When I founded Indigo Physiotherapy in 2016, few people were openly discussing pelvic floor health. Perinatal and perimenopausal symptoms, pelvic pain, and incontinence were often dismissed as inevitable parts of life. While awareness has grown—thanks in part to social media—misinformation remains widespread. Among the most common misconceptions? That kegels are the universal fix for pelvic floor dysfunction.
So let’s set the record straight: kegels are not always the answer. And in some cases, they can do more harm than good.
What Is a Kegel, and Why Is It Overprescribed?
A kegel is a contraction of the pelvic floor muscles. Named for Dr. Arnold Kegel, who began prescribing these contractions in large quantities for women he was treating in 1948, the pelvic floor contraction was actually first introduced by pioneer women’s health physiotherapist and choreographer Margaret Morris, who began studying the pelvic floor in 1936. Obviously, her name and claim to fame never hit stride like Dr. Kegel’s, who admittedly did a lot to bring attention to pelvic health and pelvic floor dysfunction.
Your pelvic floor is a complex network of three muscle layers that provide:
- Organ support (bladder, uterus/prostate, rectum)
- Core and pelvic stability
- Sphincter control (preventing leaks)
- Sexual function
Many people assume that if they experience leaking, they must have a weak pelvic floor and should do kegels to strengthen the pelvic floor. But here’s the reality: tight doesn’t always mean strong, and weak doesn’t always mean loose. In reality, a tight muscle is actually a tense muscle, unable to keep up with the demands placed upon it (through exercise and/or daily activities). And if a muscle cannot elongate to go through its full length and range of motion, it subsequently can’t do its job effectively.
When Kegels Can Make Things Worse
In pelvic physical therapy, we see many clients who have been overdoing kegels—sometimes doing 100+ per day. This can actually lead to a hypertonic (too tight) pelvic floor, causing:
- Pain during intercourse or tampon use
- Difficulty emptying the bladder or bowels
- Tailbone pain and tension
- Increased risk of pelvic pain disorders
Your pelvic floor muscles aren’t large, global muscles like your glutes or quads. Doing hundreds of contractions a day would be like repeatedly clenching your fist for hours—eventually, your hand would cramp up and lose function. The same happens with your pelvic floor.
Quality of the pelvic floor contraction is much more important than quantity.
The Right Way to Strengthen Your Pelvic Floor
These muscles shouldn’t be trained by just “squeezing really hard,” often prescribed like stopping the flow of urine (and please never do that when sitting on the toilet, it trains the bladder to empty incompletely).
Pelvic floor contractions SHOULD be performed with breath coordination to avoid compensations and possibly pushing down through the pelvic floor (which can make prolapse or incontinence worse). A correct contraction involves:
- Inhale deeply—expanding your belly with a diaphragmatic breath. A diaphragmatic breath should not only expand your belly, but also the rib cage in all directions.
- Exhale gently—while doing a gentle pinch, squeeze and lift of the pelvic floor.
- Release fully—imagine your sit bones (ischial tuberosities) getting farther apart. Because relaxation is just as important as contraction.
Good training with kegels may only be a small number of reps a day!
And did you know that other exercises, like bridges or squats, when combined with pelvic floor muscle contractions, can be more effective than kegels alone? Our pelvic floor does not work in isolation just laying on our backs. We need to train our body for the functional demands we face every day!
What Should You Do Instead?
Get assessed by a pelvic floor therapist. A skilled PT will perform an internal and external evaluation to determine if your pelvic floor is weak, tense, or both—and develop a tailored plan to address your symptoms, including training you in home exercises, tools or stretches specific to your presentation. Both men and women have a pelvic floor and can benefit from pelvic floor physical therapy.
Avoid biofeedback-only approaches. If a provider puts you on a machine and tells you to do 100 kegels per session, that’s a red flag. Find someone else.
Listen to your body. If kegels cause discomfort, pain, or worsening symptoms, stop and consult an expert.
- If you are postpartum, wait until any tear has fully closed (usually when your medical provider has instructed you that you can return to sexual penetration.)
- If you have any deep hip, low back, or pelvic pain that is aggravated either during or after doing kegels or pelvic floor muscle contractions, stop doing them and consult a pelvic physical therapist
- If you have been doing kegels regularly, and your symptoms aren’t improving, it’s very likely you’re chasing the wrong answer or not performing them correctly- see an expert pelvic physical therapist.
Train holistically. The pelvic floor doesn’t work in isolation—it’s part of a larger system. Addressing hip mobility, breathwork, and core/hip/glute strength is often more effective than kegels alone.
The Bottom Line
Pelvic floor health is nuanced, and kegels are not a one-size-fits-all solution. The pelvic floor muscles are small muscles that may need lengthened with stretching and/or strengthened with lower repetition, high quality contractions. Additionally, they benefit from strengthening the surrounding musculature of the core and glutes.
If you’ve been doing kegels without improvement—or if you’re experiencing pain, leakage, or tightness—it’s time to see a pelvic floor physical therapist.
At Indigo Physiotherapy, we take a whole-body, science backed approach to pelvic health. Our expert clinicians assess your unique needs and guide you toward effective, evidence-based treatments—no cookie-cutter solutions, no unnecessary kegels.
