Kegel Exercises: When They Help, When They Don't, and What the Research Says

Kegel exercises are one of the most commonly recommended exercises in healthcare. Doctors, midwives, and wellness blogs all seem to agree: "Do your Kegels." But here is something that rarely gets mentioned - Kegels are not right for everyone, and in some cases, they can actually make your symptoms worse.

As a pelvic floor physiotherapist, I see the consequences of this one-size-fits-all advice regularly. Some people benefit greatly from Kegel exercises. Others come to me with worsening pain, urgency, or discomfort precisely because they have been doing Kegels without knowing whether their pelvic floor actually needed strengthening in the first place.

This article breaks down the pros and cons of Kegel exercises so you can understand when they help, when they do not, and why a proper assessment matters more than any generic exercise prescription.

What Are Kegel Exercises?

Kegel exercises - named after Dr. Arnold Kegel, who popularized them in the 1940s - involve repeatedly contracting and relaxing the pelvic floor muscles. These are the muscles that form a supportive sling at the base of your pelvis, helping to hold your bladder, uterus (in women), and rectum in place.

A Kegel contraction feels like you are trying to stop the flow of urine midstream or hold in gas. You squeeze and lift, hold for a few seconds, then fully relax. The idea is that by strengthening these muscles, you can improve bladder control, support your pelvic organs, and prevent or reduce leakage.

That idea is sound - but only when your pelvic floor actually needs strengthening. And that is where the problems begin.

The Pros: When Kegel Exercises Help

There is solid research supporting Kegel exercises for certain conditions, particularly when they are taught correctly and supervised by a pelvic floor physiotherapist.

Stress Urinary Incontinence

This is where the evidence is strongest. Stress incontinence - leaking urine when you cough, sneeze, laugh, or exercise - happens when the pelvic floor muscles are too weak to withstand sudden increases in abdominal pressure. A major Cochrane review (Dumoulin et al., 2018) confirmed that supervised pelvic floor muscle training is effective for treating stress urinary incontinence in women. The key word here is supervised - the benefits came from structured programs with professional guidance, not from doing Kegels on your own at home without any assessment.

Mild Pelvic Organ Prolapse

Pelvic organ prolapse happens when the pelvic organs (bladder, uterus, or rectum) drop lower than they should because the muscles and tissues supporting them have weakened. Research by Braekken et al. (2010) showed that pelvic floor muscle training could produce a small but measurable lift in women with stage I-II (mild) prolapse. For more advanced prolapse, however, the benefits are limited because the main problem is damage to the connective tissue and ligaments - not just the muscles.

Postpartum Recovery (With Assessment First)

After childbirth, gentle pelvic floor exercises can help the muscles recover. However, it is important to have a pelvic floor assessment first, ideally around 6 weeks postpartum. Some women develop a hypertonic (overactive) pelvic floor after delivery - where the muscles are too tight rather than too weak - and Kegels would be the wrong approach in that situation.

Before and After Certain Surgeries

For some patients undergoing prostate surgery or certain gynaecological procedures, pre-surgical pelvic floor strengthening (called "prehabilitation") and post-surgical recovery exercises can improve outcomes. Again, this should be guided by a physiotherapist who has assessed the individual.

The Cons: When Kegel Exercises Make Things Worse

This is the part that rarely gets discussed, and it is arguably more important than the pros - because doing the wrong exercise when your body does not need it can set you back rather than help you move forward.

Overactive or Hypertonic Pelvic Floor

This is the single biggest reason Kegels backfire. An overactive pelvic floor is one where the muscles are already too tight, tense, or in spasm. Think of it this way: if you had a muscle spasm in your calf, you would not treat it by doing more calf raises. You would stretch it, massage it, and let it relax. The same logic applies to the pelvic floor.

Conditions linked to an overactive pelvic floor include:

• Chronic pelvic pain - ongoing pain in the lower abdomen, pelvis, or genital area
• Painful intercourse - tense pelvic floor muscles can make penetration painful or impossible
• Vaginismus - involuntary tightening of the vaginal muscles
• Vulvodynia - chronic vulvar pain without an identifiable cause
• Urinary urgency and frequency - feeling like you need to urinate constantly, even when your bladder is not full
• Difficulty emptying your bladder or bowels - the muscles cannot relax enough to let things pass through
• Tailbone pain - tight pelvic floor muscles attach to the coccyx and can pull on it

For all of these conditions, Kegels add more tension to muscles that are already too tense. The result? More pain, more urgency, and more frustration. Research by FitzGerald and Kotarinos (2003) described this as a "short pelvic floor" and found that Kegel exercises made symptoms worse in these patients.

