Why Kegels are Bad for your Tight Pelvic Floor

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Note to Readers: Yesterday we posted a blog summarizing an article titled “Stop Doing Kegels: Real Pelvic Floor Advice for Women (and Men)” written by Nicole Crawford and published on BreakingMuscle.com. There was some confusion that resulted from the post about when kegels are and are not appropriate. The article advises that women (and men) should never do kegels. I do not completely agree with the article. While women and men with tight pelvic floors should never do kegels, they are appropriate for a certain patient population, patients that have weak pelvic floors.

But what about patients who have weak and tight pelvic floors?

This updated edition of the post, will fully explain when kegels are and are not appropriate, including what is appropriate in situations when the pelvic floor muscles are both weak and tight. I apologize for any confusion, but am thankful for the opportunity to add clarity to this issue that I know is super-confusing to so many!

Kegels are no good for a hypertonic or “tight” pelvic floor.

For decades doctors, PTs, trainers, therapists, you name it, have been hammering away at women—and men too—that if they want to strengthen their pelvic floors, they must do their kegels.

Getting folks to stop doing kegels is a bit of an uphill battle because it’s advice that’s seeped into the mainstream consciousness. On an episode of “Sex in the City” Samantha jokes about doing her kegels; Oprah Winfrey had experts on her show dispensing the advice to her zillions of viewers, and if you google “kegels” you’ll come up with about 1.3 million hits.

So you can imagine my delight when I came across an article that went against the party line, and actually delved into the potential harm kegels can do to the pelvic floor. An issue that PTs who treat the pelvic floor are all too familiar with.

The article is titled “Stop Doing Kegels: Real Pelvic Floor Advice for Women (and Men)” is written by Nicole Crawford and published on BreakingMuscle.com.

Ms. Crawford’s article is a Q&A with Katy Bowman—a master’s level Biomechanist whose focus is the mechanical causes of disease. In the past, Ms. Bowman has made waves advising folks against doing kegels.

Ms. Bowman says that at the heart of the problem with doing kegels to strengthen the pelvic floor is a theory in biomechanics called: “Overgeneralized Theory of Strength.” When you do a kegel, she explains, you are doing a muscular contraction, and if you already have a tight pelvic floor, contracting these muscles will only make it tighter, making your pelvic floor problems worse.

Here I agree with Ms. Bowman 100%. If you have a tight pelvic floor, or even a pelvic floor with active trigger points, you should not do kegels. Doing kegels under these circumstances will compound your pelvic floor problems.

Ms. Bowman goes on to say that kegels are never appropriate. In her prior writing on the topic, she’s held that doing kegels can actually cause weakness. As an alternative to kegels for pelvic floor strengthening, Ms. Bowman recommends deep squats. Her reasoning is that deep squats strengthen the glutes, which in turn “pull the sacrum back, stretching the pelvic floor from a hammock to a trampoline” and thus providing for a stronger or more stable pelvic floor.

Here is where I am forced to disagree with Ms. Bowman both on her assertion that kegels are never appropriate and her advice that deep squats are a better way to combat a situation where the pelvic floor is weak.

If you’re not someone who has dealt with the symptoms of a tight pelvic floor, you might wonder why a tight muscle is a bad thing. Often folks equate tight muscle with “toned” muscle. In fact, here’s a comment from a reader on this very point:

“Why is a tight pelvic floor a bad thing? Isn’t it the same as a toned pelvic floor? And a toned muscle is not a bad thing. I understand that if you over-do it, your pelvic floor muscles can become too tight, but isn’t that the same as with any other muscle fatigue in the body when you over do it? The muscle rests and relaxes a bit then it’s fine.

A toned muscle is not a bad thing, the reader is correct. Unfortunately, however, if you “over do it” with your pelvic floor muscles, they do not just rest and relax. Your pelvic floor muscles are the only group of muscles in the body that never get to rest, ever. If they completely relaxed we would be incontinent. So, they are working all the time to maintain continence, to support our pelvic organs, and to contribute to our posture and stability.

Therefore, these muscles are “working out” all the time, and don’t follow the same rules as the other muscle groups in our body. If you do get carried away with kegels and over-strengthen your pelvic floor muscles, they can become  too tight, which in turn can cause dysfunction and symptoms, such as pain, urinary urgency and frequency, among others.

When this happens, it often takes the expertise of a pelvic floor PT to return the pelvic floor muscles to a normal tone to eliminate the symptoms.

So, the pelvic floor muscles do not need extra strengthening from doing kegels, unless something has happened that has overstretched them or injured them in some way that has made them truly weak (not weak AND TIGHT, more on that in a bit). Your pelvic floor muscles can become overstretched and weak after childbirth, around menopause, and after some gynecological surgeries. And this overstretching and weakening can lead to organ prolapse.

So kegels are appropriate when the pelvic floor is truly weak and/or overstretched. I prescribe them all the time for this patient demographic. And there are many experts in the field of pelvic floor rehabilitation that will strongly agree that doing kegels are appropriate when pelvic floor muscles are overstretched and/or weak. And in fact, there are many articles in medical journals that support this.

It’s important to note though that many postpartum women can actually have tight pelvic floor muscles so any woman who thinks she needs to do kegels after pregnancy should absolutely get an evaluation by a trained PT to make sure that is indeed what she needs to do. Because if you start a pelvic floor strengthening program when you actually have a tight pelvic floor, you will create problems, I promise you. So, unless you’ve been evaluated by a pelvic PT, and told you have a weak, not tight, pelvic floor, do not continue to do kegels.

So tight muscles = kegels bad. Weak and/or overstretched muscles = kegels okay. Oh, if only we could end things here. But as anyone who has researched the pelvic floor knows, there is no black and white when it comes to this part of our anatomy–only lots of shades of gray, and more than 50, I can tell you that much!

Here’s the clincher: it is possible for a weak pelvic floor to also be tight and/or to contain active trigger points. In this situation, it is NOT okay to do kegels.

So what does someone who has both a tight and a weak pelvic floor do, especially if he or she has a prolapse or other symptoms caused by the weakness. Well, the appropriate course of action in this situation would be to first work to clear up the tightness and trigger points with PT and whatever other treatments are appropriate. And then once the pelvic floor muscles are at a healthy tone–no longer too tight, and all active trigger points gone–do kegel exercises recommended by a trained PT to strengthen your pelvic floor without fear of causing further problems.

