Why Doing More Kegels Isn’t Always the Answer
If you’ve been told to do Kegels for bladder leakage, pelvic organ prolapse, pelvic pain, or postpartum recovery, you’re not alone.
Pelvic floor exercises are one of the most commonly recommended treatments for pelvic health issues. Unfortunately, many people perform them incorrectly—or do exercises that aren’t appropriate for their specific condition.
At Legacy Physical Therapy in St. Louis and Creve Coeur, Missouri, we regularly work with patients who have spent months or even years doing pelvic floor exercises without seeing improvement. In some cases, their symptoms actually became worse.
Let’s discuss some of the most common mistakes people make with pelvic floor exercises and what you should do instead.
Mistake #1: Assuming Everyone Needs Kegels
One of the biggest myths in pelvic health is that every pelvic floor problem is caused by weakness.
The reality is that pelvic floor dysfunction can involve:
- Weakness
- Excessive tension
- Poor coordination
- Difficulty relaxing
- Scar tissue restrictions
- Breathing dysfunction
- Core muscle dysfunction
For example, someone experiencing:
- Painful intercourse
- Constipation
- Difficulty emptying their bladder
- Tailbone pain
- Chronic pelvic pain
may actually have pelvic floor muscles that are too tight rather than too weak.
Adding more Kegels to an already tight pelvic floor is like continuously tightening a clenched fist. Eventually, the muscles become fatigued, irritated, and less functional.
This is why a proper evaluation by a pelvic floor physical therapist is so important before starting a pelvic floor exercise program.
Mistake #2: Holding Your Breath
Many people unintentionally hold their breath while performing pelvic floor exercises.
When this happens:
- Pressure increases inside the abdomen
- The diaphragm stops moving normally
- Pelvic floor coordination decreases
- The exercise becomes less effective
Your pelvic floor and diaphragm are designed to work together.
As you inhale, your pelvic floor gently lengthens and relaxes.
As you exhale, your pelvic floor naturally lifts and contracts.
When breathing is coordinated with movement, the pelvic floor functions more efficiently.
At Legacy Physical Therapy, we often spend time teaching patients how to breathe properly before we ever prescribe strengthening exercises.
Mistake #3: Doing Too Many Repetitions
If some Kegels are good, more must be better, right?
Not necessarily.
Many people perform hundreds of pelvic floor contractions each day because they think it will accelerate results.
Unfortunately, muscles need balance.
Too much exercise can lead to:
- Muscle fatigue
- Increased tension
- Poor coordination
- Worsening symptoms
The pelvic floor is no different than any other muscle group in your body.
You wouldn’t do 500 bicep curls every day and expect optimal results. The same principle applies to pelvic floor training.
Quality is far more important than quantity.
Mistake #4: Forgetting to Relax
Most people focus entirely on the contraction portion of a pelvic floor exercise.
However, relaxation is equally important.
A healthy pelvic floor should be able to:
- Contract
- Relax
- Lengthen
- Respond automatically to pressure changes
If the muscles never fully relax after a contraction, they can gradually become overactive.
This may contribute to:
- Pelvic pain
- Painful sex
- Constipation
- Difficulty emptying the bladder
- Pelvic pressure
Many of our patients are surprised to learn that learning to relax the pelvic floor is often more important than strengthening it.
Mistake #5: Exercising in the Wrong Position
Many people only perform pelvic floor exercises while lying down.
While this may be a good starting point, real life happens in upright positions.
Your pelvic floor needs to function when:
- Walking
- Lifting
- Exercising
- Carrying children
- Running
- Jumping
- Getting out of a chair
As your strength and coordination improve, exercises should be progressed into more functional positions.
A comprehensive pelvic floor rehabilitation program addresses how the muscles work during daily activities—not just while lying on your back.
Mistake #6: Ignoring the Rest of the Body
Your pelvic floor does not function in isolation.
It works closely with:
- Your diaphragm
- Deep abdominal muscles
- Hips
- Glutes
- Low back
- Rib cage
Weakness or dysfunction in these areas can contribute to pelvic floor symptoms.
This is why pelvic physical therapy should involve much more than Kegels.
At Legacy Physical Therapy, we take a whole-body approach because we know the root cause of symptoms often extends beyond the pelvic floor itself.
Mistake #7: Expecting Immediate Results
Many people become discouraged when symptoms don’t improve after a few days of exercises.
Like any muscle training program, pelvic floor rehabilitation takes time.
Factors that influence recovery include:
- Severity of symptoms
- Muscle coordination
- Tissue healing
- Hormonal changes
- Breathing patterns
- Activity level
- Consistency with treatment
Most patients begin noticing improvements over several weeks, with continued gains occurring over the course of their treatment plan.
Patience and consistency are key.
Signs Your Pelvic Floor Exercise Program May Not Be Working
You may benefit from a pelvic floor physical therapy evaluation if:
- Your symptoms aren’t improving
- Leakage continues despite doing Kegels
- You experience pelvic pain
- You have painful intercourse
- You feel pelvic heaviness or pressure
- You struggle with constipation
- You have difficulty emptying your bladder completely
- Your symptoms worsen with exercise
These are all signs that a more individualized approach may be needed.
How Pelvic Floor Physical Therapy Can Help
At Legacy Physical Therapy, our expert pelvic floor physical therapists evaluate much more than just strength.
We assess:
- Muscle tension
- Coordination
- Breathing patterns
- Core function
- Hip and back mobility
- Scar tissue restrictions
- Movement strategies
From there, we create a personalized treatment plan designed specifically for your symptoms and goals.
Whether you’re dealing with bladder leakage, pelvic organ prolapse, pelvic pain, constipation, pregnancy-related symptoms, postpartum recovery, menopause concerns, or men’s pelvic health issues, the right exercise program can make all the difference.
Get Expert Pelvic Floor Physical Therapy in St. Louis and Creve Coeur
If you’ve been doing pelvic floor exercises but aren’t seeing the results you hoped for, it may be time for a more individualized approach.
The team at Legacy Physical Therapy has helped thousands of women and men throughout the St. Louis area overcome pelvic health challenges and return to the activities they love.
We offer one-on-one pelvic floor physical therapy at our Valley Park and Creve Coeur locations and would love to help you determine the best path forward.
Call us at 636-225-3649 or schedule a free phone call with a therapist to learn how pelvic floor physical therapy can help you move, feel, and live better.
