To Kegel or Not to Kegel?
Why kegels aren't always the answer — and what your pelvic floor actually needs.
You mentioned leaking when you cough, sneeze, or run — and your doctor told you to just do kegels. Sound familiar? Let's talk about why that advice is often incomplete.
Yes, sometimes kegels are exactly what's needed. But in my experience as a pelvic floor physical therapist, when I actually assess someone, I find that many people are already holding too much tension in the pelvic floor — and what they really need to learn is how to let go.
Your Pelvic Floor Is a Muscle — Which Means It Moves
The pelvic floor, like any other muscle group, both contracts and relaxes. It has a full range of motion. Think about your bicep: it shortens as your elbow bends, and lengthens as your arm straightens. Neither phase is optional — you need both to lift a grocery bag off the counter.
The pelvic floor works the same way. A kegel is the contraction and lift. But there's an equally important other half: the release back to baseline.
Think of It Like a House
Picture a house with three levels — a basement, a main floor, and an attic. Here's how your pelvic floor maps onto that:
The Pelvic Floor House
A healthy pelvic floor moves fluidly between all three levels depending on what you're doing.
When you're relaxing on the couch, your pelvic floor lives on the main floor. When you cough, jump, or pick up your kids, it lifts to the attic — then it should come back down to the main floor.
If you're chronically holding tension — stuck in the attic — you've lost that range of motion. And a muscle that can't move through its full range can't generate a strong, coordinated contraction when it matters most.
Three Things Your Pelvic Floor Actually Needs
Strength is only one piece of the puzzle. What we're really after is all three of these working together:
The ability to contract and generate force when you need it.
Contracting when demand rises — and releasing back to the main floor, automatically.
The ability to move from the attic, to the main floor, and to the basement — on demand.
The Breath Connection
Here's something most people don't know: your pelvic floor and your diaphragm move together, all day long, without you thinking about it.
As you inhale, your diaphragm drops down — and your pelvic floor gently descends with it, moving toward that basement. As you exhale, both lift back up. This happens thousands of times a day, completely subconsciously.
The takeaway: If your pelvic floor is stuck in a constant state of tension, it can't participate in that natural rhythm with your breath. When a cough, sneeze, or jump demands a strong contraction, it's starting from a compromised position — and leaking becomes the result.
So before assuming you need to do more kegels, it's worth asking: do you know how to fully release your pelvic floor? Can you feel the difference between gripping and letting go? These are the questions a proper assessment can actually answer.
Kegels have their place — but they're not a one-size-fits-all solution. Your pelvic floor deserves a more complete picture.
Not Sure Where You Stand?
A pelvic floor assessment can tell you whether tension, weakness, or coordination is driving your symptoms — so we can actually address it.
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