Kegels help leaks from a weak pelvic floor, but some symptoms come from muscles that won't relax. Here's how to do Kegels well and when to see a physio.
You've been told to do Kegels. Squeeze, hold, release, repeat while waiting for the kettle. For a lot of women that's good advice. For some, it's the wrong exercise for the problem they actually have.
Kegels, also called pelvic floor muscle training, strengthen muscles that have got weak. They're a first-line treatment for leaking when you cough, laugh or exercise. But some pelvic floor problems come from muscles that stay tight and won't let go. Those need help to relax, and that's a job for a specialist physio.
What Your Pelvic Floor Does
Your pelvic floor is a sling of muscles at the base of your pelvis. It holds up your bladder, bowel and uterus, and it helps control when you pee, poo and pass wind. It needs to tighten when you cough or lift and relax fully when you go to the toilet.
Problems can go either way. Pregnancy and birth can stretch and weaken these muscles, and the piece on what happens to your pelvic floor after pregnancy covers that in detail. Other women have the opposite problem. Cleveland Clinic describes pelvic floor dysfunction as when your body keeps tightening these muscles instead of relaxing them.
When Kegels Help
Kegels are best for stress incontinence, the leak that happens when you sneeze, laugh or jump. The NHS says a training programme should involve at least 8 squeezes, at least 3 times a day. It should last at least 3 months. A GP can refer you to a specialist to start one.
That 3-month timescale is worth hearing. Mayo Clinic says you can expect results within a few weeks to a few months. Plenty of women stop after a fortnight because nothing has changed yet.
Kegels have limits. Mayo Clinic says they're less helpful if you leak large amounts when you sneeze, cough or laugh, and for overflow incontinence. Overflow incontinence is when a full bladder leaks small amounts without warning.
How to Do Kegels Properly
To find the right muscles, squeeze as if you're stopping yourself passing wind. You can also picture stopping your pee midstream. But Mayo Clinic warns don't make a habit of using Kegel exercises to start and stop your urine stream. Doing it while you pee can stop your bladder emptying fully, which raises the risk of a urinary tract infection.
- Squeeze for about three seconds, then relax for three seconds.
- Work up to 10 to 15 squeezes in a set, at least three sets a day.
- Keep your stomach, thighs and buttocks relaxed.
- Breathe normally. Don't hold your breath.
The relax part counts as much as the squeeze. Maybe you can't feel the muscles let go between squeezes, or can't tell if you're doing it right. Either is a good reason to ask for a referral.
When the Problem Is Tightness, Not Weakness
An overactive pelvic floor causes a different set of symptoms. Cleveland Clinic lists ongoing pain in the pelvis, genitals or rectum, having to start and stop when you pee, and pain during sex. It also notes that up to half of the people with long-term constipation also have pelvic floor dysfunction.
Straining on the toilet and stress and anxiety are among the factors Cleveland Clinic links to it. If you notice you hold tension without meaning to, why your body feels tense even when you're not stressed may help explain it.
Squeezing harder isn't the fix here. Cleveland Clinic says the most common treatment is biofeedback, which shows you on a screen what your muscles are doing. Physical therapists can teach you exercises to stretch these muscles and improve their coordination, and relaxation such as yoga or warm baths can ease tension.
What This Means for Your Workouts
Strength training is good for you, and the guide to starting strength training as a woman covers the basics. But Cleveland Clinic warns that heavy weightlifting or repeated jumping can increase pelvic floor tension and make symptoms of dysfunction worse. If you have pelvic pain or leaking, ask a physio which movements to adjust rather than stopping everything.
When to See a GP
See a GP if you leak urine or feel a heaviness or bulge in your vagina. Go too if you have pain during sex, or pelvic pain or constipation that won't settle. Also go if you've done Kegels for a few months with no change. Ask about a referral to a pelvic health physiotherapist, who can check whether your muscles are weak, tight or poorly coordinated.
Frequently Asked Questions
How Do I Know if My Pelvic Floor Is Tight or Weak?
Leaking when you cough, sneeze or exercise usually points to weakness. Pelvic pain, pain during sex, trouble starting to pee and long-term constipation can point to muscles that won't relax. Only a proper assessment can tell you for sure, so ask your GP about a pelvic health physio.
Can You Do Kegels Wrong?
Yes. Common mistakes are holding your breath, squeezing your stomach, thighs or buttocks, and practising by stopping your pee midstream. If you're unsure, a pelvic health physio can check your technique.
How Long Do Pelvic Floor Exercises Take to Work?
Mayo Clinic says to expect results within a few weeks to a few months. The NHS recommends training for at least 3 months. If nothing has changed by then, see your GP.
This article is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making changes to your health routine.
