement. You stay in charge of what happens, the whole way through.
Bladder Bowel Pain Pregnancy& postpartum Prolapse &sexual health
What pelvic health physiotherapy actually covers. Most people arrive thinking it's only one of these.
+ Tell me more

People sit on this for years, and that's understandable. It feels private, it's awkward to raise, and most of us were brought up to just get on with things. Meanwhile it starts making decisions for you: which exercise class you go to, how far you'll be from a toilet, whether you travel at all. That's a lot to carry on your own.

You don't have to live like that. The pelvic floor is a group of muscles, and muscles respond to being looked at properly and trained properly. A lot of what helps is habit and technique rather than effort.

Worth knowing. This is education, and it can't tell you what's going on in your own body. It works best alongside an assessment with someone who can.
Which of these is closest to the truth?
Right. Common and treatable are two different things, and this is both.
Not quite. These turn up in all kinds of bodies at all ages, and most respond well to treatment.
2
Lesson 2 · 3 min
Meet your pelvic floor
Where it sits, and the four jobs it does.

Think of a hammock slung across the base of your pelvis, from the pubic bone at the front to the tailbone at the back.

The short version

  • It's a group of muscles. Like any muscle group it can be too weak, too tight, or just badly coordinated.
  • It has four jobs: closing off the bladder and bowel, supporting the organs above it, playing a part in sex, and helping steady your trunk.
  • A good pelvic floor tightens when it needs to and lets go completely afterwards. You need both halves.
FRONT BACK Pubic bone Sittingbone Sittingbone Tailbone Pelvic floormuscles
Looking up at the pelvic floor from underneath. The muscles fill the space between the pubic bone at the front, the two sitting bones at the sides, and the tailbone at the back. Not to scale.

Show me my anatomy

This part differs
Pick one above and every diagram and cue on this page switches to match. Change it whenever you like. None of it leaves your device.
Bladder Rectum Uterus pubic bone tailbone Pelvic floormuscles UrethraVaginaAnus
Simplified side view, not to scale. Organs above, muscle layer below, and three openings passing down through it. Every body is a little different.
Bladder ProstateRectum pubic bone tailbone Pelvic floor muscles Urethra Anus Penis
Simplified side view, not to scale. The urethra runs from the bladder, through the prostate, then down through the pelvic floor before it turns forward. That is why prostate surgery and pelvic floor function are so closely tied together.
+ Tell me more

Most people only know about the first job. It closes off the bladder and bowel so you stay dry. It supports the organs sitting on top of it. It plays a part in arousal, erection and orgasm. And it works with your breathing and deep abdominal muscles to steady you when you move.

That means a pelvic floor problem can show up as leaking, or urgency, or heaviness, or pain, or difficulty with sex, or a back that keeps flaring. Different symptoms, same muscle group.

Relaxed doesn't mean floppy. A healthy muscle tightens when it needs to and lets go afterwards. If your pelvic floor is always partly switched on, it can be both tight and weak at the same time.
A pelvic floor that's always a bit tense is best described as:
Exactly. A muscle held partly on all day gets tired rather than strong, which is why more squeezing isn't always the answer.
Have another go. A muscle that never fully lets go gets tired rather than strong, so it can be tight and weak at the same time.
3
Lesson 3 · 3 min
Breathing and pressure
Why "just do Kegels" was never the whole story.

Your trunk works like a soft canister. Your breathing muscle is the lid, your pelvic floor is the base, and they move together.

The short version

  • Breathe in and the base gently drops. Breathe out and it gently lifts. That's normal, and it happens without you doing anything.
  • Holding your breath and bracing hard sends pressure straight down onto the pelvic floor. Do that day after day, and it can drive symptoms.
  • Breathe out on the effort. Lifting, standing, pushing a pram, the hardest part of a squat.
Breathe in Ribs widen, base drops Breathe out Ribs settle, base lifts diaphragm pelvic floor Top and bottom move together, every single breath.
You don't have to make this happen. It already does. The job is to stop getting in its way.
Helps
  • Normal-sized breaths, with the in and the out a little longer than usual
  • Breathing out as you lift, stand or strain
  • Letting your belly move
Gets in the way
  • Big forced "deep breaths" with a lot of effort
  • Holding your breath through the hard bit
  • Sucking your stomach in all day
Try the breathing timerA gentle visual to breathe along with. Less effort is better.
+ Tell me more

Most people get taught to take big deep breaths. For a pelvic floor that's already working too hard, that just adds effort. Normal-sized breaths with a slightly longer in and out do more, and they're much easier to keep up.

