Why Kegels Could Actually Be Making Your Pelvic Floor Worse

Someone told you to do Kegels. Maybe it was your GP after your second baby. Maybe it was a magazine article you read in a waiting room. Maybe it was well-meaning advice from a friend who swore they fixed everything. And so you did them. Religiously. In the car, at your desk, lying in bed at night. You squeezed and held and released, over and over, for months.

And things got worse.

You're not imagining that. You didn't do them wrong. You weren't weak or inconsistent. The advice itself may have been the problem — and that deserves to be said clearly, without hedging.

The Kegel Gospel Has a Huge Gap in It

Here's what nobody tells you: Kegels are a strengthening exercise. They work by contracting the pelvic floor muscles. And just like any other muscle in your body, if it's already tight, shortened, or in a state of near-constant tension, contracting it more isn't going to help. It's going to make things worse.

This is the part that gets glossed over almost entirely in mainstream women's health conversations. The assumption — baked into decades of advice — is that pelvic floor problems mean weakness. Leaking when you sneeze? Weak. Prolapse symptoms? Weak. Pressure, heaviness, urgency? Weak, weak, weak.

Except that's not always true. Not even close.

A significant number of women — particularly women in perimenopause and beyond — have what's called a hypertonic pelvic floor. That's a pelvic floor that's too tight. Too short. Holding on for dear life and never fully letting go. And when that's what's happening in your body, Kegels are essentially like telling a clenched fist to grip harder. The muscles are already shortened. They've lost strength not because they're underworked but because chronically tight muscles become weak muscles. That's how muscle physiology works.

So What Does a Hypertonic Pelvic Floor Actually Feel Like?

This is where a lot of women get blind-sided, because the symptoms can look almost identical to a weak pelvic floor. Which is infuriating. Right?

You might experience:

• Urgency — that sudden, desperate need to get to the bathroom right now
• Leaking when you run, sneeze, or jump (yes, even with a tight pelvic floor)
• Pain or discomfort during sex
• A feeling of heaviness or pressure in your pelvis
• Difficulty fully emptying your bladder or bowel
• Lower back or hip pain that doesn't have an obvious cause
• Tailbone pain

You go to your doctor. Maybe you mention the leaking or the pelvic pressure. And you get told, “Oh, that's normal at your age, just do your Kegels.” And you walk out feeling dismissed — because you are being dismissed — and you go home and do more Kegels and wonder why you're not getting better. Sound familiar?

I want you to know: that's not a you problem. That's a massive gap in how women's pelvic health gets taken seriously.

Why Kegels Specifically Backfire on a Tight Pelvic Floor

Let's get into the actual mechanics, because understanding this might be the thing that finally makes it click.

Your pelvic floor isn't meant to operate in isolation. It's a fluid system — working in sync with your diaphragm, your deep abdominal muscles, and your lower back. When you breathe in, your diaphragm drops, and your pelvic floor gently descends. When you breathe out, both lift. It's a rhythm. A conversation between muscles that happens automatically, all day long.

Kegels interrupt that rhythm. By isolating the pelvic floor and forcing a conscious, repetitive contraction, you're pulling one part of the system out of sync with the rest. If your pelvic floor is already hypertonic — already braced and shortened — you're essentially training it to stay in that contracted state even longer. You're reinforcing the very pattern that's causing your symptoms.

There's also a straightforward physiological reality here: muscles that are chronically shortened don't function well. They lose their ability to generate force through their full range of motion. Strength comes from being able to both contract and fully release. A pelvic floor that can't relax properly isn't a strong pelvic floor — it's a tired, overworked one that's quietly going down the well.

What Actually Helps a Hypertonic Pelvic Floor

Before we go any further — please hear this: I'm not saying Kegels are universally bad. For women with a genuinely weak, underactive pelvic floor, they can be genuinely helpful. The problem is that they've been handed out as a universal prescription without any assessment of what's actually going on. That one-size-fits-all approach is what causes harm.

