What Are Hypopressives?
An evidence-informed guide to pelvic floor & core recovery
QUICK FACTS
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A breathing & postural exercise method for pelvic floor and core rehabilitation
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Developed by physiotherapist Dr Marcel Caufriez in the 1980s
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Used to support people with pelvic organ prolapse, urinary incontinence & core dysfunction.
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Focuses on breathing, posture and pressure management rather than isolated pelvic floor contractions
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Supported by a growing body of research, including randomised controlled trials
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Published UK service evaluation of 140 women with pelvic organ prolapse
Hypopressives are a specialised breathing and postural exercise method designed to improve the way your pelvic floor, deep abdominal muscles and diaphragm work together.
They combine specific body positions with controlled breathing techniques to encourage an automatic activation of the deep core and pelvic floor muscles, while helping to manage pressure within the abdomen.
Originally developed in the 1980s to support women recovering from pelvic floor problems after childbirth, hypopressives are now used internationally by pelvic health physiotherapists, healthcare professionals and exercise specialists to support people with conditions such as pelvic organ prolapse, urinary incontinence, core weakness and diastasis recti.
Unlike traditional pelvic floor exercises, which focus on consciously contracting the pelvic floor muscles, hypopressives aim to improve the body's natural postural and breathing mechanics, helping your pelvic floor respond more effectively during everyday activities such as lifting, walking, coughing and exercise.
Research into hypopressives has grown considerably over the past decade, with multiple randomised controlled trials reporting improvements in pelvic floor symptoms, quality of life and deep core function.
Alongside this published evidence, our 2024 UK service evaluation involving 140 women with pelvic organ prolapse found an average 73% improvement in prolapse symptoms and quality of life following the Create Lift® programme. Read our Service Evaluation.
Whether you're completely new to hypopressives or wondering whether they're right for you, this guide explains how they work, what the current evidence says, who they may help and how to get started safely.
How do hypopressives work?
The pelvic floor doesn't work in isolation. Every breath you take, every step you walk and every time you lift, cough or laugh, your diaphragm, abdominal muscles and pelvic floor work together to manage pressure inside your abdomen.
When this coordination isn't working efficiently, or pressure repeatedly pushes downwards onto the pelvic floor, symptoms such as prolapse, urinary leakage or a feeling of heaviness may become more noticeable.
Hypopressives combine posture, breathing and periods of breath holding (known as apnoea) to activate the core muscles that support your trunk and pelvis. This includes the pelvic floor, the transversus abdominis (your deepest abdominal muscle), the diaphragm and other postural muscles.
The aim isn't simply to strengthen one muscle. Instead, hypopressives train the whole pressure management system, helping these muscles work together more effectively during everyday life.
Many people also notice improvements in posture, breathing mechanics, rib cage mobility and body awareness, all of which may contribute to better pelvic floor function over time.
What does the research say?
Interest in hypopressives has increased significantly over the last decade, and the research base continues to grow.
Several randomised controlled trials have investigated hypopressives for pelvic organ prolapse, urinary incontinence and deep core recovery.
While more high-quality research is still needed, current studies suggest hypopressives may improve pelvic floor symptoms, quality of life and abdominal function for many women.
Research has reported improvements in:
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Pelvic organ prolapse symptoms
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Stress urinary incontinence
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Urge urinary incontinence
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Quality of life
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Deep abdominal muscle activation
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Diastasis recti (abdominal separation)
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Posture and trunk stability in some studies
Alongside the published research, our 2024 UK service evaluation followed 140 women with diagnosed pelvic organ prolapse who completed the Create Lift® programme. On average, women reported a 73% improvement in prolapse symptoms and quality of life, with the majority achieving improvements of 50% or more.
While individual results vary, both the published evidence and our clinical outcomes suggest hypopressives may offer a valuable option for people seeking a conservative, exercise-based approach to pelvic floor rehabilitation.
How can hypopressives help?
Hypopressives are most commonly used as part of a conservative rehabilitation programme for people experiencing pelvic floor and deep core dysfunction. Rather than focusing on one symptom in isolation, they aim to improve the way your breathing, posture, diaphragm, abdominal muscles and pelvic floor work together, to create improvements.
Research and clinical experience suggest hypopressives may help improve a range of symptoms and conditions, particularly when taught as part of a structured programme.
These include:
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Pelvic organ prolapse
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Stress urinary incontinence
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Urge urinary incontinence
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Diastasis recti (abdominal separation)
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Feelings of pelvic heaviness or dragging
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Deep core weakness
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Reduced postural control
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Breathing mechanics and rib cage mobility
Everyone is different, and no exercise programme can guarantee results. However, growing research alongside our published hypopressives service evaluation suggests many women experience meaningful improvements in symptoms, confidence and quality of life.
