Why Kegels Aren’t For Everyone: A Pelvic Floor Therapist’s Perspective

For the longest time, kegels were considered the gold standard exercise for proper maintenance of your pelvic health, for men and women both! The concept was that everyone should do as many kegels as possible to keep your pelvic floor muscles healthy and strong. We are flooded with this concept from the internet, OBGYNs, and even our own family and friends. Any pelvic health condition, whether that be incontinence, prolapse, or pain with sex, kegels were considered to be the cure-all. However, while kegels are used to build strength in the pelvic floor muscles, they’re not a universal remedy. 

As a pelvic floor therapist, I hear this daily- so, let’s unpack why Kegels aren’t a one-size-fits-all remedy: 

1. Not all pelvic floor muscles are weak
   1. Kegels, by definition, are an activation of your pelvic floor muscles. However, your pelvic floor, just like any other muscle group, needs to be able to contract and relax. So maybe your pelvic floor muscles can contract, but what if they can’t relax? 
   2. Typically when pelvic floor muscles are unable to relax, they’re considered overactive which can lead to many issues including pain with intercourse, urinary urgency, constipation, and pelvic pain. In these cases, relaxation and downtraining of the pelvic floor is necessary. Kegels would further feed into the pattern of overactivity. 
2. Some symptoms can be misleading
   1. If you’re experiencing urinary incontinence, it’s easy to assume that you’re leaking because the muscles aren’t strong enough to hold urine in. While that concept rings true, you could also be leaking due to overactivity of the pelvic floor muscles. If the muscles are overactive, there could be an imbalance in the pressure system of your bladder and pelvic floor causing during times of sneezing, coughing, laughing. However, without a pelvic floor assessment, you’re just guessing. 
3. Technique is everything
   1. Kegels are an isolated pelvic floor contraction. So how do you know if you’re doing them right? If you’re kegel’ing you shouldn’t be squeezing your glutes, holding your breath, or bearing down. Doing too many of these alternate movement patterns, in an attempt to kegel, could also cause other issues.  
4. Every pelvic floor is different
   1. Each pelvic floor can vary based on many factors. Some of these factors include age, sexual history, childbirth history, activity level, posture, trauma history, genetics, and even your breathing pattern. Additionally, what works for one pelvic floor may not have the same effect on yours. Thus, an individualized assessment of your pelvic floor is the best way to cater to your pelvic floor experience and symptoms-rather than jumping headfirst into Kegels. 
5. Additional tools in the toolbox
   1. Kegel’s are not the end all, be all in the pelvic floor world. There are many other aspects to treatment that are including, but not limited to: breathing re-education, core stability, mobility work, lifestyle modifications, manual techniques, and pelvic floor relaxation. 

The Bottom Line: 

Kegels have a place in pelvic floor therapy, but they’re not a cure-all. When done blindly, they can reinforce dysfunction rather than resolve it. If you’re dealing with pelvic floor symptoms, the best thing you can do is seek a pelvic floor therapist who can assess your specific needs and guide you in the right direction.

Your body deserves more than a one-size-fits-all solution.