This is also why squeezing alone often doesn't fix things. If breath-holding, gripping and straining are pushing pressure down all day, adding squeezes on top doesn't change the load.

You're about to lift something heavy. What do you do with your breath?
Yes. Breathing out through the effort stops pressure stacking up on the pelvic floor.
Try again. Holding your breath or gripping hard pushes pressure down. Breathing out through the effort is the one you want.
4
Lesson 4 · 4 min
Lift, and let go
The release is half the exercise.

Squeezing is the easy half. Letting go all the way is the half some people skip, and it matters just as much.

The short version

  • A good contraction feels like a gentle lift up and in, not a push down or a bear-down.
  • Let go completely between each one. If you can't feel the release yet, that's common, and it's the part worth working on first.
  • A few well-controlled reps beat a lot of rushed ones.
  • You need two kinds. Longer holds for support, quick ones for a cough or a sneeze.
At rest Soft, doing nothing Lift Up and in, gently Let go All the way back down The third picture matters just as much as the second one.
Give the release as much attention as you give the squeeze.

Finding the muscles

Choose vulva or penis in lesson 2 and the cues here will match your anatomy.
The cue. Imagine gently stopping yourself from passing wind, then drawing that feeling forwards and up, as if lifting something small inside. You should feel a lift up and in. Your buttocks, thighs and stomach stay relaxed, and you keep breathing.
The cue. Imagine gently stopping yourself from passing wind, then add a feeling of lifting the penis up and in. Use about half the effort you think you need. Nothing should push down. Your buttocks, thighs and stomach stay relaxed, and you keep breathing.
Signs it's going well
  • A gentle lift up and in
  • You're still breathing normally
  • The release feels as clear as the squeeze
  • Buttocks and thighs stay quiet
Signs to change something
  • Any downward push or bearing down
  • Breath-holding, or a hard belly grip
  • Squeezing your buttocks together
  • You can't tell when you've let go
Please don't practise by stopping your urine mid-stream. It's fine as a one-off check, and if you've been doing it, no harm done. Just leave it from here, because doing it regularly can upset how your bladder empties.
Open the exercise coachSets the timing for you, including the full release between reps.
+ Tell me more

The two kinds do different jobs. Longer holds build the endurance that gets you through the day. Quick sharp ones are what you use just before a cough, a sneeze or a lift. That quick one has a name, the Knack, and it's often the fastest way to change day-to-day leaking.

How many and how long depends on what your pelvic floor is actually doing. Better to have that assessed than guessed at, especially if yours turns out to need relaxing more than strengthening.

Which part of a pelvic floor exercise is easiest to miss?
Right. Plenty of people can find a squeeze. Fewer let go completely, and that's where a lot of the trouble comes from.
Close. The release is the one worth checking, though. A squeeze without a full let-go leaves the muscle partly switched on.
5
Lesson 5 · 4 min
Toilet, bladder and bowel habits
The changes that cost nothing and often do the most.

Your bladder and bowel learn from what you do, for better or worse.