So, to summarize: kegels are not appropriate for folks with a tight pelvic floor or active trigger points or folks with a weak AND TIGHT pelvic floor. But, it’s okay to do kegels to strengthen a weak pelvic floor.

I hope this updated post has cleared up all confusion. But, if you still have questions or concerns, please don’t hesitate to send them my way.

All my best,
Liz


100 thoughts on “Why Kegels are Bad for your Tight Pelvic Floor

    • As I mentioned in another response to a comment, I have to disagree with Katy that Kegels are never appropriate. I think they are a useful treatment strategy for a pelvic floor that is overstretched/not tight and weak. Sorry for the confusion!

      I’ve revised the blog to reflect this, please give it a read if you have time.

      All my best,
      Liz

      • Have you ever encountered a woman who strained her Pubicoccygeous? I’ve had two children (last one 21 months ago). And 4 mornings ago I woke up with pain on the left side of my vagina and into my clitorus. It has not gotten better (only been 4 days I guess). I saw a pelvic floor specialist this morning and she believes I have strained that muscle. Have you ever encountered this?

        • Author Liz Akincilar says:

          Hi Kim,
          Yes, I’ve definitely treated many people with an impaired or dysfunctional pubococcygeus muscle. A ‘strained’ pubococcygeus is not really the right word to describe it though. I think what she meant was that the muscle is dysfunctional; likely it is tight or hypertonic. A tight pubococcygeus muscle can absolutely contribute to vaginal and/or clitoral pain. I don’t know if it is definitely the primary pain generator, as iother muscles/nerves/structures could also be causing the pain, but it could be contributing to it. It sounds like you got to the right provider very quickly so you should be in good shape. Good luck!

          Liz

  1. Thanks for your response Liz. I appreciate it. I read the other comment and your response regarding tightness and weakness, which I do get.

    Unfortunately, I’m more confused than ever. I am seeing a quality women’s health PT that wasn’t easy to find. I’ve actually been reading Katy Bowman’s blog for months. I really like what she’s saying about the PF as well as whole body alignment. Based on her blog, it seems she really isn’t recommending the kegal for anyone, including those of us with prolapse. She has responded that too many kegals might actually result in prolapse for some, so I don’t understand why I would then use them to correct prolapse. I’m finding it impossible to get a straight answer that women’s health professionals agree on. I have read that she warns not to go to a deep squat right away with prolapse as it could increase intra-abdominal pressure, but I haven’t found anywhere that she recommends kegals for prolapse. Speaking of elephants in the room, I think those of us who have prolapse are a giant one. There’s a lot of current information about treating pelvic floor tightness or avoiding prolapse, but not much new on the treating prolapse front. I know I and others with prolapse are unsure on how to proceed. Thanks for your time!

    • Hi Dee,

      It is confusing, no doubt about it. In fact, I’ve done a complete re-write of my blog post in the hopes of completely clearing up the confusion once and for all–if you have a sec, please give it a read!

      In answer to your above question, and as reflected in the updated version of my post, I have to disagree with Katy that Kegels are never appropriate. I think there is a time and place for them. Therefore, if you are seeing a good pelvic floor physical therapist and she is prescribing Kegels for you, that may be the correct treatment for your pelvic floor.

      Thank you for reading and taking the time to write in!
      All my best,
      Liz

  2. This is a suprise to me. How can you tell women to STOP doing Kegels? What do you tell women with prolaps? And women past menopause, which have had surgery, or even hysterectomy? If women dont have any options at that age or with that kind of problems, they will live in pain, and discomfort.

    • As I mentioned in the above comment response, I have to disagree with Katy that kegels are never appropriate. I think they are a useful treatment strategy for a pelvic floor that is overstretched/not tight and weak. Sorry for the confusion!

      I have re-written the blog to reflect this, please give the updated version a read if you have a sec.

      All my best,
      Liz

      • Most women which have a pelvice prolaps problems have weak pelvice. My concern is, what kind of excersise should they do? I was told by my pelvice therapist that I should never do a wide squat at my gym class. And after my prolaps surgery, I did not know this, and did squats, and I have had discomfort since! My therapist told me NOT to do squats, since it presses down on the pelvice mussles. This is totally different from what is said here. Now if this article is meant for young women which have not had any children, I can see that. This needs to be clear, for all women with prolaps or pain in the pelvice.
        Gunna.

        • In the article, Liz says that she disagrees with Katy Bowman about doing squats to strengthen the pelvic floor! So she is NOT advocating doing squats for people with weak pelvic floor muscles!

      • Hi, Is Urinary Frequency is always associated with tight pelvic muscles ? Can it be due to weak Pelvic muscles ? Please explain the relation.

        • Stephanie Prendergast, MPT says:

          Tight pelvic floor muscle can be one of the causes of urinary urgency and frequency for multiple reasons. They can cause reflexive reactions to the bladder stimulating an urge, they can compress the urethra also stimulating an urge, and they can lead to incomplete voiding which can also lead to U/F. Weak PF muscles are more commonly associated with the postpartum period or peri-menopause. These groups can have urgency and frequency as well but the weak muscles themselves are not always the cause though they can be a contributing factor. Age-related and hormonal factors can play a role in this group as well. Tight muscles are more often the culprit in younger women.

  3. It seems to me that the general problem is that the “experts” are telling EVERYONE to do kegels across the board. I think this speaks to the general lack of knowledge about the pelvic floor in the healthcare community and beyond. Telling everyone to do kegels is akin to telling everyone to take blood pressure medication–not everyone needs it, and for some it would be harmful!

    • Hi Michele,

      We recommend either “squat drops” or “flat back drops.” You can see photos of each as well as a video of the “flat back drop” towards the end of this blog post: http://www.pelvicpainrehab.com/blog/2012/08/pelvic-floor-drops-weak-and-tight-muscles-tilted-pelvis-and-more.

      We aren’t proponents of the “deep squat,” which Katy Bowman describes. You might be able to find more info on that version on her website: http://www.alignedandwell.com/katysays/

      Please let me know if you have any more questions.

