The Most Common Advice in Women’s Health — And Why It Falls Short
If you have ever mentioned a pelvic floor symptom to anyone — a friend, your OB, your mother, a fitness influencer — you have almost certainly been told to “do your Kegels.” Leaked a little when you sneezed? Kegels. Feeling pelvic pressure? Kegels. Pain during sex? Kegels. Postpartum? Kegels.
Kegels have become the default answer to every pelvic floor question, and on the surface, it seems reasonable. The pelvic floor is a group of muscles. Kegels exercise those muscles. Stronger muscles should fix the problem, right?
Not exactly. And for a significant number of women, this advice is not just incomplete — it is actively making things worse.
What a Kegel Actually Is (And Is Not)
A Kegel is a voluntary contraction of the pelvic floor muscles — a squeeze and lift. It was developed in the 1940s by Dr. Arnold Kegel as a strengthening exercise for women with urinary incontinence after childbirth.
Kegels are a strengthening exercise. That is what they do. They make the pelvic floor muscles contract harder.
What Kegels do not address:
- Muscle coordination — can your pelvic floor fire at the right time, in the right sequence, with the right amount of force?
- Muscle relaxation — can your pelvic floor fully release and lengthen after contracting?
- Speed of contraction — can your muscles react quickly enough for high-impact activities like running or jumping?
- Integration with the rest of your body — does your pelvic floor work in coordination with your diaphragm, deep core muscles, and hips?
- Breathing patterns — is your breathing creating appropriate or excessive pressure on the pelvic floor?
- Postural habits — is your alignment throughout the day supporting or stressing your pelvic floor?
- Tissue mobility — are there restrictions, scar tissue, or trigger points in the muscles that need to be addressed?
A Kegel is one exercise that addresses one dimension of pelvic floor function. Treating the full range of pelvic floor dysfunction requires addressing all of the dimensions listed above.
When Kegels Help
To be clear: Kegels are not bad. They are a legitimate exercise with good evidence behind them for specific situations. Kegels can be helpful when:
- You have confirmed pelvic floor weakness through a professional assessment
- Your muscles have good coordination but simply lack strength
- You are doing them correctly (which requires more technique than most people realize)
- They are part of a broader treatment program, not the only thing you are doing
For mild stress incontinence caused by genuine weakness — particularly in the early postpartum period — properly performed Kegels combined with other rehabilitation strategies can be very effective.
When Kegels Make Things Worse
This is the part that most women never hear, and it is critically important.
If your pelvic floor is too tight, Kegels can make your symptoms worse.
Your pelvic floor muscles need to do two things: contract and relax. A healthy pelvic floor has full range of motion — it can squeeze strongly and then release completely. Many women with pelvic floor dysfunction have muscles that are already in a chronically shortened, tense state. This is called a hypertonic pelvic floor or pelvic floor muscle spasm.
When you do Kegels on an already tight pelvic floor, you are asking muscles that cannot relax to contract even harder. Imagine making a fist and holding it as tight as you can, all day long, and then someone tells you to squeeze harder to fix the pain in your hand. That is what Kegels do to a hypertonic pelvic floor.
A tight pelvic floor can cause:
- Pelvic pain — aching, burning, or pressure in the pelvis
- Pain during intercourse
- Difficulty fully emptying the bladder
- Urgency and frequency (feeling like you always need to go)
- Constipation and straining
- Pain that radiates to the hips, low back, and inner thighs
For these women, the answer is not more strengthening. It is learning to release, lengthen, and relax those muscles — often with the help of manual therapy, breathing techniques, and relaxation training.
The Problem No One Talks About: Most Women Do Kegels Wrong
Even when Kegels are appropriate, research consistently shows that up to 50% of women perform them incorrectly when given only verbal or written instructions. Common mistakes include:
- Bearing down instead of lifting up (which pushes the pelvic floor down — the opposite of what you want)
- Squeezing the glutes, inner thighs, or abs instead of the pelvic floor
- Holding breath during the contraction (which increases downward pressure)
- Only contracting without practicing the release
- Doing too many, too often, without adequate rest
An incorrect Kegel is not just useless — it can reinforce bad patterns and contribute to dysfunction. This is one of the biggest reasons that “just do Kegels” fails so many women. Without hands-on assessment and feedback, you simply do not know if you are doing them correctly.