The short version

  • Sit down, don't hover. Hovering keeps the pelvic floor switched on, so you never fully empty.
  • Give it time and go gently. Straining is the habit worth changing first.
  • Going "just in case" over and over teaches your bladder to start signalling earlier.
  • Constipation and pelvic floor symptoms travel together, so sorting one usually helps the other.
Lean forward, elbowson knees, belly soft Knees a little higherthan your hips A small stool works,or a stack of books
Same position for bladder and bowel. Sit down properly, get comfortable, give it a moment.
Worth trying
  • Sit fully down, every time, including in public toilets
  • Feet supported so knees sit slightly above hips
  • Let the belly go soft rather than pushing
  • A few slow, easy breaths at the end, once you have finished
  • Go when you need to, not on a schedule of "just in case"
Worth easing off
  • Hovering over the seat
  • Pushing or straining to get started or finished
  • Rushing, or going with one eye on the door
  • Scrolling your phone and sitting there for ages
  • Cutting fluids right down to reduce trips
One easy experiment. At the end of every toilet visit, stay sitting and take a few normal-sized breaths with a slightly longer in and out. The pelvic floor is at its most relaxed just after emptying, so it's a good moment to let it settle, and it often helps finish the job. Try it for a couple of weeks and keep it if it helps.
Fill in your bladder diaryThe same 2-day diary we hand out in clinic. The single most useful thing you can bring to a first appointment.
+ Tell me more

Most people go somewhere between four and eight times a day, and plenty sleep right through. If you're well outside that, it's worth knowing rather than worth worrying about. Two days of a diary will tell you far more than trying to remember, and there's no wrong answer to write down.

Constipation matters more than people expect. A bowel that's hard to empty means straining again and again, and that loads the pelvic floor and everything supporting it. Fibre, fluid and not rushing on the toilet do a lot here.

You're heading out and don't need to go. What's the better habit?
Yes. Emptying a bladder that isn't full, over and over, teaches it to signal at smaller and smaller volumes.
Not quite. Habitual "just in case" trips train the bladder to signal earlier, and drinking less usually makes urgency worse.
6
Lesson 6 · 3 min
What actually happens if you come in
The bit most people are actually worried about.

It starts as a conversation in a private room with your clothes on. Everything after that's your decision.

How a first appointment usually goes

You talk, we listenWhat's happening, when it started, what it's stopping you doing, and what you'd like to get back to. This is most of the first visit.
We look at how you move and breatheFully clothed. Posture, breathing, how you brace, how you get up off a chair, and often how you walk or squat.
An internal assessment may be offeredIt's the clearest way to see what the muscles are doing. It's also optional, and it's never needed to start treatment. Plenty of people begin without one.
You leave with a planUsually two or three things to try, in your own words, plus what to expect and when to check back in.

About consent

Nothing happens without you agreeing to it first, and agreeing once doesn't lock you in. Ask questions, ask for a chaperone, ask what something is for, ask to stop, change your mind halfway through. None of that's awkward for us, and you won't be the first to ask. It's a normal part of the job.

Small practical things

  • Wear whatever is comfortable. You don't need special clothes.
  • An initial assessment runs around an hour. Most people book online and choose their location.
  • Bringing a filled-in bladder diary, or a few notes, makes the first visit much more useful.
  • Virtual appointments are available across BC if getting to a clinic is the barrier.
Build your "bring this with me" sheetTick what applies, add your goals, print it. Two minutes.
+ Tell me more

Worry about the internal exam keeps a lot of people away for years, and that's completely understandable. It's one tool among several. If it isn't right for you, or isn't right yet, there's still plenty to assess and plenty to work on.

Progress isn't usually a straight line, and function tends to improve before symptoms fully settle. Getting through a workout, sleeping through the night, going somewhere without mapping the toilets. Those changes often come first, and they count.

Is an internal examination required to see a pelvic health physiotherapist?
Correct. It gets offered and explained, and it's entirely optional. You can start treatment without one.
Not quite. It may be offered because it gives good information, but it's optional and you can say no at any point.

You don't need to have it figured out before you book.

Bring your questions, or bring nothing at all. An assessment is a conversation first, you set the pace, and you decide what happens next.

Book pelvic health physiotherapy See the tools first

A note on what this is

Lift & Let Go is educational and supports the care you receive from your clinician. It doesn't replace individual medical advice, and it can't tell you what's going on in your body. If you have new, severe or worsening symptoms, or any concern during pregnancy, please contact your healthcare provider. If you can't pass urine at all, have heavy bleeding, a fever with pelvic pain, or new numbness in the saddle area or both legs, seek care promptly.