      All the best,
      Liz

    • Before you start doing “deep squats”, you may want to ensure you don’t have pelvic organ prolapses (POP). If you do, deep squats (eg.wide legged stance) are contraindicated in this condition, as is any exercise that increases intra-abdominal pressure. For more on this, please search for YouTube for the name Michelle Kenway. She is an Aussie PT who specializes in POP and PF dysfunction.
      IMNSHO, POPs are not only due to lack of exercise/weak PF but also can be the result of ‘torn/sheared fascia’ (r/t many factors such as childbirth, aging, menopause, EDS (Ehlers-Danlos Syndrome), and a woman’s particular collagen genes, obesity, retroverted uterus (4x POP risk), etc). I learned this from my UroGyn surgeon who studies collagen genes. She has patients some of whom have had zero children who have POP and serious PF problems. I did have the POP surgery and after several years of frustration realize that no amount of Pilates and Yoga and PF PT would have fixed my Stage 2 cystocele, Stage 3/4 rectocele, very large enterocoele, being pulled down by my enlarged Adenomyosis uterus, etc.

  4. Hi Liz,

    I am a man and Im curious to what extent your advice applies to the male gender? Many suggested kegeling to retain harder and longer lasting erections, or suggested it as cure to erectile dysfunction. What are you thoughts?

    Cheers

    • Thank you for your question. It is fairly uncommon for men to need to do Kegels because there aren’t too many reasons for a man’s pelvic floor muscles to become weak. Weak pelvic floor muscles are the only reason one would need to do Kegels. One situation a man would likely need to engage in a pelvic floor strengthening program (do Kegels), is after a prostatectomy. There is no research to support Kegels for better erections or orgasms. In fact, if you do too many Kegels when you don’t need to, you’ll make your pelvic floor muscles too tight which will negatively effect the muscles ability to contract optimally.

      All my best,
      Liz

      • I find it is as important if not more important for men to strengthen the PF. Most men are tight and weak in this area and studies show weak PF to be a contributing factor to ED and other male issues.

  5. I’m 23 weeks pregnant and have been told that kegels are absolutely beneficial. Now I’m doubting this advice. But how do I know whether my pelvic floor is weak or hypertonic, or just normal? Would doing kegels be helpful for birth if my pelvic floor is normal to begin with?

    • Dear Lisa,

      There’s so much information out there, it is difficult to know which is the best for you. Being pregnant puts extra demand on the pelvic floor, simply because there is more weight that needs to be supported, among other things. During labor and birth, the muscles relax and stretch to accommodate the baby. Kegels are a “shortening” exercise, so when you voluntarily recruit them and do a Kegel, the muscles contract and therefore build strength (similar to a bicep curl). The tricky thing about the pelvic floor is that it is on all the time to support us, maintain continence, and aid in sexual function. It’s working now to hold in urine and stool, and support your uterus and growing baby. As the demand increases on the muscles, they must be strong enough to continue to work properly and accommodate the new demands. Kegels will help strengthen the pelvic floor, not necessarily “relax” it, if you will. And, yes, it can be helpful in pregnancy if the muscles are beginning to tire out and become weak. Usually signs of weakness include stress incontinence, for example. But, it’s hard to tease that out in late pregnancy because the baby is also tap dancing on your bladder! To really tell what state your pelvic floor is in, it is best to have an evaluation by a qualified physical therapist. She can evaluate your muscles and assess whether they are weak, short, or strong, and if you should be doing Kegels or not. To answer specifically if they would be helpful in birth, my personal opinion is that they are more helpful in the recovery of birth (if you are on the weaker side going into delivery).

      If you are strong going into labor, and you are able to relax your pelvic floor and bear down appropriately, you may have a little easier recovery. Again, this is all woman-specific, and there are a lot of variables to take into consideration. So…should you do Kegels while pregnant? It depends on where you are now, and what state your pelvic floor is in. Remember, your pelvic floor muscles are working all the time, so your pelvic floor may be perfectly strong and may be accommodating the pregnancy and added demand on them just fine, so you may not need to take any action, it really just depends on the woman. So touching on the WebMD comment, it’s not completely bunk, because yes those muscles help support all those structures mentioned, but like I mentioned above, Kegels don’t help relax or lengthen the muscles, and that’s what you really need for birth. It’s all about balance. You want the muscles to be strong to continue to support you and the baby, and also decrease the risk of urinary incontinence after birth, but at the same time, you need to be able to relax them and control them appropriately. The best way to learn how to do all those things is to have an evaluation by a qualified pelvic floor physical therapist. I believe the overall message here is that this is an issue that’s complicated with many variables. So an across the board edict to either “do Kegels” or “don’t do Kegels” is just not appropriate.

      All my best,
      Marcy

  6. Sorry, as a follow up to the comment above, WebMD says this:
    “Kegel exercises help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles during your pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.”
    Is this bunk?

    • Dear Lisa,

      There’s so much information out there, it is difficult to know which is the best for you. Being pregnant puts extra demand on the pelvic floor, simply because there is more weight that needs to be supported, among other things. During labor and birth, the muscles relax and stretch to accommodate the baby. Kegels are a “shortening” exercise, so when you voluntarily recruit them and do a Kegel, the muscles contract and therefore build strength (similar to a bicep curl). The tricky thing about the pelvic floor is that it is on all the time to support us, maintain continence, and aid in sexual function. It’s working now to hold in urine and stool, and support your uterus and growing baby. As the demand increases on the muscles, they must be strong enough to continue to work properly and accommodate the new demands. Kegels will help strengthen the pelvic floor, not necessarily “relax” it, if you will. And, yes, it can be helpful in pregnancy if the muscles are beginning to tire out and become weak. Usually signs of weakness include stress incontinence, for example. But, it’s hard to tease that out in late pregnancy because the baby is also tap dancing on your bladder! To really tell what state your pelvic floor is in, it is best to have an evaluation by a qualified physical therapist. She can evaluate your muscles and assess whether they are weak, short, or strong, and if you should be doing Kegels or not. To answer specifically if they would be helpful in birth, my personal opinion is that they are more helpful in the recovery of birth (if you are on the weaker side going into delivery).

