When Are Kegel Exercises the Wrong Solution?

Kegel exercises have a reputation for being somewhat of a magic elixir. Want to have better sex? Kegels. Hoping for an easier birth? Kegels. Need to stop peeing when you laugh or jump? Yep, you know it.

While it does make sense to turn to Kegels in certain situations, they’re not a one-size-fits-all approach to healing postpartum.

How I knew my pelvic floor needed help

I gave birth for the first time a few months ago. The delivery was vacuum-assisted, meaning the final push of labor happened quickly. My son’s entire body emerged in less than 15 seconds—head, shoulders and all.

A few weeks later, when the postpartum haze began to clear, I realized my pelvic floor felt different. It felt heavy, but emptying my bladder took three trips to the bathroom. I could barely hold a Kegel, but I dutifully did 30 each time I nursed, which felt like all day.

My friend encouraged me to see a pelvic floor therapist, and I laughed. I barely had time to shower. When was I going to carve out 90 minutes to go to an appointment by myself? Plus, I’d just had an almost eight-pound person emerge from my being. Things were supposed to be a little weird.

Then, one day, as I was scrolling Instagram, I came across a post from Triggered Pelvic Physical Therapy in Arlington, Texas, founded by Oluwayeni Abraham, P.T., D.P.T., aka Dr. Yeni.

"Kegels cannot replace seeing a pelvic floor therapist the same way toothpaste doesn’t replace you seeing your dentist," the post said.

I wasn’t just going to Kegel my pelvic floor back to how it used to feel.

What is the pelvic floor?

Think of the pelvic floor like a hammock, said Monica Grover, D.O., an OB-GYN and the chief medical officer at VSPOT, a women's intimate health platform in New York City.

"The pelvic floor muscles run between the pubic bone and the tailbone," she explained. "They extend to the right and left sides of the pelvis and attach to the sitting bones. There are two main muscles that intertwine with each other, known as the levator ani and coccygeus."

Grover said a woman’s pelvic floor muscles support the reproductive organs, bladder and bowels. The urethra, vagina and anus all pass through the pelvic floor muscles. Strong muscles are important.

"For postpartum women in particular, Kegel exercises can prevent incontinence and strengthen vaginal muscles. Weakened pelvic floor muscles can cause urinary and bowel incontinence, as well as painful intercourse," Grover said.

Sometimes, however, the pelvic floor can get too strong. In that case, Kegels aren’t the answer.

Why shouldn’t you do Kegels?

Kegels aren’t right for everyone, despite the perception they're an exercise all women (and men) should do.

If you’re experiencing leaking or incontinence, Kegels may be a good idea. Tight pelvic floors need to be taught to relax, however, and Kegels only serve to further tighten the muscles, according to Abraham. Think of it like this: If your hamstring felt tight, you wouldn’t continue to do deadlifts. Instead, you’d do elongating stretches to lengthen the muscle. Sometimes, the pelvic floor can contract but can’t fully relax.

A pelvic floor that’s too tight can result in the following:

• Inability to fully empty the bladder despite feeling the need to urinate
• Constipation
• Lower back pain, especially during your period
• Deep tailbone pain
• Painful sex or feeling like your partner is hitting a wall during sex

Abraham suggests giving your body and hormones time to return to a more normal state after birth. If by eight or 10 weeks postpartum, your pelvic floor or any part of you is still feeling off, a pelvic floor physical therapist can help come up with a treatment plan.

How to relax the pelvic floor

A tight pelvic floor is tight for a reason.

"It’s not like the pelvic floor muscles just decide to be tight on their own. It's your body, your brain learning over time that the tightness is the safest place to be and constantly sending signals there to remain tight," Abraham said.

Many behaviors can lead to a tight pelvic floor, also called a hypertonic pelvic floor:

• Constantly holding in urine
• Birth trauma or scar tissue
• Consistent tightening of the core or abs during workouts
• Grinding your teeth or clenching

To send a message to the muscles that they can relax, start with diaphragmatic breathing.

"Whenever we use our diaphragm to breathe, it helps to elongate the pelvic floor," Abraham said. "But it also helps to do something called 'down regulation' of the nervous system: it really calms your nervous system. Your muscles need to get the message that they can relax, and diaphragmatic breathing does this."

You can also try stretching. Yoga poses such as happy baby and cobbler or sitting in a deep squat can help to relax and elongate the pelvic floor.

Who shouldn’t do Kegels?

In addition to anyone with a tight pelvic floor, you should skip Kegels if you’ve ever been diagnosed with "interstitial cystitis," or a condition that results in significant pelvic and bladder pain, which can sometimes be caused by muscles that are too tight, according to Grover.

"In this situation, Kegel exercises are considered a contraindication unless managed under professional care," she said.

You can have a looser pelvic floor with active trigger points or knots and tension, and in that case, a physical therapist may also not want you doing Kegels. And finally, it’s not recommended to practice Kegels by starting and stopping your urine stream.

"Doing Kegel exercises while emptying your bladder can actually lead to incomplete emptying of the bladder, which increases the risk of a urinary tract infection," Grover said.

Even doing Kegels correctly might not be the best way to strengthen the pelvic floor in some situations. Before diving into Kegels, check in with your doctor or a pelvic floor physical therapist.