What Comprehensive Pelvic Floor PT Actually Includes
So if Kegels alone are not the answer, what is? Here is what a thorough, evidence-based pelvic floor treatment program looks like:
Assessment first. Before any treatment begins, a pelvic floor PT evaluates your muscles to determine what is actually happening. Are your muscles weak? Tight? Poorly coordinated? A combination? This assessment — which may include internal evaluation of muscle tone, strength, and coordination — gives you a clear starting point. Without it, any exercise program is a guess. You can learn more about what this looks like on our what to expect page.
Manual therapy. Hands-on treatment to address trigger points, scar tissue, muscle tension, and restrictions in the pelvic floor and surrounding muscles. This is something you cannot do on your own and is a significant part of why PT is more effective than a home Kegel program alone.
Breathing retraining. Your diaphragm and pelvic floor are directly connected — they move together with every breath. Dysfunctional breathing patterns (chest breathing, breath-holding, shallow breathing) can create excessive downward pressure on the pelvic floor. Retraining breathing mechanics is often one of the most impactful interventions.
Coordination and timing training. Teaching your pelvic floor to fire at the right moment — before a cough, during a lift, in response to impact. This is different from raw strength and often more important for functional activities.
Progressive loading. Gradually challenging the pelvic floor with increasing demands — from basic exercises to functional movements to sport-specific activities. If your goal is to return to running, your pelvic floor needs to be trained for running, not just trained to squeeze and hold.
Postural and movement education. How you sit, stand, lift, and move throughout the day affects your pelvic floor. Small adjustments in daily habits can reduce unnecessary stress on these muscles.
Core integration. The pelvic floor does not work in isolation. It is part of a system that includes your deep abdominals, your diaphragm, and your multifidus (deep back muscles). Effective treatment addresses the entire system. Issues like prolapse are often connected to pelvic floor dysfunction and benefit from integrated treatment.
Home program. A personalized set of exercises and strategies tailored to your specific findings — not a generic printout of Kegels.
Why a Specialist Matters
Not all physical therapists are trained in pelvic floor rehabilitation. And among those who are, the depth of training varies significantly.
A Pelvic Rehabilitation Practitioner Certification (PRPC) represents one of the highest levels of specialization in pelvic floor PT. It requires extensive post-graduate training, clinical hours, and a board examination. A PRPC-certified therapist has the skills to differentiate between a weak pelvic floor, a tight pelvic floor, a coordination problem, and a combination — and to design a treatment plan accordingly.
This distinction matters because the wrong approach can set you back. Strengthening a pelvic floor that needs to relax. Stretching a pelvic floor that needs to strengthen. Treating symptoms without addressing root causes.
Dr. Danaya holds her PRPC and brings both advanced clinical training and personal experience as a four-time postpartum mom to every patient she sees. You can learn more about her background and approach on her bio page.
What About the Exercises You See Online?
Social media is full of pelvic floor exercise programs — “30-day Kegel challenges,” “pelvic floor workout routines,” and influencers demonstrating exercises with millions of views. Some of this content is created by qualified professionals and contains good information. Some of it is not and does not.
The fundamental limitation of any online exercise program is that it cannot assess you. It does not know whether your pelvic floor is weak, tight, or both. It does not know your breathing patterns, your posture, your birth history, or your specific symptoms. It gives you a generalized program based on assumptions.
For some women, a general program may help. For others, it may do nothing. For others still, it may make things worse. The only way to know what your pelvic floor actually needs is to have it evaluated by a qualified specialist.
The Bottom Line
Kegels are not bad. They are just one small part of a much bigger picture. If you have been diligently doing your Kegels with no improvement — or if your symptoms have gotten worse — it is not because you are doing something wrong or because your body is broken. It is almost certainly because Kegels alone were never going to be enough for your specific situation.
Your pelvic floor deserves the same quality of care you would expect for any other part of your body: a thorough assessment, an accurate diagnosis, and an individualized treatment plan.