      If you are strong going into labor, and you are able to relax your pelvic floor and bear down appropriately, you may have a little easier recovery. Again, this is all woman-specific, and there are a lot of variables to take into consideration. So…should you do Kegels while pregnant? It depends on where you are now, and what state your pelvic floor is in. Remember, your pelvic floor muscles are working all the time, so your pelvic floor may be perfectly strong and may be accommodating the pregnancy and added demand on them just fine, so you may not need to take any action, it really just depends on the woman. So touching on the WebMD comment, it’s not completely bunk, because yes those muscles help support all those structures mentioned, but like I mentioned above, Kegels don’t help relax or lengthen the muscles, and that’s what you really need for birth. It’s all about balance. You want the muscles to be strong to continue to support you and the baby, and also decrease the risk of urinary incontinence after birth, but at the same time, you need to be able to relax them and control them appropriately. The best way to learn how to do all those things is to have an evaluation by a qualified pelvic floor physical therapist. I believe the overall message here is that this is an issue that’s complicated with many variables. So an across the board edict to either “do Kegels” or “don’t do Kegels” is just not appropriate.

      All my best,
      Marcy

  7. I have a question. I have been dealing with pelvic floor and SI joint issues since my pregnancy 2 years ago. I saw a great PT in my area for over a year. First, I stretched the pelvic floor, then we moved on to Kegel’s after all my pelvic floor pain was gone. I had little increase in strength with kegel’s so after several months we started using a vaginal stimulator. This did increase muscle strength, and after 45 days I stopped using it. My pelvic floor soon started loosing strength again and I noticed that the stimulator increased my SI joint and groin pain. She suggested using the stimulator 1-2 times a week then using the dilator after to stretch, but it causes more groin and SI jt pain. I think the stimulator is also contracting my psoas. I have tried different positioning with the stimulator with no relief. She says there is not much else we can do. Are there any other ways to strengthen the pelvic floor when Kegel’s are not enough? could other postural changes like Kati suggests help in this situation? What are my other options? I have seen other PT’s who also specialize in pelvic floor who have been little help.

    • Dear Shannon,

      I am assuming you are referring to a home “e-stim” machine, or NMES unit to help assist with pelvic floor muscle contractions. I’m glad your PT had you balance out strengthening with stretching, I think that is a smart way to go. As with any muscle group, if you don’t maintain your exercises, strength will decline. My question is, how did you know you were losing strength? Did you start to experience leaking or other symptoms? Personally, I prefer not to use e-stim machines, so I have my patients do a combination of isolated pelvic floor strengthening (if appropriate) in conjunction with deep abdominal work and functional exercises. We need our pelvic floors to be strong during daily activities, not just when we are laying down. Posture will also play a role in your SIJ, PFM, and groin pain, and should be addressed, as well as looking at the function of your abdominal and multifidi muscles (core). I would suggest being evaluated by a PT who specializes in post-partum PT and pelvic floor dysfunction, to see if she can link orthopedic issues with your pelvic floor issues. I hope this helps. Good luck!

      Marcy

  8. Hi Liz

    Your post is very informative and highlights the importance of truly understanding pelvic floor’s responsibility and function. It is a myth that a tight pelvic floor cannot be dysfunctional and that all pelvic floor exercise is created equal for all people.

    Any muscle that has become tight has been shortened by default and the opposing muscles become long and weak. It is hard to distinguish within the pelvic floor exactly which muscle is short and tight, but it is important for women who want to consider deep squats as a way of effectively working their pelvic floor to note the role and responsibility of the muscles within the butt (as well as their own postural limitations) to ensure they are ‘doing their job’ of extending the hip, or rotating the hips and knees outward, instead of primarily stabilising the pelvis because of instability within the pelvis, which can cause dysfunction within the pelvic floor when the buttocks act as a stabiliser for the pelvis as their primary role when this should not be the case.

    This faulty recruitment alone can cause the piriformis to become overactive along with the ischiococcygeus and together they can cause the pubococcygeus to become underactive. Since this part of the pelvic floor is crucial to ensuring continence during intra abdominal pressure, deep squatting without ensuring the effectiveness of this muscle and the whole pelvic platform alongside the transverse abdominals, can actually be detrimental. The important thing for the practitioner and the patient is to understand muscle and movement in relation to the individuals history and lifestyle.

    My book Pelvic Floor Secrets, gives the reader a user friendly guide to understanding their pelvic floor and be able to seek the appropriate assistance for their individual desired outcome.

    We are all individuals and we all function uniquely, so we should not look for shop shelf exercise programmes if we want optimal health.

    Stay blessed

    Jenni Russell

    • Hello,
      I started pelvic floor exercises with a very good pelvic floor therapist. I was doing the exercises everyday for a uterine prolapse. Doing 2 second kegels, 5 second kegels and 7 second kegels. Suddenly I got severe spasms in vagina and rectAL area. went back she said my muscles got to strong from the Kegels and they started causing the spasms. since then which has been 2 months still the left side of the butt rectAL area and left side of vagIna is to tight and spasms once in awhile still. We are trying to break up the tightness but it has been hard. But no more Kegels for now unti, this is all over with. also rectal feels very weird from this. I think the nerve is bad. So sometimes doing Kegels is not good if you do to many of them

  9. I think what is not being recognized, and is most important, is diet. If you do kegels or any exercise, you want to eat the proper foods. In this case you want foods rich in fat and protein, such nuts, seeds fatty meats like beef or chicken with the skin. Organ meats are good also. You want to eat these foods within an 1.5 after doing the exercises. The reason is because, the pelvic floor is made up of mostly slow twitch fibers that deal with mostly fat. This makes sense since the muscles have to work all day, so they need a constant source of energy, which fat provides. The protein helps with small repairs that may need to be done. The rest of the muscle fibers are fast twitch which deal with sugars. This helps deal with quick reactions like sneezing or physical labor.

    People tend to think exercise is the main thing that changes their body, but it’s just a piece of the puzzle. Without the proper foods, exercise won’t do much, but with the right foods, and eaten at the proper time, exercise will make your muscle STRONG, yet relaxed when it needs to be.

    I know these things because I work out, and made no changes until I did things different with my diet, and timing of eating the foods according to my exercise routine.

    Hope this helps someone.

  10. So your saying tht kegals can negatively impact a mans ability to achieve and or sustain an erection right? I ask this question because I often read on websites men claiming their erections have improved because of kegals but my experience is a negative one. I had trouble achieving and or maintaining an erection. When I did it was a weak erection. Am I the only man complaining about the negatives of kegals? I feel that way.

