Do You Need to Kegel? Understanding Your Pelvic Floor

If you’ve ever mentioned a pelvic floor concern to a friend, searched for pelvic floor exercises online, or talked with a healthcare provider about urinary leakage, there’s a good chance you’ve heard the same advice:

“You should do Kegels.”

Kegel exercises have become almost synonymous with pelvic floor health. And while pelvic floor strengthening can absolutely be helpful for some people, Kegels aren’t the right solution for every pelvic floor problem.

Your pelvic floor is a complex group of muscles that needs to do much more than simply squeeze. These muscles need to contract when you need support, relax when you need to release tension, lengthen as pressure changes, and coordinate with your breathing and the rest of your body.

So, do you need to Kegel?

Maybe. Maybe not.

Understanding what your pelvic floor is doing and what it actually needs is a much better place to start.

If you’re considering pelvic floor therapy on the NH Seacoast, here’s what you should know before adding hundreds of Kegels to your daily routine.

What Exactly Is Your Pelvic Floor?

Your pelvic floor is a group of muscles and connective tissues located at the bottom of your pelvis.

Think of it as a supportive muscular hammock that helps support the pelvic organs and contributes to bladder, bowel, sexual, and core function.

The pelvic floor is part of a larger system that includes your:

• Diaphragm
• Abdominal muscles
• Back and spinal muscles
• Hips
• Pelvis
• Nervous system

These structures constantly communicate and work together as you breathe, move, exercise, lift, cough, sneeze, and perform everyday activities.

Your Pelvic Floor Has Several Jobs

Your pelvic floor helps with:

• Controlling urination
• Supporting bowel function
• Supporting the pelvic organs
• Contributing to sexual function
• Maintaining continence
• Managing abdominal pressure
• Supporting your core
• Coordinating with breathing and movement

Because the pelvic floor has so many responsibilities, pelvic floor dysfunction can present in many different ways.

You may experience urinary leakage, pelvic pain, constipation, urgency, pelvic pressure, difficulty relaxing, or changes in sexual function.

And those different symptoms don’t necessarily require the same treatment.

What Are Kegels?

Kegels are exercises that involve intentionally contracting the pelvic floor muscles.

The basic idea is similar to squeezing and lifting the muscles you would use to stop yourself from passing gas or temporarily interrupt urine flow.

When performed appropriately, pelvic floor contractions can help improve muscle strength, endurance, coordination, and awareness.

But here’s the important part:

A pelvic floor contraction is only one function of the pelvic floor.

Your pelvic floor also needs to be able to let go.

Your Pelvic Floor Needs to Contract AND Relax

Imagine your biceps.

You wouldn’t expect your biceps to stay flexed all day. You need them to contract when you lift something and relax when you’re finished.

Your pelvic floor is similar.

It needs to contract when you need support and control, but it also needs to relax during activities such as urinating, having a bowel movement, and sexual activity.

Why Relaxation Matters

If your pelvic floor muscles are constantly tense or have difficulty relaxing, repeatedly contracting them may not address the underlying problem.

Some people with an overactive pelvic floor may experience:

• Pelvic pain
• Pain with intercourse
• Difficulty starting or fully emptying urination
• Constipation or difficulty relaxing to have a bowel movement
• Pelvic or abdominal tension
• Tailbone discomfort
• Pain in the hips or low back

In these situations, the goal may be to improve relaxation, mobility, coordination, and awareness, rather than simply increasing strength.

When Pelvic Floor Strengthening May Be Helpful

Strengthening exercises may be appropriate when the pelvic floor muscles have difficulty generating enough force or maintaining support.

For example, pelvic floor strengthening may be part of treatment for some people experiencing:

• Urinary leakage with coughing or sneezing
• Leakage during running or exercise
• Leakage with lifting
• Pelvic floor weakness
• Some bowel control concerns
• Recovery following certain pelvic or prostate procedures

Exercise Doesn’t Have to Mean “Squeeze Harder”

Effective pelvic floor strengthening isn’t necessarily about performing as many contractions as possible.

