How to Choose a Pelvic Floor App, Including Ours

We make one of these, so read this with that in mind. What follows is the list of questions we would ask about any pelvic floor app, including ours, and at the end we answer all seven about Pelvi in public, including the two where the answer is not flattering.

Before anything else: you may not need an app

The treatment that guidelines recommend first is supervised pelvic floor muscle training, at least three months of it, for stress or mixed urinary incontinence (NICE NG123). The word supervised is doing real work in that sentence. In one study, after brief verbal instruction only 49% of women produced an ideal pelvic floor contraction, and 25% used a technique that could actively promote incontinence (Bump et al., 1991).

No phone can tell whether you are lifting or bearing down. If you have never been assessed, the highest-value thing you can buy is not a subscription, it is one appointment. What happens in that appointment is here. The right role for an app is doing the work between appointments, which is most of the work.

The three kinds of pelvic floor app

Nearly everything in the stores falls into one of three groups, and they are not competing with each other so much as solving different problems.

Published evaluations of this market are not flattering. One review found 120 pelvic floor apps in the stores and scored 32 in detail; only about a third cited any primary literature at all (Barnes et al., 2019). Popularity and a good rating tell you about the onboarding, not about the clinical content.

Seven questions to ask before you subscribe

1. Does it know the difference between weak and tight?

This is the question that matters most, because getting it wrong makes symptoms worse rather than merely wasting time. A pelvic floor that is short and overactive needs release before strength, and a strengthening program handed to it will increase urgency, ache and pain with sex. At minimum, an app should ask about pain, urgency and painful sex during onboarding, and should route those answers somewhere different from "more contractions". If the only path through the product is strengthening, it has answered no.

2. Can it deliver the guideline dose, for the guideline duration?

The prescription is at least 8 contractions three times a day, sustained for at least three months (NICE NG123). Look at the app's own program length. A seven-day challenge is not a course of treatment, and a plan that runs out in three weeks is measuring against the wrong yardstick. The dose, and how to split it, is here.

3. Does it progress, or does it repeat?

Muscles adapt to demand. If week nine is the same session as week one, nothing is being asked of you that was not already easy. Real progression shows up as longer holds, harder positions, then movement, then load: lying, sitting, standing, walking, lifting, jumping. Ask whether the app ever gets you upright and moving, because that is where leaking actually happens.

4. Can you see the movement?

Written instructions are how people end up training the wrong muscle, which is the whole finding of the technique study above. Video is not a luxury here. Check that the exercises are actually filmed and demonstrated rather than described in a paragraph next to an illustration.

5. Does it measure anything a clinician would recognise?

Streaks and minutes measure the app. They do not measure you. The instruments clinicians recognise are the ICIQ-UI SF for urinary symptoms and the PFDI-20 for the wider picture, and an app that captures those gives you something you can hand over at an appointment. Both are explained here, and you can score yourself with them whether or not your app supports them.

6. Who made the content, and will they say?

Look for a named person with verifiable credentials and a real page you can check: a licence number, a practice, a professional profile. A stock photo captioned "our medical team", or a named doctor whose name returns nothing anywhere on the web, is worse than no claim at all, because it tells you what the company does when nobody is checking.

7. What does it do when you get worse?

Every serious product needs an off-ramp. Ask what happens if you report pain, or a bulge, or blood. A good app tells you to stop and see someone, by name, with a link. A bad one has no field for that information at all and offers you tomorrow's session regardless.

How Pelvi answers its own questions

Marked honestly. Two of these are a no, and we would rather you read that here than find out after paying.

Delete it immediately if it does any of these

• Promises to cure prolapse, or to guarantee you will never leak again. Neither is a claim any evidence supports.
• Tells you to push, bear down or strain as part of a pelvic floor exercise.
• Has no way to report that things got worse, and no point at which it tells you to see someone.
• Escalates the dose without ever checking technique. Hundreds of repetitions a day is a red flag on its own.
• Names a clinician you cannot find anywhere else. Try searching the name and the credential. It takes thirty seconds.
• Cannot be cancelled from inside the app, or hides what it will charge you and when.

The honest limits of any app

The evidence base supports the training, not the delivery mechanism. Pelvic floor muscle training works: eight times more likely to report cure of stress incontinence than no treatment, 56% versus 6% across four trials graded high-quality (Cochrane, 2018). An app is a way of getting that training done consistently for three months, which is genuinely hard and genuinely where most people fail. It is not a second opinion, it is not an examination, and it cannot see what you are doing.

The best outcome, for most people, is both: one assessment to find out what is actually wrong, and then something that gets the work done on the two hundred days when nobody is watching.