Kegels - Should I do them or not?

Jill Heath, PT, DPT

If you Google search “pelvic floor” in the hopes of figuring out your own concerns or ailments, you likely pull up the advice from many folks advocating for Kegels.  Incontinence? Do kegels! Pelvic pain? Kegels are the answer! Things don’t feel the same since having kids? You should probably do Kegels.

But fortunately another message is also spreading - not everyone should do Kegels.  That creates a lot of confusion. Are we supposed to do Kegels or not?  

“Kegels” refers to the exercise that engages the pelvic floor muscles (for more info on those muscles, check out some of my earlier blog posts).  Things get complicated when you consider a few points:

  • Muscles don’t operate as an island of their own - they work as a team with other muscles.  So, to continually strengthen the pelvic floor muscles on their own, without linking them to the other core muscles or use them functionally, means your body doesn’t know how to use them when it needs them (ie, not peeing when you jump). Read this blog post for more
  • Sometimes a problem in a muscle isn’t that it’s weak, but that it’s too tight.  For example, what if you had soreness in your hip? Would you assume it’s weak and start doing lots of exercises for it?  Maybe, or you might do some rolling or stretching to loosen it.  Same with the pelvic floor. Often, it’s overactive, meaning it is tense most or all of the time, which is causing the issues.
  • A study showed that 49% of women do Kegels incorrectly, even with verbal instruction (1).  Continuing to work on muscles in the wrong way can be at best a waste of time, and at worst, create new issues.

The best way to know what to do with your pelvic floor is to have an assessment by a physical therapist with specialized training in treating pelvic floor conditions, like me.  In that assessment, we figure out whether it's indicated to strengthen (as in, being unable to stop the flow of urine midstream or hold back gas).  On the other hand, if the muscles are overactive, then doing repetitions of strengthening is actually what you don’t want to do. A pelvic floor with high tension is common in runners (again, not always), especially those with a short stride.  Symptoms that sometimes go along with an overactive pelvic floor include hip tightness, glute pain, constipation, and difficulty starting the flow of urine. In this case, learning how to relax the pelvic floor is important.  Schedule a virtual consult to figure out what the right plan is for you!

Stay tuned for the next post, where we go further into how to contract the pelvic floor muscles.

1. Bump et al. Assessment of Kegel muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug; 165: 322-7

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About the Author

Jill Heath is a licensed physical therapist and owner of She PT, LLC. She received a Doctorate of Physical Therapy and B.S. in Exercise Science from Northern Arizona University. During years of practice helping individuals of all ages recover from a variety of conditions, she developed a passion for working with women. She opened She PT, LLC with the purpose of meeting not only the unique physical needs of women, but also empowering women to take charge of their well-being by making care accessible.