The Truth About Kegel Exercises (And When They Can Make Things Worse)

If you have mentioned any postnatal pelvic floor symptom to a healthcare provider - or even a well-meaning friend - you have almost certainly been told to do your Kegels. It is the default recommendation, offered so automatically that most women do not realise it comes with important caveats.

Kegel exercises are a valuable rehabilitation tool for many postnatal women. But they are not universally appropriate, they are frequently performed incorrectly, and for a significant subset of women, they can actually worsen symptoms. Here is what you need to know.

What a Kegel is actually supposed to do

A Kegel exercise - named after gynaecologist Arnold Kegel, who developed them in the 1940s - involves contracting the pelvic floor muscles, holding that contraction, and releasing. The purpose is to strengthen the muscles that control continence and provide pelvic organ support.

Performed correctly, a Kegel feels like a gentle lifting and squeezing sensation internally - as though you are trying to stop the flow of urine and prevent passing wind simultaneously. The key word is "lifting". The movement should be upward and inward, not a downward bearing-down pressure.

Research from Kari Bø and colleagues has consistently shown that many women cannot correctly identify their pelvic floor muscles without instruction, and a proportion actually bear down when asked to "do a Kegel" - the exact opposite of the intended movement. Bearing down repeatedly is counterproductive and can contribute to prolapse symptoms over time.

The technique problems that make Kegels ineffective

Even among women who understand the correct direction of movement, several common errors reduce the effectiveness of Kegel exercises. Breath-holding while contracting raises intra-abdominal pressure and works against the pelvic floor rather than with it. Using gluteal muscles, inner thighs, or abdominals to substitute for weak pelvic floor muscles - which is easy to do without realising - means the pelvic floor gets very little actual training stimulus. Contracting but not fully releasing prevents the muscle from achieving a full range of movement; a muscle that cannot relax properly cannot generate a strong contraction.

A physiotherapy assessment that includes internal examination can identify whether you are activating the correct muscles and in the correct direction - information you simply cannot get from a handout or an app.

When Kegels are not appropriate: the hypertonic pelvic floor

The most important caveat around Kegel exercises is this: a pelvic floor that is too tight will not benefit from more squeezing, and may be worsened by it.

A hypertonic pelvic floor (also called an overactive or high-tone pelvic floor) is one where the muscles are chronically contracted and have difficulty relaxing. This is more common than many people realise, particularly in women who are anxious, athletes who have trained their pelvic floor intensively, or women who have experienced birth trauma or have a history of pelvic pain.

Symptoms that may indicate hypertonicity include difficulty fully relaxing the pelvic floor, pain with vaginal examinations or sex, difficulty fully emptying the bladder or bowel, a sense of pelvic pressure or urgency, and paradoxically - leaking. A hypertonic pelvic floor can prevent the bladder from filling properly, triggering urge symptoms, or create a situation where the muscle cannot generate a controlled contraction under load.

For a hypertonic pelvic floor, the treatment is down-training - learning to consciously release and lengthen the pelvic floor - not more Kegels. This requires assessment to identify correctly, which is why a pelvic floor physiotherapy consultation matters.

What effective pelvic floor training actually looks like

Evidence-based pelvic floor training is not simply doing three sets of ten squeezes per day. It includes assessment of baseline tone and coordination before prescribing exercises, exercises at both slow (endurance) and fast (power) speeds to train different muscle fibre types, full release between contractions to train the complete range of motion, integration with breathing - coordinating the pelvic floor with the diaphragm, and progressive load increase over time as capacity improves.

Cochrane reviews consistently show that structured, supervised pelvic floor training programmes produce significantly better outcomes than unsupervised programmes. The structure and progression matter as much as the exercises themselves.

How the Postnatal Recovery programme approaches this

The programme does not simply hand you a sheet of Kegel exercises. It guides you through understanding how your pelvic floor works, how to find the correct muscles, how to coordinate movement with breathing, and how to progress through endurance and power training in the right sequence. Sessions build on each other so that by the time you are training under load, your foundations are solid.

If at any point in the programme you notice that exercises are increasing rather than reducing your symptoms, please take that seriously and seek individual physiotherapy review.