Why Kegels Aren’t Enough For A Happy Pelvic Floor

Unhappy muscles cause all sorts of problem. They can cause us pain, they can make us move funny. If our pelvic floor muscles are unhappy, they can cause us symptoms like urinary incontinence, urinary urgency and frequency, UTI like symptoms even though we’re having negative tests, constipation and painful sex.

Muscles need three things to be happy:

  1. They need to be strong enough to perform the tasks being asked of them.

  2. They need to be flexible enough to move through a full range of motion rather than be stuck in a shortened or "tight" state.

  3. They need to be coordinated so that they do what you're asking them to do, when you ask them to do it.

Have you ever been to Top Golf? I SUCK at top golf. But it’s not because I’m not strong enough to be good at it. And it’s not because I’m not flexible enough to be good at it. I’m strong enough to lift the club, swing it and hit the ball at leasttt far enough to get some points. The muscles around my shoulders are also flexible enough to let my arms move all the way through the swing. The reason I suck at Top Golf is because despite my adequate flexibility and strength, my coordination is crap. I whiff it 75% of the time I try to hit the ball. My brain simply cannot find the ball in space while I’m swinging. And after 20 or 30 swings, my shoulders start to hurt because I’m swinging so hard and missing almost every time.

I could totally get better at Top Golf. But doing bicep curls and overhead presses would not be the most effective way for me to improve. The most effective way to improve would be for me to hire a coach who could teach me how to swing, what the right body positioning and mechanics are. Then once I learned what I’m supposed to do, I’d have to practice. If I did that, I’m fairly confident my I’d go from crap at Top Golf to at least mediocre.

For better or worse, the same things that make me suck at Top Golf can make a person have bladder, bowel or sexual dysfunction. It can be strength, flexibility or muscle control.

Impairments in any of these three areas can cause symptoms.

If your pelvic floor muscles aren't strong enough to perform a task, they can get overpowered when you need support. This can lead to symptoms like vaginal heaviness and leakage, back pain or sacroiliac joint and pubic symphysis pain. If your muscles aren't flexible enough, this tension can exacerbate the above symptoms and contribute to symptoms like urinary urgency, urinary frequency, pain with penetration and constipation.

If your muscles are lacking coordination, they won't follow the directions your brain sends. It won't matter what you want them to do, they'll have a mind of their own. This can contribute to virtually any pelvic floor symptom. If you have the strength to hold in pee when you sneeze but your brain doesn’t know how to use that strength, you’ll leak. If you have the flexibility to allow for pain free penetration but your brain doesn’t know how to relax your pelvic floor, penetration will hurt.

Kegels are an isolated pelvic floor muscle strengthening exercise

If your symptoms are a result of a lack of pelvic floor strength, kegels (also known as a pelvic floor muscle contraction) may be an appropriate part of your rehab. But if your symptoms are the result of deficits in coordination or flexibility, kegels will not work. And most often, pelvic floor symptoms like the are a combination of a lack of strength, limited flexibility, and suboptimal coordination in both the pelvic floor and surrounding muscles.

And even if kegels need to be part of your rehab…

Your pelvic floor doesn't work in isolation. If weakness is the problem, we likely need to strengthen more than just your pelvic floor. Your pelvic floor works with your diaphragm and breath, abdominals, glutes and hip rotators to control bladder, bowel and sexual function and to contribute to support for your back and hips. They need support from these muscles to do their job well.

If tension is the issue… rehab may look more like this —> than kegels.

And what if you're lacking coordination?

It’s common to lack awareness of this part of our body. If this feels like you, know that a little practice goes a long way. Working with a pelvic floor PT can help you strengthen that mind-body connection, reconnect you with what’s going on in your body and help construct a personalized plan based on your needs and goals. Kegels may be ineffective, unecessary or counterproductive in this case, too.

So, you see, even if kegels are PART of the program (and that’s an if) they’re rarely enough. Working with your local pelvic floor physical therapist can help get address your bladder, bowel and seuxal symptoms to get you back to moving, living and loving the way you want to.


At Lady Bird Physical Therapy, we’re passionate about keeping you active and support your pelvic health through all stages of life. If you’re struggling with bladder, bowel or sexual symptoms, give us a call at 512-766-2649 or message us here to set up an appointment with one of our amazing pelvic floor physical therapists!


This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.

Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.

She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.

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