What does the research say?
Research into hypopressives has grown considerably over the past decade, particularly in the areas of pelvic organ prolapse, urinary incontinence and deep core recovery. While more high-quality research is still needed, the current evidence suggests hypopressives may offer a valuable conservative treatment option for many people experiencing pelvic floor dysfunction.
Several randomised controlled trials have reported improvements in prolapse symptoms, urinary incontinence and quality of life with hypopressives. Other studies have found improvements in deep abdominal muscle function, and emerging evidence suggests hypopressives may also support recovery from diastasis recti.
As with all rehabilitation research, no single study provides the complete picture. Individual results vary, and hypopressives are not a guaranteed solution for everyone. However, when the published research is considered alongside clinical experience, the overall findings are encouraging.
What has the research found?
Current research suggests hypopressives may help improve:
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Pelvic organ prolapse symptoms and quality of life
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Stress urinary incontinence
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Urge urinary incontinence
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Deep core muscle function
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Diastasis recti (abdominal separation)
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Posture and breathing mechanics in some studies
Researchers continue to investigate who benefits most from hypopressives, how they compare with other rehabilitation approaches and the most effective ways to deliver treatment. As the evidence base grows, our understanding of where hypopressives fit within pelvic floor rehabilitation will continue to develop.
Alongside the published research, we wanted to better understand the outcomes women were achieving through the Create Lift® programme.
In 2024, we published a UK service evaluation involving 140 women with diagnosed pelvic organ prolapse who completed the Create Lift® programme (14-week one-to-one programme). The evaluation looked at women's experience of accessing our service and also outcomes in terms of prolapse symptoms and quality of life before and after completing the programme.
Overall, we found:
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An average 73% improvement in prolapse symptoms and quality of life.
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94% of women reported improvements of 50% or more.
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61% reported improvements of 70% or more.
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Women had been living with symptoms for an average of 37 months before joining the programme.
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Improvements were reported across women with anterior, posterior and apical prolapse (single, double or triple), with Stage I, II and III (with one individual with Stage IV prolapse).
Although a service evaluation cannot demonstrate cause and effect, it provides valuable insight into how women responded to hypopressives when delivered as part of a structured rehabilitation programme.
You can read a summary of our findings below or download the full published service evaluation.
What does this mean?
The current evidence suggests hypopressives may play an important role in conservative pelvic floor rehabilitation, particularly those experiencing pelvic organ prolapse, urinary incontinence and deep core dysfunction who haven't responded to traditional conservative treatments.
Like any rehabilitation programme, results vary from person to person, and there is no single approach that is right for everyone. The most appropriate treatment will always depend on your individual symptoms, assessment and goals.
What gives us confidence is the combination of growing published research, our own experience and the outcomes we've seen through our published UK service evaluation. Together, they suggest that hypopressives may offer a safe, evidence-informed option for many people looking to improve their pelvic floor and core function without surgery.
What the current research into hypopressives suggests:
Pelvic Organ Prolapse: Multiple randomised controlled trials (RCTs) have reported improvements in prolapse symptoms and quality of life with hypopressives.
Urinary incontinence: Several studies have found reductions in urinary incontinence and improvements in symptom severity, pelvic floor function and quality of life.
Diastasis recti: Early research suggests hypopressives may improve abdominal separation.
Deep core function: Studies have reported improvements in activation of the deep abdominal muscles involved in trunk stability.
Quality of life: Across several studies, participants reported improvements in pelvic floor symptoms and day-to-day quality of life.
The evidence continues to grow. Most published studies have involved relatively small numbers of participants, and further high-quality research will help us better understand which people benefit most and how hypopressives compare with other rehabilitation approaches. However, the findings to date are encouraging and support hypopressives as a promising conservative option for pelvic floor rehabilitation.
