Why “Just Do Kegels” Isn’t Always the Answer

"Just do Kegels!"
It’s the go-to advice for incontinence, pelvic pain, and postpartum recovery. But what if that advice is misleading—or even harmful?

While Kegels can be incredibly helpful for some, they are not a one-size-fits-all solution. In fact, for many women, doing Kegels can worsen their symptoms, especially if they have an overactive pelvic floor.

If you've been diligently doing Kegels but your symptoms are getting worse instead of better, you may be dealing with pelvic floor muscle overactivity. Recognizing the signs and understanding what to do instead can make all the difference in your recovery.

What Are Overactive Pelvic Floor Muscles?

An overactive pelvic floor means your muscles are tense or unable to fully relax. Instead of working in a healthy cycle of contraction and relaxation, the muscles stay in a guarded, shortened, or gripping state—often without you realizing it.

To put it in perspective:
Think of your shoulders slowly rising toward your ears throughout the day due to tension. Eventually, this leads to pain, fatigue, and dysfunction—and you wouldn’t treat that with more shoulder strengthening. Your pelvic floor is no different.

The Kegel Misconception

Kegels involve contracting the pelvic floor muscles to help improve strength and control. They’re great when someone has muscle weakness or struggles to initiate a contraction.

But if your muscles are already in a tightened state, adding more contraction is like tightening a muscle that's already clenched. Imagine doing shoulder shrugs all day when your upper traps are already overactive—it only makes things worse.

The confusing part?
Overactive pelvic floor muscles can mimic symptoms of an underactive or weak pelvic floor: leaking, heaviness, or pelvic pressure. That’s why many women say, “Kegels didn’t work for me.”

Instead of offering relief, you may notice:

• Increased pelvic pain

• Worsened urgency or frequency

• More discomfort during sex

• Frustration with lack of progress

Signs of an Overactive Pelvic Floor

🚨 Bladder + Bowel Symptoms:

• Urinating frequently (every hour or less)

• Sudden, intense urges to urinate (urge incontinence)

• Feeling like you can’t fully empty your bladder

• Straining or constipation

• Painful bowel movements

🚨 Pelvic Pain or Pressure:

• Persistent tailbone, hip, low back, or groin pain

• Discomfort when sitting, especially on hard surfaces

• Pain during sex (at entry or deeper)

• A feeling of tightness, heaviness, or burning in the pelvis

• Difficulty using tampons

🚨 Muscle Coordination Issues:

• Trouble starting or stopping the flow of urine

• Leaking despite doing "everything right"

• Inability to relax—especially during rest or deep breathing

What Causes an Overactive Pelvic Floor?

If these signs sound familiar, here are common root causes:

1. Chronic Stress & Anxiety

Stress often shows up as physical tension—including in the pelvic floor. Many people subconsciously clench these muscles during stressful moments.

2. Previous Trauma or Injury

Physical trauma, surgeries, or emotional trauma can lead to long-term protective muscle guarding.

3. Poor Posture & Movement Patterns

Long periods of sitting, poor body alignment, or compensatory movements can contribute to muscular tension.

4. Overexercising or Poor Technique

Too many Kegels, holding contractions too long, or never learning proper relaxation can create muscle imbalance.

5. Chronic Medical Conditions

Conditions like endometriosis, interstitial cystitis, or IBS can lead to chronic guarding of the pelvic floor muscles.

When to See a Pelvic Floor Physical Therapist

If this sounds like you, the first step is to pause the Kegels. Focus instead on:

• Relaxation techniques

• Diaphragmatic (belly) breathing

• Gentle stretches or yoga

• Mindful movement and posture

Still unsure if your pelvic floor is tight, weak, or both? A pelvic floor physical therapist can assess your individual needs and guide you with a tailored treatment plan.

You don’t have to guess—or suffer—any longer.

Not all pelvic floor dysfunction is solved with Kegels.
In fact, the real key to healing may lie in letting go, not holding on tighter.