    • Dear Todd,

      If your ED is caused by a too tight pelvic floor or trigger points within your pelvic floor, than yes doing Kegels can be harmful.

      All my best,
      Stephanie

        • Dear Mark,

          I would recommend that you see a qualified pelvic floor PT. Where are you located; perhaps we could recommend one to you in your area?

          All my best,
          Liz

  11. Hi Liz
    I am a 57 yo man who underwent a robotic prostatectamy 3 months ago and have been doing pelvic floor exercises which i started about 2 months before sugery as instructed by my doctor.As i have had very little incontinance for the first 3 weeks after my surgery to being totally continant inside 3 months prompts my question which is:
    Can a person in my situation now do too many pelvic floor exercises?Is it possible that by doing too many exercises can make urinating difficult?
    What are your thoughts?
    Thanks

    • Dear Phil,

      Yes, actually that is possible. You can ‘over-strengthen’ your pelvic floor muscles, which in essence, makes the muscles too tight. Unfortunately, it’s almost impossible for you to tell whether your pelvic floor muscles are strong enough to discontinue the exercises or if you need to continue to do them. I would seek the advice of a pelvic floor PT who can evaluate the strength of these muscles and make a recommendation as far as a continued exercise program.

      All my best,
      Liz

  12. Hi Liz,

    Thanks for your valuable information. I am a 30 years old male and am having premature ejaculation problem, it was then someone advised me do kegel exercise which by starting solved my problem to a good level but the thing which I want to ask is that I found it more useful when I stop my urine stream 2-3 times every time I go for urine. so could you plz tell me should I continue doing it or this could be harmful.
    Many thanks Sharma

    • Dear Sharma,

      No, I would not continue to stop your urine stream every time you void. That could cause your pelvic floor muscles to become too tight which can cause an array of pelvic floor issues. Also, to my knowledge, having a strong pelvic floor does not necessarily have anything to do with premature ejaculation.

      All my best,
      Liz

  13. I have been on drugs to control early signs of BPE and when I started Kegal, there was remarkable improvement in urine stream and even ejaculatory force initially but after about six weeks I started experiencing difficulty in sustaining erections and ejaculatory sensation became too brief. I don’t know w
    hether to stop the exercise and if so how?
    Thanks

    • Dear Gana,

      I would recommend that you stop doing Kegels if they are causing you problems. Not sure what you mean by, “if so how?”

      Liz

  14. Whenever I do kegels I end up with a lot of bladder irritation and have just gotten an uti after doing them for a few weeks. It bothers me within a few minutes of finishing them. Anyone else have this problem? I’ve been to a PT in the past, so I think I’m doing them correctly.

    • Dear Reader,

      I would recommend that you discontinue Kegels and get an evaluation with a qualified PT; it might be that as the article describes you have a tight pelvic floor and that is why you are experiencing pain with Kegels. A qualified PT will be able to tell you if your PF is indeed tight and he/she can manually work on it to reverse the hypertonicity (tightness).

      Best,
      Liz

  15. I am currently studying to become a pre/post natal fitness instructor and I am learning a whole lot when it comes to Pelvic Floor issues. If you have time, check out this website. I recently took a certification course in Pfilates (Dr. Bruce Crawford). Exercises to eliminate urinary incontinence, prolapse and strengthen the PF. However, i was told if the client is hypertonic, these exercises are not good for them. Same idea as mentioned in the article. No kegels if you are too tight.

    http://www.belliesinc.com (3 women in fitness and physio, working with moms on their PF and TVA… dealing with diastasis Recti)

    http://www.pfilates.com

  16. I have been suffering from premature ejaculation for a long time now which I think was brought on by doing Kegel exercises. I have completely stopped doing Kegels since and I haven’t found any improvements. Is it because my pelvic floor is too tight? I get involuntary contractions which is what always sends me over the edge. Is there something I can do to stop these involuntary contractions? I’m unsure if I need to further strengthen my PC muscle or if it’s too tight and I need to do some sort of stretches to alleviate any tightness that is causing the involuntary contractions. I would really appreciate a response I have been suffering from PE for several years.

    • Dear Hayden,

      I’m sorry but it’s impossible for me to answer your questions without evaluating you.

      That said, I would advise against any further strengthening because if you do have pelvic floor tightness that will worsen it. I advise you to see a pelvic floor PT for an evaluation. Where are you located; perhaps I can refer you to one in your area.

      All the best,
      Liz

        • Dear Hayen,

          We do not know of a PT in Wheaton; however, there is an amazing PT in Chicago that is worth traveling to see; she is one of the best in the business. Her info is below:

          Kotarinos Rhonda PT Chicago IL (630) 620-0232 RKotarinos@msn.com

          Best,
          Liz

          • Hi Hayden,

            I have been having the exact same problem and question as you. It would be of great help if you could tell me if you had any progress by tackling your pelvic floor. Was it too much tension or not enough strength?

            It is great to hear people seek out help and discuss this. Thank you,

            Alex

  17. I know that when I was first aware of kegels, and my PC, I was too aware of that area and that would cause me to Pre-mature ejaculate. After Kegels became second nature, it was more like if I wanted to ejaculate, I could but it was all mental, I had a sense of awareness like a count down that sense of awareness allowed me to focus on other area like the mood, lighting,my partner, then it was as easy as adjusting my thoughts.

  18. My complaint was a spot in area of left labia that hurt with prolonged sitting. PT told me to do Kegel exercises, but when I did the pain spread to my entire pelvic area. It’s been 4 weeks and pelvis still has burning pain. Could that spot have been a trigger point–tight muscle? How can I come back from this?

    I am using valium suppositories but they don’t help very much. Also sometimes it seems the pelvis hurts more than that initial trouble spot.

    Any help?

    • Hi Sheila,

      It is possible that your initial discomfort could have been a trigger point in your labia, however I cannot say for sure without evaluating you. My advice is that you see a local pelvic floor therapist who can determine the source of your pain, and also treat the issue. Where are you located? I may be able to refer you to a therapist.

