Are Kegels Always the Answer?

In the pelvic floor education world we talk so much about doing Kegels to help with urinary incontinence, how to do them correctly and what devices can help one engage these muscles correctly. Believe it or not, though, there are times when Kegel exercises might not be the answer for you. That is why it is so important to consult with a pelvic floor physical therapist to adequately determine what is the correct course of action for you. We are going to talk a little here about when Kegels may not be the appropriate solution.

Though it is true that in many cases the pelvic floor muscles are weak, or “hypotonic,” in some cases the pelvic floor muscles are overactive, or “hypertonic”. In these cases, the muscles are already tight and working overtime, so when needed to stop leakage they don’t work.

What we want for the pelvic floor is like any other muscle group. We want a balance of strength, endurance, flexibility, and coordination. When muscles are overactive they are typically too tight and weaken because they are contracting within a limited range. This is different from weakened, or lax, muscles that are too long and benefit from strengthening through Kegels exercises. Instead, tight or shortened muscles typically benefit best from relaxation and lengthening, then later learning to strengthen them correctly once relaxation and lengthening is mastered.

In the case of overactive pelvic floor muscles, the priority is learning relaxation techniques to help keep these muscles from working so hard. A pelvic floor therapist can help teach the necessary relaxation techniques, use massage techniques to relax the muscles, and further educate you on activities to avoid. Your pelvic floor physical therapist can also teach you ways to alleviate pain, specific to your problem.

So how do you know if you need to strengthen the muscles of your pelvic floor?

Putting things in simple terms, tight or shortened pelvic floor muscles (hypertonic) can lead to the following: pain, urinary frequency, stress incontinence, incomplete voiding, difficulty achieving orgasm, pain with intercourse, pain during or post-ejaculation, constipation, and hemorrhoids. Lengthened or weak pelvic floor muscles (hypotonic) can lead to: urinary or fecal incontinence, pelvic instability, difficulty achieving an orgasm, and organ prolapse.

Indications that Kegel exercises may not be the right option for you may include the following:

  • Pain in the low back or pelvic region including hips, genital and rectal areas.
  • Leakage with high intensity exercise or athletic activities.
  • Urinary problems such as needing to go frequently, extreme urgency, interruption in the urine stream, or inability to completely empty.
  • Pain with urination.

Something else to consider is that if you have been performing Kegels and your symptoms have not improved, or maybe even worsened. In this case Kegels may not be the right treatment option for you and, again, it is important you consult the advice of a pelvic floor physical therapist who can assess the underlying condition causing your problems and determine an appropriate treatment plan.

Questions? Give me a call 816-607-3747 or message me. I’m always happy to chat.


Dr. Katy Rush

The Perfect Pelvis

"We Help Active Adults & Athletes Get Back To Workouts and Sports They Enjoy without surgery, stopping activities they love, or relying on pain medicine."