Your therapist may focus on:

• Proper muscle activation
• Holding a contraction
• Releasing completely afterward
• Coordinating contractions with breathing
• Timing the contraction with movement
• Building endurance
• Using the pelvic floor appropriately during functional activities

The quality of the movement matters more than simply counting repetitions.

When Kegels May Not Be the Best Place to Start

One of the biggest reasons to have a pelvic floor evaluation is that symptoms don’t always tell you whether your pelvic floor is weak or overactive.

For example, urinary urgency doesn’t automatically mean you need stronger pelvic floor muscles.

Pelvic pain doesn’t automatically mean you need to stretch.

And leakage doesn’t necessarily mean you should start doing hundreds of Kegels.

A Tight Pelvic Floor Can Still Be a Problem

A pelvic floor can be strong and still not function well.

If the muscles are holding too much tension, they may have difficulty responding appropriately when you need them to relax or coordinate with movement.

This is sometimes referred to as an overactive or hypertonic pelvic floor.

Treatment may focus on helping the muscles recognize when they need to relax rather than simply teaching them to contract more forcefully.

What Causes Pelvic Floor Tension?

There isn’t always one obvious cause.

Pelvic floor tension can be associated with things such as:

• Chronic stress
• Pain
• Previous injury
• Surgery
• Pregnancy or childbirth
• Repetitive straining
• Certain exercise patterns
• Breathing and pressure-management habits
• Protective muscle guarding

Sometimes people don’t even realize they’re holding tension in their pelvic floor.

You may be able to clench your pelvic floor without realizing it, just as people sometimes unknowingly hold tension in their shoulders or jaw.

Your Breathing and Pelvic Floor Work Together

One of the most important pieces of pelvic health is understanding the relationship between your diaphragm and pelvic floor.

Your diaphragm is your primary breathing muscle. As you breathe, your diaphragm and pelvic floor respond to changes in pressure within your abdomen.

What Happens To Your Pelvic Floor as you Breathe?

During a relaxed inhale, the diaphragm moves downward and the pelvic floor can lengthen and respond to that change in pressure.

During exhalation, the diaphragm rises and the pelvic floor can respond as part of the body’s pressure-management system.

This doesn’t mean that every pelvic floor problem can be fixed simply by “breathing correctly.”

Instead, breathing is one part of understanding how your pelvic floor coordinates with your entire body.

What Happens When You Hold Your Breath?

Holding your breath during lifting or exercise can significantly change pressure within your abdomen.

That isn’t automatically dangerous or wrong. Breath strategies can vary depending on the activity and individual, but understanding how you manage pressure can be an important part of pelvic floor rehabilitation.

A pelvic floor therapist can help you learn how to coordinate breathing, bracing, and pelvic floor activity with the movements that matter to you.

What About Men and Kegels?

Pelvic floor exercises aren’t just for women.

Men have pelvic floor muscles too, and those muscles contribute to bladder control, bowel function, sexual function, and pelvic support.

Pelvic Floor Therapy for Men

Men may seek pelvic floor therapy for concerns such as:

• Urinary leakage
• Urinary urgency
• Pelvic pain
• Bowel dysfunction
• Sexual-function concerns
• Pelvic pain associated with ejaculation
• Recovery following prostate procedures
• Difficulty relaxing the pelvic floor

Kegels After Prostate Surgery

Pelvic floor strengthening may be recommended as part of recovery after certain prostate procedures, particularly when urinary control is affected.

However, performing the exercises correctly matters.

Some people compensate by tightening their abdominal muscles, glutes, or other areas instead of appropriately engaging the pelvic floor.

A pelvic health professional can help determine whether you’re activating the correct muscles and whether strengthening is actually what you need.

That’s why postpartum pelvic floor therapy should be individualized.

If you’re seeking Pelvic Floor Therapy Services in the NH Seacoast area, the Ability Allies Pelvic Wellness Team is here to help.

You can find us in Portsmouth, Dover, and Epping.

Just call now and schedule your evaluation today. Making the appointment is half the battle, and showing up is the hardest part.