“Why more Kegels aren’t always the answer”
Say "pelvic floor" and most women think of one thing: Kegels.Leaking when you sneeze? Do Kegels. Running to the bathroom? Do Kegels. Just had a baby? Do Kegels.
Kegels can be a great tool. But here's something I wish every woman knew: your pelvic floor needs to know how to relax just as much as it needs to know how to squeeze. And for some women, more Kegels can make things worse.
What your pelvic floor actually does
Your pelvic floor is a group of muscles that sits like a hammock at the bottom of your pelvis, from your pubic bone in the front to your tailbone in the back. It holds up your bladder, bowel, and uterus.
A healthy pelvic floor does three jobs:
Tightens when you need support, like when you cough, lift, or jump.
Relaxes when you need to let go, like when you pee, have a bowel movement, or have sex.
Works with your breathing. It moves down a little when you breathe in and back up when you breathe out.
Think about your biceps. A strong bicep can curl a heavy bag. But if you kept it flexed all day, it would get tired, sore, and actually weaker. Your pelvic floor works the same way.
When the problem is too much tension
Lots of us hold tension without noticing. We clench our jaw at the computer. We tighten our shoulders in traffic. We suck in our stomach all day. And often we hold our pelvic floor tight too.
Over time, a pelvic floor that can't fully let go can show up as:
Needing to pee often, or sudden strong urges
Trouble starting your stream, or feeling like you didn't fully empty
Constipation or straining
Pain or discomfort with intimacy
Pain in your tailbone, hips, or low back that doesn't seem to go away
Leaking, because a muscle that's always tight has nothing left to give when you cough or sneeze
If your muscles are already tight, adding more squeezing is like asking that flexed bicep to flex harder. It doesn't fix the problem.
Even when you need strength, how you do it matters
Kegels aren't the enemy. Plenty of women do need more strength.
But the details matter. In one well-known study, only about half of women could do a correct Kegel after a quick verbal explanation. Some were even bearing down, which is the opposite of what you want.
So if you've been doing Kegels faithfully and nothing has changed, it doesn't mean you failed. It may mean you need a different plan.
Try this: a pelvic floor relaxation breath
This takes a few minutes and can help you feel what "letting go" is like.
Lie down with your knees supported, or sit with your feet flat on the floor.
Place your hands around the sides of your lower ribs.
Breathe in slowly through your nose. Let your ribs and belly gently widen. Picture your pelvic floor softening and dropping, like a hammock that sways down.
Breathe out naturally. Don't squeeze or force anything.
Repeat for 5 to 8 slow, easy breaths.
The goal isn't to do anything. It's to stop doing so much.
How a pelvic floor PT can help
You can't tell whether your muscles need strength, relaxation, or better coordination just by guessing. Most women need a mix of all three.
That's what a pelvic floor evaluation is for. We look at how your muscles squeeze, how they let go, and how they work with your breath and the rest of your body. Then you get a plan that fits what your body actually needs, not a one-size-fits-all list.
It's one-on-one and private, and you'll have time to ask every question you've been holding onto.
You don't have to keep guessing
If you've been doing Kegels and still have leaking, urgency, constipation, or pain, that's your sign to get it checked. Common doesn't mean you have to live with it.
If this sounds familiar, let's talk. Email me at emily@essentialmovementpt.com or request an appointment here.
— Dr. Emily, Essential Movement Physical Therapy
This post is for education only and isn't a diagnosis. If you have new or changing symptoms, talk with your healthcare provider.
Sources
Bump RC, et al. "Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction." American Journal of Obstetrics and Gynecology, 1991: https://pubmed.ncbi.nlm.nih.gov/1872333/
Pelvic Floor First (Continence Foundation of Australia), "The hypertonic pelvic floor": https://www.pelvicfloorfirst.org.au/?p=412
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