Key Hypopressives Research Studies:
Study | Study Type | Main Finding |
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Mitchell et al. (2025) | Systematic review | Review of RCTs: found HEs better for QOL; PFMT better for PF strength |
Katz & Barbosa (2023) | Systematic review | Reviews the current evidence base and highlights encouraging findings alongside the need for further research |
Ramírez-Jiménez et al. (2023) | Randomised controlled trial | Positive changes in diastasis recti and core recovery |
Molina-Torres et al. (2023) | Randomised controlled trial | Improvements in urinary incontinence outcomes |
Moreno-Muñoz et al. (2021) | Clinical study | Improvements in diastasis recti |
Parle et al. (2021) | Clinical trial | Improvements in prolapse symptoms with 8 week hypopressives programme |
Navarro-Brazález et al. (2020b) | Randomised controlled trial | Positive effects on pelvic floor symptoms and quality of life |
Navarro-Brazález et al. (2020a) | Randomised controlled trial | Improvements in pelvic floor muscle function and urinary incontinence |
Resende et al. (2019) | Randomised controlled trial | Improvements in prolapse symptoms and quality of life |
Frequently asked questions about hypopressives
Question | Quick answer |
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What are hypopressives? | A breathing and postural exercise method that supports pelvic floor and deep core function |
Who are they for? | People with pelvic organ prolapse, urinary incontinence, diastasis recti and deep core dysfunction |
Do they work? | Research suggests they improve symptoms for many people, although results vary |
How long does it take? | Many women notice changes within the first few weeks, while others can take longer depending on their symptoms |
Are they safe? | They are suitable for many people but there are important contraindications, so professional guidance is recommended |
What are the main contraindications? | Uncontrolled high BP, pregnancy, heart conditions, recent surgery, COPD and some hernias. There are others so check with your hypopressives trainer before starting |
Are hypopressives evidence-based?
As interest in hypopressives has grown, so has the amount of published research. While the evidence base is still developing, several randomised controlled trials have reported improvements in pelvic organ prolapse symptoms, urinary incontinence, quality of life and deep core function following structured hypopressives programmes.
Like many areas of women's health and rehabilitation, more high-quality research is still needed, and hypopressives are not a guaranteed solution for everyone. However, the current evidence suggests they may be a valuable conservative treatment option for many people experiencing pelvic floor dysfunction.
If you'd like to explore the research in more detail, you can find a summary of the current evidence above.
Do hypopressives work?
Every person is different, so no exercise programme can guarantee results. Factors such as your symptoms, how long you've had them, your overall health, genetics and how consistently you practise can all influence your progress.
Research suggests hypopressives may improve symptoms of pelvic organ prolapse, urinary incontinence and deep core dysfunction for many people. In our own programme experience, we've also seen many women regain confidence in everyday activities such as walking, exercising, lifting their children and returning to the activities they enjoy.
The key is learning the technique correctly and following a structured programme that's appropriate for your individual needs.
How long does it take for hypopressives to work?
Everyone progresses at their own pace, but many women tell us they begin noticing improvements within the first few weeks. This might include feeling less pelvic heaviness, improved bladder control or not thinking about their symptoms so much.
For others, progress is more gradual, particularly if symptoms have been present for several years or if other factors are contributing to pelvic floor dysfunction.
Like any rehabilitation programme, consistency is important. Regular practice over several months is usually needed to achieve meaningful and lasting improvements.
Can hypopressives help pelvic organ prolapse?
Pelvic organ prolapse is one of the most common reasons people discover hypopressives. Many women come to us after trying pelvic floor exercises or other treatments, changing their activity levels, and about 1 in 2 are already considering surgery.
Hypopressives aim to improve the way your diaphragm, deep abdominal muscles and pelvic floor work together. By combining posture, breathing and pressure management, they help improve the support and function of the pelvic floor during everyday activities such as walking, lifting, coughing and exercise.
Research into hypopressives for pelvic organ prolapse has grown considerably over the last decade. Several randomised controlled trials have reported improvements in prolapse symptoms and quality of life following structured hypopressives programmes. While more research is still needed, the findings to date suggest hypopressives may be a valuable conservative treatment option for women with prolapse.
Are hypopressives better than Kegel exercises?
It's a question we're asked all the time, but the answer isn't quite as simple as saying one is "better" than the other.
Pelvic floor muscle training (Kegels) remains the recommended first-line conservative treatment for many pelvic floor conditions because it has the largest body of research supporting its use. Current clinical guidelines are based on this extensive evidence.
Hypopressives are a newer approach, and although the research base is growing, it is still much smaller. Encouragingly, a large randomised controlled trial by Navarro-Brazález (2020) and colleagues found that women who completed hypopressives, pelvic floor muscle training, or a combination of both all experienced significant improvements in pelvic floor symptoms, quality of life and pelvic floor muscle function, with no statistically significant differences between the three groups.
Rather than viewing them as competing approaches, it's often more helpful to think about which rehabilitation programme is the best fit for your individual symptoms, pelvic floor function and goals. Some women benefit from pelvic floor muscle training, some from hypopressives, and some from a combination of both.
As research continues to develop we'll gain a clearer understanding of who benefits most from each approach. At the moment, pelvic floor muscle training remains the gold standard because of its stronger evidence base, while hypopressives are an increasingly researched option that may offer meaningful benefits for many women. Hypopressives in the clinical setting may be particularly useful for those who haven't gained meaningful benefit from pelvic floor muscle training, have a hypertonic pelvic floor, those who can't squeeze their pelvic floor and those who are awaiting surgery but keen to avoid it.