"Just do kegels." It's the most common piece of advice given to anyone with a pelvic floor concern — leaking, prolapse, postpartum recovery, you name it. It's on every postpartum discharge sheet. It's in every women's magazine. It's well-intentioned.
And it's often the wrong advice.
Not always. But often enough that I spend a significant portion of my clinical time undoing the harm caused by people doing kegels they didn't need — or doing them in a way that made their symptoms worse.
What a kegel actually is
Contract vs. release
A kegel is a contraction of the pelvic floor muscles — a lift and squeeze, followed by a full release. The key word there is release. A true kegel isn't just the contraction. It's the complete cycle of contract and let go. Most people do the first half and forget the second.
When you contract without fully releasing, you're training your pelvic floor to hold. And a pelvic floor that's always holding is one that's too tight — which creates its own set of problems.
When kegels make things worse
If your pelvic floor is already hypertonic — meaning the muscles are chronically tense and can't fully relax — doing kegels is like clenching an already-clenched fist. You're adding more tension to a system that's already overloaded.
Signs your pelvic floor may be too tight rather than too weak: pain during sex, difficulty with penetration, urgency or frequency without leaking, constipation or straining with bowel movements, tailbone or hip pain. If any of those sound familiar, kegels may be the last thing you need right now.
When kegels do help
Kegels are genuinely useful when the pelvic floor is weak, underactive, or poorly coordinated — and when they're done correctly, with full relaxation between reps. Stress urinary incontinence (leaking with coughing, sneezing, or jumping) can often be significantly improved with a proper strengthening program. Postpartum reconnection, when approached gently and at the right time, also benefits from kegel work.
The difference is in the assessment. You can't know which approach is right for your body without understanding what your pelvic floor is actually doing — and that requires evaluation, not guesswork.
What to do instead of guessing
Before you do another kegel, ask yourself: do I actually know whether my pelvic floor needs more strength or more relaxation? If the answer is no, that's not a gap you should try to fill with an internet search.
Pelvic floor PT exists precisely for this. One assessment can give you a clear picture of what your muscles are doing, what they need, and how to get there — without wasting months doing exercises that don't match your body.
A simple check-in: after your next kegel, can you fully let go? Place a hand low on your belly, take a breath, and on the exhale, see if you can feel your pelvic floor soften. If you're not sure what "release" feels like, that's valuable information — and it's exactly what we work on together.
Your pelvic floor is more nuanced than a squeeze-and-hold. It deserves more nuanced care.