      Regards,

      Casie

  19. Hi,

    I suffer from idiopathic pudendal neuralgia. Upon examine, by my new women’s health PT she said I have a weak pelvic floor. She wanted me to do kegals, which I have not done due to the advice of almost everyone I know who knows about PN/PNE. My new women’s health PT wants me to try to tighten/strengthen my gluetes to see if we correct a femoral anterior glide syndrome. How on earth do I tighten my glutes without doing a kegal or tightening my pelvic floor muscles. I am at a loss.

    Thanks,
    Dee

  20. Liz and Steph, I took your course a while back and have been using the connective tissue mobilization techniques with many of my patients and most often with success, so thank you so much. In reading about when to do or not do kegels (as mentioned in your blog, Liz), I have to question you on something. You state that not all patients should do kegels. I understand that. But I disagree that all patients with “tight” or “shortened” PFM should automatically NOT do kegels. I have found actually that learning to contract and then relax (at times relaxing for double or more of the time contracting) has helped some women learn to relax. With manual stretching I have used a hold relax or contract relax technique to enhance relaxation and aid with mobilization after. Think about Jakobson’s relaxation techniques. We ask one to squeeze a muscle (ie. hands or biceps or facial muscles) and then feeeeel the relaxation of the same muscles. I find it similar with many PF patients. If they actively can feel themselves contract they often then learn to better let go or relax and then if necessary to be manually stretched & they tolerate it better. I have often had women who are tight and weak, I think partly because they have little “range” of contraction. So I work on stretching them but also have them contract and relax the PF to increase the amount of active movement of those muscles. Only if doing kegels causes more pain or tightness or spasm do I tell them to stop. Also, lets not forget about the circulatory benefits of contracting the PFM. Improving blood flow can help tight structures as well. It is very confusing to both therapists and patients to read all these varying opinions of dos and don’ts even though we mean well. I appreciate that you repeatedly recommend people be evaluated by a therapist specializing in PF issues. Every patient and situation is unique and that’s why it is important, as you suggest, that a therapist evaluate their specific needs. I just haven’t found too often that doing kegels has made someone get too tight (unless they were very strong, super hypertonic or in spasm to begin with or if they do kegels too often thru the day). Obviously when doing PF contractions has increased pain or spasm with a pt. I have instructed them to stop. Also biofeedback with vaginal sensor has helped teach some patients to relax and then be able to contract and relax more normally. Thanks for all you do to help. I don’t know where you find all the time!! Lynne

    • Hi Lynne,

      Yes we agree with you that not all patients with tight PFM should automatically rule out kegels, which is why I emphasize that in my post:

      “I do not completely agree with the article. While women and men with tight pelvic floors should never do kegels, they are appropriate for a certain patient population, patients that have weak pelvic floors.” We appreciate your feedback.

      Best,

      Liz

  21. My pelvic floor muscles are tight as a results of heavy squatting with bad form for over a month straight.
    Can tight PFM cause a loss of libido in men?
    Can they also cause constricted genitals that seem to shrink them or cause a lack of blood flow and sensitivity?
    The squats also threw my posture out of whack… Will prolonged bad posture cause these issues too?

    How would I stretch the PFM? I’ve done a lot of trigger point therapy already but has helped but not enough.

    Thanks!

    • Dear Max,

      Tight PFM themselves are not going to cause a loss of libido in men, but if you have pain or discomfort with sexual activity, that could indirectly contribute to a decreased libido. Yes, tight PFM can restrict blood flow to the genitals that can affect the ability to get and maintain an erection. They may also affect sensitivity, but I think less so. Sensitivity is going to be more affected by nervous structures. I don’t think that tight PFM would cause the genitals to shrink though. Prolonged poor posture can affect just about everything in the body from your head to your feet, so yes, it can also affect the pelvic girdle. The pelvic floor muscles need to be manually stretched for it to be effective, i.e., a skilled physical therapist needs to manually stretch the musculature with one finger inserted into the anus to access the muscles. You can lessen the activity of the pelvic floor, or relax them intentionally, with instruction from a pelvic floor physical therapist, but it is impossible to get into a particular position or move a body part to stretch the pelvic floor musculature specifically like you would a hamstring.

      All my best,
      Liz

      • Thank you very much that was perfect.
        I was hoping atleast one of those issues could be the cause.
        Do you recommend ROLF or any other type of alignment treatment?

  22. Hi Liz. Thank you for your good article. I want to point out that Katy Bowman’s opinion as stated above is inaccurate. She does agree that kegels are appropriate in instances such as post delivery. See her famous article online with sweat mama.
    She also advocates a deep squat but only while going into great detail regarding the appropriate pre-strengthening excercise and stretches to do to begin to work towards the goal of a deep squat such as she advocates.

    Nancy

  23. Hi, my perineum muscles feel tight and the bloodflow to my genitals Is significantly hindered. My scrotum and penis have significantly lost bloodflow. I have Been to several PT’s and the only thing they let me do at home as exercises are a kegel squeeze with my rectum muscles And Then relax it. Altough this sometimes relaxes my anus muscles temporarily i’m not sure if this is also good for relaxing my perineum muscles. (i also have been checked for trigger points but i have none). My PT says that you can only relax your pelvic floor by contracting it first. Is that true?

    When my PT uses biofeedback i Can bring it back to 3-4 eventually (when starting usually around 5, sometimes higher), but the bloodflow in genitals still isn’t right when it’s 3-4. I’m wondering if the biofeedback isn’t maybe measuring my tensed perineum muscle And only the tension around my rectum possibly?

  24. Do you think there is a downfall to doing squats for people with hypo or hyper tonic PVF?
    Im thinking about how strong the adductors work in a parallel stance squat and there tension on the pubis.

  25. Hi,

    Being a complete laywoman in the whole thing, I must say I’m confused. I am now 6 months pregnant and was told to do pelvic floor exercises whenever I can.
    I assume my pelvic floor is weak if I need to cross my legs while sneezing, but how do I know if they’re toned, tight or most of all “have active trigger points.” Could you explain it somehow?

    Regards,
    Marlen

    • Hi Marlen,

      Until a pelvic physical therapist internally evaluates your pelvic floor, its difficult to know whether you have weak or tight muscles. As long as your physician has cleared you for intercourse, a pelvic floor PT can still evaluate you, and treat you internally. I would recommend that you see a local therapist in your area.

