All Your Kegel Questions Answered by a Pelvic Floor PT

We get a LOT of questions about kegels (otherwise known as pelvic floor muscle exercises). If you're curious about pelvic floor exercise, you're in the right place: Let’s dive in and demystify kegels!

Who are kegels for, and who should avoid them?

Kegels can be highly effective for treating a variety of pelvic floor symptoms. Pelvic floor physical therapists frequently teach kegels to patients with bowel or bladder leaks, sexual dysfunction, pelvic organ prolapse, and more. They also form an integral piece of prehab and rehab during pregnancy and the postpartum period.

Anyone with a pelvic floor (spoiler: that’s all of us, regardless of our sex!) can benefit from kegels. However, the amount and type(s) of kegel exercises you do must be tailored appropriately to your needs. After all, the same gym routine doesn’t work equally well for every body: your pelvic floor muscles are no different.

There are some situations in which you may need to avoid kegels or adjust how hard you squeeze, though these are pretty rare. For example, if you’re pregnant and your healthcare provider has put you on pelvic rest, you should not practice kegels and shouldn't squeeze your hardest without explicit permission. More on that to come.

What are kegels?

Kegels are strengthening exercises designed to improve the power, endurance, flexibility, and coordination of your pelvic floor muscles…when performed correctly. Strong and healthy pelvic floor muscles will help to improve all the functions of your pelvic floor. These include:

• Giving you control over bowel and bladder functions
• Providing support to your pelvic organs (bladder, uterus, etc.)
• Adding strength and stability to your core and lower spine
• Enhancing sexual function and allowing for vaginal childbirth, if applicable
• Circulating blood and immune fluids between the pelvic floor tissues and the rest of your body

How do I know if I'm doing a kegel right?

To perform a proper kegel, you’ll cinch the muscles at the opening like a purse string and pull them up and in. This creates a stabilizing tension on your pelvic joints and closes the urethral and anal openings. If you have a vagina, it also closes the vaginal canal.

This is not always an intuitive movement, especially if you’ve never tried it before. Did you know that one-quarter of people with vaginas perform kegels incorrectly, even when they think they are doing them right? It takes practice to learn correct kegel form!

To learn how to access your pelvic floor muscle, try some of these verbal, tactile, and visual cues to learn what works for you.

Verbal cues:

• Imagine you’re peeing and you need to stop your urine mid-stream. Squeeze the muscles that would stop the stream.
• Please don't practice this too often while you're actually peeing, it could cause some unwanted issues for your bladder (NIDDK Kegels)
• Squeeze the muscles that help you hold back gas.
• Squeeze your muscles like you are trying to pick up a blueberry with your vagina.
• Squeeze your muscles like you are trying to move your tailbone towards your pubic bone.
• Try to “nod” your clitoris down.

Tactile cues:

• Place your clean fingertips on the tissue between the vaginal and anal openings (aka the perineal body). Contract your muscles to lift that tissue away from your fingertips.
• Try inserting a clean finger into the vaginal or anal opening (using some lube helps). Squeeze your muscles around your finger.

Visual cues:

• Hold a mirror between your legs so you can see your vulva. Pull open the labia slightly so you can see your vaginal opening, too. Squeeze your pelvic floor muscles and look for the muscle between your vagina and anus (the perineal body) to pull up away from the mirror. You may also see anal and vaginal openings closing slightly, and you may even be able to see your clitoris tuck in a bit.

Note that these cues are mostly tailored towards those with vaginal anatomy, but people with penises can do kegels, too!

Should I feel kegels in my lower abdominals?

It’s very common to feel your lower abdominals engaging when you contract your pelvic floor. While you can isolate and contract each muscle group individually, there aren’t many real-world situations when that happens. Good news: Your deep abdominals and pelvic floor muscles work better together.

If you feel your lower abdominals engage when you’re doing kegels, make sure that you also feel your pelvic floor muscles contracting. Avoid letting your stronger outer abs (your “six-pack”  and obliques) do all the work.

If this feels difficult, don’t worry! A pelvic floor physical therapist can help you learn how to coordinate your pelvic floor and deep abs.

Can kegels be bad for you?

Not usually. Unless there's a medical reason that prohibits you from exercising your pelvic floor muscles, it's not common for kegels to cause harm. However, if you experience pain when you do a pelvic floor contraction you should stop and let your provider know so they can develop a program that works for you.

Not everyone will benefit from kegels. This is especially true if you’re doing them incorrectly or without the proper prep work. For example, some people think they are engaging their pelvic floor muscles when in fact, they are just squeezing their glutes or bracing their abs. While usually isn’t harmful, it doesn’t accomplish the goal of kegels: to specifically engage the pelvic floor muscles.

In other situations, you may need to learn how to relax and lengthen your pelvic floor muscles before or as you start strengthening them. This doesn’t mean you can’t do any kegels: you may just need to balance them with relaxation and stretching of the pelvic floor.

Think of this like training any other muscle group: you probably know you should pair hard strength training workouts with stretching and other recovery techniques. Your pelvic floor muscles work the same way!

What are the signs that you're overdoing kegels?