If you suspect you might have a hypertonic pelvic floor, the single most important thing you can do is see a pelvic floor physiotherapist. Not a general physio. A specialist in pelvic health who can actually assess your muscle tone, function, and coordination. They will change your life. I mean that.

But there are also things worth understanding about what helps, conceptually:

Learning to release, not just contract

For a tight pelvic floor, the goal is downtraining — teaching those muscles to let go. This often involves specific breathing techniques, positions that encourage pelvic floor relaxation (like a supported squat or child's pose), and learning to feel the difference between tension and release. That last part sounds simple, but for many women who've been bracing their pelvic floor unconsciously for years, it takes real practice. It's one of those things where you do a little thing that has a bigger impact than you'd ever expect.

Diaphragmatic breathing as a starting point

Because the diaphragm and pelvic floor move together, slow, deep belly breathing is genuinely therapeutic for a hypertonic pelvic floor. It's not a magic fix on its own, but it restores some of that natural rhythmic communication between the structures. Try lying on your back, hands on your belly, and breathing slowly enough that you can feel your whole abdomen — including your pelvic floor — gently expand and release.

Movement that supports the whole system

Walking, gentle yoga, swimming — these kinds of whole-body movements support pelvic floor function in ways that isolated Kegel contractions don't. Your pelvic floor was designed to work dynamically, as part of movement. Not to be drilled in isolation while you sit at a traffic light.

The Perimenopause Piece Nobody Talks About

Here's where I need to flag something that gets masked almost entirely in standard pelvic floor conversations. Perimenopause changes things. Significantly.

Oestrogen plays a massive role in the health and elasticity of pelvic floor tissues. As oestrogen fluctuates and eventually declines through perimenopause and menopause, those tissues become less supple. This can contribute to both weakness and hypertonicity — because the body sometimes responds to that loss of tissue integrity by bracing harder. Holding on. Compensating.

That means what worked for your pelvic floor in your thirties may be completely wrong for your body now. Your hormonal landscape has shifted, and your pelvic floor is living in a different environment than it was. If you're working through this alongside other perimenopausal symptoms — the sleep disruption, the anxiety, the brain fog — it's worth reading more about what perimenopause actually involves, because the pelvic floor story doesn't exist in isolation from the rest of your hormonal health.

And if your pelvic symptoms are being dismissed alongside everything else you're experiencing — if you're getting “your labs are fine, everything looks normal” while you're leaking, in pain, or struggling with urgency — I want you to know that's not an acceptable response. You deserve actual investigation, not a pat on the head and a Kegel handout.

The Assessment Question That Changes Everything

Here's a question that should be asked before any pelvic floor advice is given: Is this pelvic floor too weak, too tight, or somewhere in between?

Without that answer, any prescription is a guess. Kegels aren't harmful for everyone — but recommending them without knowing the answer to that question is like giving someone a cast for a sprain without checking whether the bone is actually broken. The treatment needs to match the diagnosis.

A good pelvic floor physio will assess your muscle tone, your coordination, your posture, your breathing patterns, and your symptoms together. They'll look at the whole picture. That assessment is where your real answers are — not in a generic exercise you've been doing for years that may be actively working against you.

You can also explore our full pelvic floor and core hub for more on what a functional, evidence-based approach to pelvic health actually looks like — including what to ask when you see a specialist.

You Weren't Doing It Wrong. You Were Given the Wrong Information.

I want to come back to that because it matters. If you've been doing Kegels faithfully and things have been getting worse — the pain hasn't improved, the urgency is still there, sex still hurts — please stop blaming yourself. The advice was incomplete. The standard script around pelvic floor health has a massive blind spot, and women have been falling into it for decades.

Your body wasn't failing to respond to the right treatment. It was spiralling in response to the wrong one.

That's not your fault. And it's not something you have to keep accepting. You are on a path right now, and getting your life back starts with getting the right information so you can make informed decisions — not just following a script that was never written with your body in mind. Get the right assessment. Find a pelvic floor physio who will actually look at what your body is doing. Stop squeezing and start asking better questions.

Because the first step to healing your pelvic floor might not be doing more. It might be finally learning how to let go.