Chronic Pelvic Pain in Men

Men experience pelvic floor issues too. Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) affect a significant number of men, and the pelvic floor is often a major contributor. Research by Anderson et al. (2005) at Stanford University found that a relaxation-based approach - the exact opposite of Kegels - improved symptoms in 72% of men with this condition. A follow-up NIH-funded study by Fitzgerald et al. (2009) confirmed that myofascial physical therapy focused on releasing pelvic floor tension significantly outperformed other approaches for this population.

Telling men with chronic pelvic pain to do Kegels is not just unhelpful - it feeds the cycle of tension and pain that is causing their symptoms in the first place.

The Missing Piece: Assessment Before Exercise

The single most important takeaway from this article is this: your pelvic floor needs to be assessed before you start exercising it.

The "just do your Kegels" advice is well-intentioned, but it skips a critical step. It assumes that your pelvic floor is weak and needs strengthening. In reality, your pelvic floor might be:

• Weak - in which case Kegels may be helpful (with proper supervision)
• Overactive - in which case Kegels will make things worse
• A combination of both - some muscles tight, others weak - which requires a tailored approach
• Poorly coordinated - the muscles might be strong enough but fire at the wrong times

What Does a Pelvic Floor Assessment Involve?

A pelvic floor assessment with a physiotherapist is a thorough but gentle evaluation. It typically includes:

• A detailed health history - your symptoms, medical background, lifestyle, and goals
• External observation - looking at how the pelvic floor responds to cues like "squeeze" and "relax"
• Internal assessment (with consent) - a gentle internal examination to evaluate muscle tone, strength, endurance, and the ability to fully relax. This is the gold standard for understanding what your pelvic floor is actually doing
• Functional assessment - checking how your pelvic floor coordinates with breathing, movement, and activities like coughing

Based on the findings, your physiotherapist will design a program specific to your needs. For some people, that will include Kegels. For others, it will focus entirely on relaxation, breathing, stretching, or manual therapy. The right treatment depends on what the assessment reveals - not on a generic assumption about what your pelvic floor needs.

What Are the Alternatives to Kegels?

If Kegels are not right for you, there are many effective alternatives. Here are some of the approaches a pelvic floor physiotherapist might use:

• Diaphragmatic breathing - your diaphragm and pelvic floor move together. Learning to breathe properly is one of the most powerful ways to help a tense pelvic floor relax
• Pelvic floor relaxation (reverse Kegels) - instead of squeezing, you focus on gently lengthening and letting go of the pelvic floor muscles. This is the opposite of a Kegel and is essential for overactive pelvic floors
• Stretching - positions like deep squats, happy baby pose, and butterfly stretch help lengthen the muscles around the pelvis
• Manual therapy - hands-on techniques to release trigger points and tight spots in the pelvic floor and surrounding muscles
• Biofeedback - a sensor-based tool that shows you what your muscles are doing in real time, helping you learn to relax muscles you might not even realize you are tensing
• Whole-body movement - the pelvic floor does not work in isolation. Exercises that address posture, core coordination, and breathing patterns often improve pelvic floor function more effectively than isolated Kegels

The Bottom Line

Kegel exercises are a useful tool - but they are just one tool in a much larger toolbox. They help some people and hurt others, and the difference comes down to what is actually happening with your pelvic floor.

If you are experiencing pelvic floor symptoms - whether that is leaking, pain, urgency, heaviness, or difficulty emptying - the best first step is not to start doing Kegels on your own. The best first step is to see a pelvic floor physiotherapist who can assess what your muscles are actually doing and build a plan that is right for your body.

Your pelvic floor deserves more than a one-size-fits-all approach.

References

1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018.
2. Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? American Journal of Obstetrics and Gynecology. 2010;203(2):170.e1-7.
3. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. International Urogynecology Journal. 2003;14(4):261-268.
4. Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. The Journal of Urology. 2005;174(1):155-160.
5. Fitzgerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. The Journal of Urology. 2009;182(2):570-580.
6. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. 2011.