"Just do your kegels." You heard it from your OB, your mom, and that article you read at 2am while nursing. You have been doing them faithfully for weeks and nothing is changing. Here is what most people do not realize.
Kegels are not a one-size-fits-all solution. For some women, kegels are exactly what they need. For others, kegels can actually make things worse.
Pelvic floor muscles can be too weak. They can also be too tight. Or they can be firing at the wrong time. Each one needs a different fix, and only one of them is more kegels.
Most people assume pelvic floor problems always mean weakness. Muscles are too weak, so you strengthen them. Makes sense, right?
But a tight muscle is not the same as a strong muscle. Make a fist and hold it as tight as you can for five minutes. Your hand would not be strong after that. It would be fatigued, cramped, and weak. The same thing happens to your pelvic floor.
If your pelvic floor is hypertonic, too tight, doing kegels is like telling someone with a clenched jaw to clench harder. It does not fix the problem. It makes it worse.
Pain during sex, especially with penetration.
Difficulty inserting a tampon.
Feeling like you cannot fully empty your bladder.
Constipation, or feeling like you cannot fully empty your bowels.
Pelvic pain that feels deep, achy, or burning.
Pain in your tailbone, hips, or lower back with no other obvious cause.
Urinary urgency, feeling like you have to go right now, even when your bladder is not full.
One more: if you can squeeze but cannot fully let go afterward, that is a tight pelvic floor talking.
If any of that sounds familiar, the answer is not more kegels. The answer is learning to relax your pelvic floor.
Diaphragmatic breathing is the starting point. When you inhale deeply and let your belly expand, your pelvic floor should lengthen and relax. Many women with tight pelvic floors have forgotten how to let those muscles fully release.
Child's pose, deep squatting, and hip stretches can also help. Anything that encourages your pelvic floor to lengthen rather than contract.
Honestly, if you suspect your pelvic floor is tight, this is where a pelvic floor physical therapist makes a real difference. A PT can assess whether your muscles are too tight, too weak, or both, and build a plan that matches. Guessing can waste months.
Sometimes the muscles are not too weak or too tight. They are just not firing at the right time. You sneeze and your pelvic floor does not react fast enough. Or you try to do a kegel and you are actually bearing down instead of lifting.
This is more common than you would think. About 25% of women who try to do a kegel on their own are doing it incorrectly. Pushing down instead of lifting up, or squeezing the glutes and inner thighs instead of the pelvic floor.
A pelvic floor PT can check your technique. So can a trainer with biofeedback, like the Perifit or the Elvie, which shows on your phone whether you are contracting the right muscles.
Then do them right. Lift and squeeze, not just squeeze. Hold 5, relax 5, then 5 quick flicks. The release matters as much as the squeeze. If you can only squeeze but not let go, go back to the breathing first.
And if several weeks of steady, correct work have changed nothing, that is your sign to get assessed. Leaking that has not improved after 8 weeks of consistent pelvic floor work, pain during sex that persists, or heaviness and bulging are all reasons to see a pelvic floor physical therapist.
Pelvic Floor Exercises After Birth: When to Start and What to Do
Your First Poop After Birth: How to Make It Easier
Postpartum Essentials: What to Buy Before the Baby Comes
Postpartum Recovery Timeline: The First 12 Weeks, Week by Week
Exercise After Birth: When You Can Walk, Lift, and Run Again
Diastasis Recti Exercises: What to Do and What to Skip
C-Section Recovery Timeline: Week by Week to Full Healing
Sex After Birth: When, Why It Hurts, and What Helps
How to Check for Diastasis Recti at Home
C-Section Scar Massage: When to Start and How
Perifit vs Elvie Trainer: Which Pelvic Floor Trainer Should You Buy?
Best Peri Bottle After Birth: Frida vs the Hospital Bottle
Best Postpartum Pads: What to Buy and How Many
Dr. Meg Cochran is a licensed Doctor of Physical Therapy specializing in pelvic floor rehabilitation, a trained doula, and a mom of four. She treats women after birth through Where You Are Physical Therapy in Oxford, Mississippi.
This article is educational and is not medical advice, a diagnosis, or a substitute for in-person care. Products are named as examples. Follow your own provider's instructions. For heavy bleeding, fever, severe pain, or thoughts of harming yourself or your baby, contact your healthcare provider or call 911.
After Birth is Dr. Meg's postpartum pelvic floor recovery guide. Nine chapters, every exercise with its dose, a C-section track, the diastasis check, the return-to-run checklist, and the tight-versus-weak chapter most moms never get. An instant PDF you can read on your phone. It is educational, not physical therapy.
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