© Tall Tree Integrated Health · talltreehealth.ca

The tools

Things you can actually use

Tap one to open it. Fill it in, print it, bring it with you. It all stays on this device, and nobody else sees any of it.

Nothing you type here goes anywhere. It stays in this browser.

Down-training breathing timer

Normal-sized breaths, a bit longer in and out. Less effort is better.
This isn't deep breathing. Keep the breath a normal size and just let it take a bit longer. Most people put in far too much effort, which is a very easy mistake to make. If it feels like work, do less.
Ready
0 breaths
Set your seconds below, then press start
Sit or lie somewhere comfortable. Nothing to achieve here. Let your jaw, shoulders and belly go soft.
Breathe in
4s
Breathe out
6s
For how long
3min
A good moment for this: the end of every toilet visit. Your pelvic floor is at its most relaxed just after emptying, so that's a good time to let it settle. Stay sitting and take a few.

Pelvic floor exercise coach

Times the lift, and the full release that matters just as much.
Cues for
Hold for
5s
Rest for
8s
Repetitions
8
Rest at least as long as you hold. If you can't feel a clear release before the next one starts, that's worth listening to. Make the rest longer, or the hold shorter.
Ready
Get comfortable. Sitting, lying or standing all work. Keep breathing throughout.
Please don't practise by stopping your urine mid-stream. And if any of this brings on pain, stop. Pushing through isn't the answer here, and it's worth getting assessed. For some pelvic floors the relaxing is the work, and squeezing comes later.

The urge card

Five steps for the moment it hits. Built for your phone.
Step 1 of 5

Stop moving

Don't rush for the toilet. Stand still or sit down. Moving fast makes the urge stronger.

Urges come in waves. They rise, peak and settle. Getting through two or three without running teaches your bladder that the signal isn't an emergency. The first few times are the hardest.

Bladder diary

A 2-day log of your fluid, your voiding pattern and any leaks.
This is the same diary we hand out in clinic. Pick two ordinary days, fill it in as you go rather than from memory, and don't change your habits for it. We want your normal, and nothing you write down will surprise us.

How to fill it in

Voids: duration and urgencyCount seconds while you're urinating (1-1000, 2-1000...) and note how strong the urge was, 0 to 4. More than one void in an hour: separate them with a slash.e.g. 4/5 — urge 3
Wake and sleep timesWrite in the time column when you wake up and when you go to bed, so we can work out your daytime voiding average.
Fluids: ounces and typeRecord everything you drink, type and amount. One measuring cup is 8 oz. Include liquid foods like soup and ice cream.e.g. 8 / Orange Juice
Leaks: type and amountMark U for urge (didn't reach the washroom in time) or S for stress (cough, jump, laugh). Then rate the amount 1 to 4.e.g. S/cough — 2
Degree of urge (0-4)
0
None
1
Mild
2
Moderate
3
Severe
4
Urgent
Urinary leak amount (1-4)
11 to 2 drops. No need to change underwear.
2Wet underwear. Need to change.
3Wet pants. Also need to change outer pants.
4Wet floor. Full loss of bladder control.
Time Voidseconds · urge 0-4 Drinkounces + type LeakU / S · 1-4
Largest void
—
# voids
0
Total fluid
0 oz
# leaks
0

These four add up as you type. Everything else is yours to work out at the end.

After 2 days, work out your totals

hours awake ÷ number of voids
times up at night
+1 per 8 oz water, −1 per 8 oz caffeine or alcohol
average per day
yes or no
Bring the finished diary to your next appointment. It tells us more about your triggers and your options than almost anything else you could bring.

Bring this with me

Two minutes now saves ten at your first appointment.
Tick as many as apply. There's no wrong combination, and none of it's embarrassing to us.
This one shapes your plan more than anything else, so answer it however it actually is.

Quick refreshers

Two minutes, swipe through

How to train your pelvic floor properly

1

Find the right muscles

Imagine gently stopping yourself from passing wind, then draw that feeling up and in. You're after a lift. Nothing should push down.

Please don't practise by stopping your urine mid-stream. It's a one-off check at most.
2

Breathe, don't brace

Keep breathing the whole time and breathe out gently as you lift. If you're holding your breath or gripping your stomach, you're bringing in the wrong muscles.