      All my best,

      Melinda

  26. I think it will continue to be confusing as long as we are using exercises (kegels, squats, etc.) as a supplement to try to meet the needs of a body. The body needs a full array of movement nutrition. I think it’s the equivalent of telling someone they need calcium – but not looking at the whole picture of what the body needs. If we ate too much calcium, not enough or only calcium supplements, we’d be in trouble.

    The body works as a whole not just as a pelvic floor. One part of the body is influenced and influences other parts. We need to move in our daily life – an array of movements, to create a balanced and vibrant body state.

    In our diet – it is optimal to try to get our needs met from a healthy balanced array of nutritious food. The same applies to our movement needs. It is optimal to get our bodily needs met first by daily gentle whole body movements (i.e. walking, tai chi, gentle yoga, etc.) If supplements are then needed, specific exercises might be used as needed, then discontinued when no longer needed.

    I think an important part of movement is also stillness. We need to learn how to balance our movement with rest. Our bodies need to stretch and tone (both tight states) but our bodies also need lax states. A side effect of stress can be constantly tight bodies. One way to notice if we are relaxed is to notice if our muscles are gripping in ways they don’t need to be. Also noticing if our breath is deep (belly raising on the inhale) and slow.

    • Hello Joy,

      Yes we agree with you. Stillness, tai chi, and gentle yoga all promote body mindfulness that can sometimes be overlooked. These practices can also greatly reduce stress, which can be a big contributor to all sorts of dysfunction. Thank you for your input!

      Best,

      Casie

  27. I super appreciate this conversation and all it’s subtleties. Thanks for the courage to bring up a very nuanced and grey topic.

  28. Hi …i did kegel exercice and i confirm ur articles and that kegels is bad for man pelvic floor…it becames very tight and and i feel somme problem after ejaculation…i thought that it is a prostatit but my prostat seems to be fine …and my plev it still tight even after stopping it…so do u have advice for me …does squat can help me to relax my picelvic floor ? thank u i am realy need adivse

    • Hello Job,

      I would suggest that you see a pelvic floor specialist in your area. He or she will be able to assess your musculature, and give create a specific treatment plan for your findings. Best of luck.

      Regards,

      Rachel

  29. I m a 40 year old male and started doing kegel after i found i have some post urine dribble. I only did kegels for a week and now think that i have damaged my anal sphinsters. Now i cannot control by bowel urgency, this was not a problem before. Does doing kegel weaken your anal sphinster muscles?

  30. I went on a back recovery course a couple of years ago in a physio unit, that involved pilates moves. In the introductory class they said we should imagine our pelvic floor was a draw string back and pull it up and in; and then taught us to activate core muscles. I always like to be top of the class and really took this advice to heart, practicing all the time at the bus stop, brushing teeth, so that this became my natural unconscious state. Unfortunately after a cycling injury I started to get vulva pain and I think set up a cycle of guarding from the pain. I have been suffering severe pain for a year and have had a good amount of relief from the pelvic pain physio in London. But I am so upset that a) I can’t seem to kick the habit of tightening my pelvic floor I have to do moment to moment active relaxation all the time (as well as trigger point and stretching excercises) b) I feel so upset that I was given this advice in the first placce. When I had my first assesment my PT said that my strength was at a 5 and I was able to hold for over 20 seconds. I feel it was not needed at all and the advice from the back clinic has caused me so much pain and suffering I don’t know how to come to terms with the anger I feel towards this clinic. Do you think it’s worth writing to them to let them know that their advice has caused me severe problems?

    I see Sarah Cross at Crystal Palace Physio Group. She specialises in women’s health and pelvic floor dysfunction. She’s approachable, positive and caring and wonderful: http://www.cppg.co.uk/private-clinics/services/womens-health.html Sarah Cross S.Cross@cppg.co.uk

    • Hello Rachel,

      I am sorry to hear about your situation. We cannot advise whether or not you should write to the clinic as that is your personal choice. We do however encourage you to communicate with Sarah. Best of luck in your recovery.

      Regards,

      Liz

  31. Hi there, Im in quite a frustrating situation. I am 18 years old and from what I researched online I think i have urinary incontinence. I leak a few drops after I urinate and sometimes I feel like its stuck there. I dont have problems starting to urinate but near the end phase it becomes more difficult to get it all out and the rest kind of drips out little by little

    I think this is possibly because when I was younger I used to tense the pelvic floor muscles when I masturbated, i got used to that and thought that it was normal and I think I kind of messed up the pc muscles.

    Im in a really frustrating situation because I want to make it go away, but there are so many questions.

    Can i make it better?

    How do I know if i weakned the muscles or made them too strong and/or tight?

    Are reverse kegel exercsies helpful because I think in my case i overworked the muscles and maybe I need to make them relax…

    Any advice would be much appreciated , thanks in advance

    • Hello Alan,

      I’m sorry to hear about your situation. It is difficult to say without first evaluating you, but given your description it seems that pelvic physical therapy will help treat many of the symptoms you are currently experiencing. I would be happy to offer you a therapist recommendation. Where are you located?

      Regards,

      Liz

      • Well i live in london. I assume you live in america?

        Anyway, would you be able to tell me if reverse kegels would help?

        Or maybe just stop messing aroud with the muscles all together ? Would that restore the balance back?

        And If i go to the doctor do I need to be examined or just describe the symptoms?

        This is quite an embarassing problem…

  32. 74 yr old female and have weak pelvic floor. Waited 2 months to see a DPT that specializes in this problem. After one week of kegel excerises my bladder is extremely sore so much it hurts when I walk. Also have frequency during the day, not at night.Have another appt. tomorrow. Should I completely stop Kegels?

    • Hello Sandra,

      Yes, if kegels are causing more dysfunction, it would be best to discontinue the exercise. We also recommend that you communicate your concerns to your current therapist. If she/he is unable to assist you, we may be able to offer you a therapist recommendation for a second opinion.

      Best,

      Allison

  33. Am recovering from a radical robotic prostatectomy. (Dec. 10) I am still very incontinent. Through bio feedback I have learned that I have tight pelvic floor muscles. They have given me both relaxation and Kegel exercises to do. I am not making much if any progress. Should I stop the Kegel’s and only do the muscle lengthening exercises?

    HELP! I’M DROWNING!