Every body is different, but if you are overdoing kegels, or if kegels aren’t the right exercise for you, you will likely notice an increase in your symptoms after doing them consistently.

If you are doing Kegels to reduce symptoms of heaviness with prolapse and you notice the symptoms have increased, or you are working to reduce pain with sex, but things feel tighter and more uncomfortable, consult with a pelvic floor physical therapist: they can help you troubleshoot your symptoms and get you back on track.

How do I know if kegels are right for me?

The best way to be certain is to meet with a pelvic floor physical therapist. They can evaluate your pelvic floor muscles and help determine if kegels are the right starting point for you. If they aren’t, your physical therapist will help you figure out where to start.

We know it can be difficult for some people to find a pelvic floor physical therapist and make it to their appointments. This is a big reason why Origin offers virtual and hybrid care options: we want to ensure that everyone who needs pelvic floor physical therapy can access it, regardless of location or schedule.

While you’re preparing for a physical therapy visit, here’s a basic breakdown of who can benefit from kegels:

If your pelvic floor muscles are weak or underactive

In general, kegels strengthen and increase the tone and performance of the pelvic floor muscles. As a result, they often help improve symptoms quickly in people with pelvic floor muscles that are weak or underactive. This often includes those with pelvic organ prolapse, bowel or bladder leakage, or back or pelvic pain due to decreased joint stability.

If your pelvic floor muscles are overactive or resistant to stretch

You may have heard that you should never do kegels if your pelvic floor muscles are “tight” or “too tense”. If you live with a chronic pelvic pain condition such as endometriosis or vulvodynia, or if you have pain during or after sex, you may be wary of contracting muscles that already feel super sensitive.

Doing hundreds of kegels with poor form certainly won’t help these conditions. However, this doesn’t mean that pelvic floor contractions are forever off-limits. With the correct dosing and performance, kegels can help address conditions that involve pelvic floor muscle overactivity. These include decreased sexual arousal and enjoyment and even painful intercourse (dyspareunia). It’s how you do them that matters.

Can I do kegels if I have vaginismus or other pain with sex?

Oftentimes, yes! Intelligently prescribed pelvic floor contractions can be a useful part of a comprehensive pelvic floor therapy routine for vaginismus.

Pelvic floor contractions have gotten a bad rap for worsening the symptoms of vaginismus and other kinds of pelvic pain. Much of this comes from cases in which people with vaginismus started squeezing away without guidance on the amount or intensity of exercise they should be doing.

This means the blanket statement “kegels are bad if you have pelvic pain” probably isn’t warranted: it’s just more nuanced than that. Recent reviews and research on pelvic floor muscle training for dyspareunia and pain at the vaginal opening (vestibulodynia) show that pelvic floor muscle training can help people with these conditions.

The important caveat here: there’s a ton of variation in how researchers define and report on the pelvic floor exercises they used. This means some studies pair strengthening, contracting exercises with lengthening, stretching movements and other interventions. The participants weren’t just doing traditional kegels.

For people with pelvic floor muscles that are painful or resistant to stretch, kegels generally work best as part of a multimodal physical therapy approach. They should form one piece of a treatment plan that includes other strategies to reduce muscle tension, improve muscle coordination, and more.

Are kegels safe during pregnancy and postpartum?

Most of the time, yes. Kegels can be a safe and effective exercise to perform during pregnancy and after delivery. If you had an uncomplicated vaginal delivery, you may be able to start kegels as soon as 24 hours after you give birth.

If you experienced complications during delivery or had significant pelvic floor muscle tearing, though, ask your birth provider for guidance before starting kegels (NICE guideline, 2021).

When done properly and under the guidance of a pelvic floor physical therapist, kegels can help birthing people with all of the following:

• Shortening the first two phases of labor in first pregnancies
• Preventing and improving symptoms of urinary incontinence
• Building core strength to decrease pelvic girdle and low back pain
• Improving the symptoms of pelvic organ prolapse

That said, there are some instances in which pregnant people should avoid kegels. If your OB-GYN or midwife has placed you on pelvic rest or specifically told you to avoid pelvic floor muscle contractions, listen to them. In both pregnancy and postpartum, it’s always best to ask your birth provider or pelvic floor physical therapist before jumping into a kegel routine.

Can a kegel exercise device or app help me?

Maybe! There are apps and gadgets for everything these days, including for your kegels. Apps can help remind you to exercise your pelvic floor muscles, track your progress, and help keep you motivated.

Pelvic floor trainers such as the Perifit and KGoal, which are pressure biofeedback devices, and the Elvie trainer, which uses force and motion sensors. Think of them like video games for your pelvic floor. You insert the device into your vagina, and it uses smart sensors to guide you through an exercise routine and monitor your performance during the session.

These tools are not a substitute for a rehabilitation program provided and supervised by a pelvic floor physical therapist. However, they can be helpful for those who are typically motivated by apps and gadgets. Motivation aside, research hasn’t shown that adding these devices to a pelvic floor muscle training program offers a statistically significant benefit.

Now that you know more about kegels than you ever thought you would, it’s time to figure out how they can work for you. Schedule a visit with an Origin clinician today to get started!