Should Women Be Doing Kegels? The Full Story
When it comes to pelvic floor health, one of the most common recommendations women hear is to just "do Kegels." No guidance on how many, why they might be helpful, or when they should be avoided. The idea behind this recommendation is simple: contract and relax the pelvic floor muscles to strengthen them. But is it really that simple? Not exactly. Let’s dive into the pros and cons of Kegels, the importance of coordination, and alternative strategies for optimal pelvic floor function.
The Pros of Kegels
Kegel exercises can be beneficial in certain situations, particularly for women who have pelvic floor weakness. Some of the benefits include:
Improved bladder control: Strengthening the pelvic floor can help reduce stress urinary incontinence, which occurs when activities like coughing, sneezing, or jumping cause leakage. For some women, Kegels can provide the muscular support needed to prevent these leaks (in some instances, but not always).
Better sexual function: Increased pelvic floor strength can enhance sensation and orgasm. Strong, responsive muscles can enhance pleasure and improve intimacy.
Support for pelvic organs: Stronger pelvic muscles can provide better support for the bladder, uterus, and rectum. Weak muscles can lead to prolapse, where these organs descend and create discomfort or dysfunction. (But let me remind you that there are other reasons these organs are wanting to descend and not just a lack of muscle strength underneath) Strengthening these muscles through targeted exercises may reduce symptoms. However, Kegels alone are not the most effective strategy for providing these organs support. We need to address the reason for the underlying dysfunction and not just cover up the symptoms.
Postpartum recovery: After childbirth, some women experience a loss of pelvic floor strength due to stretching, trauma, and lack of coordination. Kegels can help restore function and rebuild muscle tone. But again, Kegels alone are not the best approach!
The Cons of Kegels
Despite their benefits, Kegels are not a one-size-fits-all solution and can even be harmful in certain cases:
Overactivity and tension: Many women have a pelvic floor that is already too tight, leading to issues such as pelvic pain, urinary urgency, or constipation. In these cases, adding more contractions can make symptoms worse rather than better.
Lack of coordination: Strengthening a muscle without understanding how it integrates with the rest of the body can lead to further dysfunction such as constipation, pain with sex, or incomplete bladder emptying. The pelvic floor doesn’t work alone—it must coordinate with the diaphragm, deep core, and hip muscles for optimal function. We often see patients who think they have been doing kegels, but they have been doing the opposite motion the whole time!
Not addressing the root cause: A weak pelvic floor may be the result of poor breathing patterns, core dysfunction, poor hip mobility and strength, or improper posture—all of which Kegels alone do not fix. Simply squeezing the muscles without addressing these underlying factors will not solve the problem.
Can worsen pain conditions: Women with conditions like vaginismus, painful intercourse, or chronic pelvic pain may have overly tense muscles that need relaxation rather than strengthening.
Autonomic Innervation: Most of the time, we don’t consciously control our pelvic floor. It has autonomic innervation, meaning it responds automatically to things like posture, breathing, and movement. If the pelvic floor is functioning well, it should engage and release naturally when needed—without us having to think about it. That’s why just doing Kegels isn’t enough; we need to address the entire system so you don’t have to rely on having the mental space to pay attention to your pelvic floor at all times - no one has time for that!
A well-functioning pelvic floor should:
Contract automatically when we need support, such as during heavy lifting.
Relax when we need it to, such as during urination or bowel movements.
Coordinate with the breath—expanding on inhale and engaging on exhale.
The Role of Coordination in Pelvic Floor Function
The pelvic floor is not just about strength; it’s about coordination. A healthy pelvic floor needs to contract, relax, and respond to movement, pressure, and breathing in a dynamic way. Doing Kegels without understanding how to integrate them with the rest of the body can be ineffective or even counterproductive.
For example, during a squat or lifting a heavy object, the pelvic floor should naturally engage to support the body. However, if the coordination between the pelvic floor and the rest of the core system is off, women may experience symptoms such as leaking urine or increased pressure in the abdomen or pelvic floor.
What Women Can Do Instead of Just Kegels
If Kegels aren’t the best approach for everyone, what should women do instead? Here are some practical strategies:
Diaphragmatic breathing: Coordinating breath with pelvic floor movement helps restore function and balance. Learning to breathe deeply with the diaphragm allows the pelvic floor to move naturally with each breath. On an inhale, the diaphragm and pelvic floor should expand. On an exhale, they should gently recoil. Practicing this helps restore balance to the pelvic floor.
Pelvic floor relaxation exercises: For women with tight or overactive pelvic floors, learning how to fully release these muscles is essential. Practices such as child’s pose, deep squatting, or even specific guided relaxation techniques can be more beneficial than Kegels.
Functional movement training: Engaging the pelvic floor during daily activities, such as lifting, squatting, or even walking, can be more effective than isolated contractions. Functional training helps integrate pelvic floor function into real-life movements.
Core and hip stability work: Since the pelvic floor does not work in isolation, strengthening the surrounding muscles—such as the glutes, inner thighs, and deep core—supports better function. Movements like bird dogs, side planks, and dead lifts can be helpful.
Postural awareness: Poor posture, especially excessive tilting of the pelvis forward or backward, can place unnecessary stress on the pelvic floor. Learning to align the pelvis properly through gentle mobility exercises and core engagement can improve function.
Mind-body approaches: Practices like yoga, Pilates, and even certain breathwork techniques can promote pelvic floor coordination and relaxation.
Final Recommendation: See a Holistic Pelvic Floor Therapist
Since every woman’s pelvic floor is different, the best approach is individualized care. A holistic pelvic floor therapist can assess your unique needs, help you find the right balance between strength and relaxation, and integrate pelvic floor function with whole-body movement. Instead of relying on generic advice to "just do Kegels," working with a specialist ensures that your pelvic floor—and entire body—functions optimally.
A holistic approach includes:
A comprehensive assessment of pelvic floor function, breath patterns, and movement habits.
Identifying whether tightness, weakness, or coordination issues are the root cause of symptoms.
Hands-on techniques, movement strategies, and exercises tailored to your body rather than a one-size-fits-all Kegel plan.
Integrating the pelvic floor into everyday movement for a natural, automatic response.
If you’re unsure about your pelvic floor health, consider scheduling an evaluation with a pelvic floor therapist who takes a holistic approach to care like Moms in Motion PT. Your body will thank you!
Request an appointment here and we will be in touch with you shortly!