    Phil

    • Author Stephanie Prendergast says:

      If your pelvic floor muscles are too tight it is not appropriate to do Kegels until the muscles are of normal length. Tight muscles cannot contract efficiently or properly. Our general rule of thumb is to lengthen then strengthen.

  34. My physical therapist has directed me to do Kegel’s every other day. I have followed this prescription while do the lengthening and relaxing exercises everyday. My incontinence has improved, but I am still not fully continent. I am told that the Kegel’s are necessary to restore continence. I don’t know if you agree but I welcome your opinion; it’s been 3 months today since surgery and I really want my life back.

    Thanks so much for you time.

    • Author Liz Akincilar says:

      “Strengthening your pelvic floor muscles when they are actually weak, as in many men who have undergone a prostatectomy, is absolutely necessary. Kegels are one type of exercise that focus on improving the motor control, which includes strength and endurance, of the pelvic floor muscles. The surrounding muscles in the abdomen and pelvic girdle likely also need to be strengthened. This is something your physical therapist should be able to assess and prescribe appropriate exercises as needed. With a prostatectomy there is a chance that there was some damage to the surrounding nerve(s) which may also be limiting your progress. You should discuss this with your physical therapist and physician. Without evaluating you myself it’s impossible to tell you what your prognosis is, but the fact that your incontinence has improved is a very good sign!”

  35. Let me add to me previous response. Some Kegel’s when recovering from a prostatectomy seem inevitable. For example, when I get up out of a chair, if I don’t squeeze my Kegel muscle I will have a gush of urine. As you can see I’m in bit of a dilemma. I’m surprised I can’t find anyone out there who has been in this bind that I am in.

  36. Hi

    I’m male and I found out that my pelvic floor muscles are very tight because of kegels. Can you recommend a good PT in London?

    Also, how long does it usually take to get rid of the tightness in the PFM, with a good PT? I know it probably depends on many factors, but can you give me an average time?

    Thanks

  37. Here’s the clincher….lol. Am I the only one that laughed at this part…..very well written 🙂 Great article. As a Pilates teacher when clients have a hard time engaging their abdominals I cue them to refer back to the kegal and then to pull in the stomach going up to the diaphragm like zipping up a tight pair of pants. Do you think this cue is ok for most health bodies over 50? xo

    • Hi Summer, unfortunately for liability reasons we cannot comment on this without having an evaluation of the person in question.

  38. Hi Liz,

    Forgive me if this has been addressed.

    Is it possible for a hypertonic pelvic floor to cause uterine retroversion?

    I’m piecing together thoughts and I’m beginning to wonder if there may be a correlation here.

    • Author Liz Akincilar says:

      Hi Jessica,

      No, to my knowledge it is not possible for a hypertonic pelvic floor to cause uterine retroversion.

      Best,

      Liz

  39. Hello, Im a 22 year old male, and I have a quesiton about an overworked/strained PC muscle. basically what happened was I was doing regular kegels for around 3 months, and my penis was doing fine, I had gotten super hard erections, able to hold it up for a long time. Well, I started to incorporate reverse kegels in along with the intense normal kegels. I did that for days, and Id do it when I masturbate to, but afters the second day, something strange happened. My pelvic floor muscle felt like it had gone numb from me doing too many reverse kegels. It was an odd feeling ,but its made it so thats I sort of have trouble pushing urine out, and while I had a very hard erection the other day, it doesnt feel so strong now, and actually feels weak and lifeless, which could be the fact that ive stopped normal and reverse kegels since then as well as the fact that i may have really strained something. When I masturbate, I dont feel much at all, and I get an aching feeling in my pelvic floor muscle from time to time. it feels strained, that much I know, but im wondering what I should do about this?? Im very worried about it. Will it heal on its own?? It feels like I badly stretched it, which could be why it feels a bit numb and odd. I havent done kegels for about 6 days now, I think.

  40. Hi, I think I have tight PC muscles because of running all day and not getting a rest. That day I felt a burning sensation in my groin area. One day later my lower abdomen felt weak/stiff and my Anus tight. That was just the symptoms I had but when I jogged a little bit I felt like a tennis ball in my anus and felt tight just a little. Rest helped a lot. I when to the doctor and told him what happened, then he checked me and felt that the perineum area was a little inflammation. Also I just want to know if tight PC muscles are the cause for abdomen rigidity and pelvic alignment?

    Thank you

    • Author Liz Akincilar says:

      Hi Adrian,
      It sounds like you may have some tightness in your pelvic floor muscles. The PC muscle is one of those muscles. It’s nearly impossible to guess which muscle or muscles in your pelvic floor are tight without evaluating you. A tight PC muscle is likely not going to cause abdominal rigidity. That is likely due to tension in the abdominal muscles themselves. A tight PC muscle may contribute to dysfunctional pelvic alignment, but there are many other muscles that are likely playing a larger role in pelvic alignment, ie, the psoas, the quadratus lumborum, the adductors, etc.

      I hope this helps!

      Best,

      Liz

  41. Hello, I have an embarassing problem. My pc muslces are very tight, ever since I was a young child (10) I tensed my pc muscles. This has resulted in very tight pc muscles, they are also very overactive. I even have difficulty passing wind because they are so tight. Would reverse kegels be good for me?

    Is there anything you can suggest to help this problem? Thanks in advance

    • Author Liz Akincilar says:

      Hi Eddie,

      Without evaluating you it’s very difficult to determine what exactly the problem is. However, if someone has diagnosed you with tight PC muscles, then yes, one thing that would help would be to relax those muscles voluntarily. I’m assuming that’s what you mean by reverse Kegels. Keep in mind that you don’t want to push out, but just relax those muscles. It’s best if you see a pelvic floor physical therapist who can show you how to do this correctly.

      I hope this helps!

      Liz

  42. I’m so happy I read this. Due to severe disc issues throughout neck to lower back I was told to do kegels as part of abdominal bracing activities but to do as many kegels all day as I could while pulling in abdomen muscles. For the past 4 months I’ve been battling what I thought were recurring UTI’s have been on rounds of antibiotics..treat first test later negative scenarios and after meds finish symptoms come right back. I have seen a urologist and scanned for kidney stones and not one question about Kegel activities. It’s such a subconscious act that even typing this reply I have to remember to relax

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