Buttocks, thighs and jaw stay relaxed. If they join in, do less.
3

Lift, and then fully let go

The release matters as much as the squeeze. Let everything come all the way back down between reps, and give it as long as the hold.

If you can't feel the release yet, that's common. Start there.
4

Quality beats quantity

A handful of well-controlled reps does more than a long rushed set. When the quality drops off, stop. That's your number for today, and it will change.

Your physio will set the right dose for you. It's different for everyone.
5

Train both kinds

Longer holds build the endurance that gets you through the day. Quick sharp lifts are what you use right before a cough, a sneeze or a lift.

That quick one has a name, the Knack, and it's often the quickest way to change day-to-day leaking.
6

Attach it to something you already do

Kettle on, red light, brushing your teeth, end of a toilet visit. Habits stick when they hang off something you already do.

And get your technique checked. Plenty of people doing this from memory turn out to be doing something else entirely, through no fault of their own.

Things people believe that aren't true

Tap a card to turn it over.

Myth

"Leaking when I cough or sneeze is just part of getting older, or part of having had kids."

Tap to see what we'd say →
What we'd say

It's common, and being common is not the same as being something you have to accept. It's one of the most treatable things we see, at any age.

Myth

"Kegels are the answer to every pelvic problem."

Tap to see what we'd say →
What we'd say

Some pelvic floors are already working too hard. Those need to learn to let go before any strengthening helps. Worth finding out which one you've got.

Myth

"I should be doing hundreds of squeezes a day."

Tap to see what we'd say →
What we'd say

Technique and a full release matter far more than volume. Overdo it and you get a tired, sore muscle rather than a strong one.

Myth

"I should go to the toilet 'just in case' before I leave, every time."

Tap to see what we'd say →
What we'd say

Emptying a bladder that isn't full, over and over, teaches it to signal at smaller volumes. The urgency usually gets worse.

Myth

"Prolapse means surgery, and no more exercise."

Tap to see what we'd say →
What we'd say

Plenty of people manage prolapse well with physio, a pessary and gradual guided loading. Surgery is one option among several.

Myth

"Pelvic pain, or painful sex, is in my head and I just have to cope."

Tap to see what we'd say →
What we'd say

Pain is real, and there are physical contributors that can be assessed and treated. Being told to cope isn't the end of the conversation.

Myth

"Pelvic floor problems are a women's thing."

Tap to see what we'd say →
What we'd say

Men have a pelvic floor doing the same jobs. Leaking, urgency, post-void dribble, pelvic pain and erection trouble all sit in this territory.

Myth

"Leaking after prostate surgery is just how it's now."

Tap to see what we'd say →
What we'd say

It's common early on, and for most men it improves. Training the pelvic floor properly, ideally starting before the surgery, tends to make that recovery smoother.

Myth

"Seeing a pelvic health physio means an internal examination."

Tap to see what we'd say →
What we'd say

It may be offered, because it gives good information. It's optional, it gets explained first, you can say no, and plenty of people start treatment without one.

Take it with you

Printable guides

Free handouts from our pelvic health team. The ones that match what you told us are highlighted.

When you want a hand

Need a hand along the way?

These lessons are a starting point, and you don't have to work all this out alone. If you want someone to tell you what's actually going on for you, that's what an assessment is for.

Pelvic physiotherapyIn person or virtual across BC
PilatesGuided, graded loading
Mental healthFor when this is wearing you down
Naturopathic medicineHormonal and bladder health
VictoriaCordova Bay · Book VictoriaJames Bay · Book VancouverCommercial Drive · Book Port CoquitlamMarpole Ave · Book

A note on what this is

These tools are educational and support the care you receive from your clinician. They don't replace individual medical advice. If you have new, severe or worsening symptoms, or any concern during pregnancy, please contact your healthcare provider. Nothing you enter into these tools is transmitted anywhere. It's stored only in this browser, on this device, and clearing your browser data will remove it.

© Tall Tree Integrated Health · talltreehealth.ca