Beyond Kegels: Understanding Pelvic Floor Health for Everyone

When most people think about pelvic floor exercises, they think of Kegels—the squeeze-and-release exercises often recommended for women after childbirth or for incontinence. But here's what many don't realize: 65% of people who think they're doing pelvic floor exercises correctly are actually doing them wrong.

More importantly, simply doing Kegels—even if you're doing them correctly—isn't always the answer to pelvic floor problems. In fact, for some people, traditional Kegel exercises can actually make symptoms worse.

Let's explore what your pelvic floor actually does, why it matters for everyone (not just postpartum women), and how to approach pelvic floor health in a way that actually works.

What Is Your Pelvic Floor?

The pelvic floor is a hammock of muscles that connect your pubic bone at the front to your tailbone (coccyx) and sitting bones (ischial tuberosities) at the back and sides. These muscles have several critical jobs:

• Support – They support your bladder, uterus or prostate, and rectum
• Sphincter control – They help control the urethra, vagina, and rectum
• Stability – They work with your deep core muscles to support your spine and pelvis
• Sexual function – They contribute to sexual sensation and function

There are actually three layers of muscles that make up the pelvic floor, and they should work synergistically with other deep core muscles—the transversus abdominis (deep abdominal muscle), multifidus (deep back muscle), and your breathing diaphragm.

Why Pelvic Floor Health Matters for Everyone

Pelvic floor dysfunction isn't just a women's issue, and it's not just about pregnancy and childbirth. Both men and women can experience pelvic floor problems, and they can manifest in various ways:

• Urinary incontinence (leaking with coughing, sneezing, jumping, or running)
• Urinary urgency or frequency
• Fecal incontinence or constipation
• Pelvic organ prolapse
• Pelvic pain
• Low back pain
• Hip pain
• Sexual dysfunction

Your pelvic floor is an integral part of your core stability system. When it's not functioning properly, it can contribute to persistent pain, poor movement patterns, and difficulty recovering from injury—issues that often seem completely unrelated to the pelvic floor itself.

The Problem with Traditional Kegel Exercises

Standard Kegel exercises typically involve repeatedly contracting (squeezing) and relaxing the pelvic floor muscles. While this can be helpful for some people, there are several problems with the conventional approach:

1. Most People Are Doing Them Wrong

Research shows that the majority of people attempting pelvic floor exercises are not performing them correctly. Common mistakes include:

• Bearing down instead of lifting up
• Holding their breath
• Gripping with the buttocks instead of the pelvic floor
• Tightening the abdomen excessively
• Creating pressure rather than a lifting sensation

Without proper instruction and feedback, you might be reinforcing an incorrect pattern for months or years without realizing it.

2. Not Everyone Needs Strengthening

Many people assume that if they have pelvic floor symptoms, their muscles must be weak and need to be strengthened. But pelvic floor dysfunction isn't always about weakness.

Some people have overactive or hypertonic pelvic floor muscles—muscles that are too tight and can't relax properly. For these individuals, more Kegels would be like telling someone with chronically clenched jaw muscles to clench harder. It makes the problem worse, not better.

3. Kegels Don't Address Coordination

Your pelvic floor doesn't work in isolation. It needs to coordinate with your breathing, your deep abdominal muscles, your deep back muscles, and your diaphragm. This coordination is what provides both stability and mobility.

Simply squeezing and releasing doesn't train this integrated function.

"The goal isn't just a strong pelvic floor—it's a coordinated, responsive pelvic floor that works in harmony with the rest of your core system."

How to Actually Engage Your Pelvic Floor Correctly

Before you can strengthen or train your pelvic floor, you need to learn how to engage it properly. Here are evidence-based cues that can help:

For Women:

• Squeeze and lift – Imagine closing off the urethra (as if stopping urine flow), then close the anus (as if stopping flatulence), and gently lift both upward toward the back of your pubic bone
• Visualization – Imagine drawing a blueberry up through a straw, or visualizing elevator doors closing and then the elevator rising

For Men:

• Lift and shorten – Visualize gently drawing your testicles up and forward into your abdomen
• Shorten the penis – Imagine gently shortening the penis (research has shown this is an effective cue)

Universal Principles:

• Breathe – Never hold your breath. Maintain a natural breathing pattern
• Gentle activation – You should feel a deep, internal lift, not a pushing out or bearing down
• No butt gripping – Your buttocks should stay relaxed
• Avoid abdominal bulging – Your lower abdomen should gently draw in, not push out

The Connection Between Breathing and Pelvic Floor Function

One of the most overlooked aspects of pelvic floor health is the relationship with breathing. Your diaphragm and pelvic floor work as a team—when you breathe in, both should descend; when you breathe out, both should gently lift.

Many people with pelvic floor dysfunction have lost this natural coordination. They might hold their breath during activities, or have chronic tension that prevents the pelvic floor from moving naturally with the breath.

Before attempting any strengthening exercises, it's important to establish this foundational breath-pelvic floor connection.

Basic Breath Coordination Exercise:

1. Sit comfortably on a small, soft ball or cushion
2. As you breathe in deeply, feel your pelvic floor gently descend and widen (you should feel slight pressure into the ball)
3. As you breathe out, feel your pelvic floor naturally lift away from the ball
4. Don't force this movement—just observe and allow it to happen

If you don't feel this natural movement, it's a sign that professional assessment would be valuable.

Progressive Pelvic Floor Training

Once you can correctly engage your pelvic floor and coordinate it with breathing, you can progress to functional training:

Stage 1: Isolated Activation

Practice the correct contraction in comfortable positions (lying down, sitting) until you can consistently feel the right muscles activating.

Hold exercises: Contract and hold for 3-5 seconds while breathing normally. Build up to 10 repetitions.

Quick flicks: Quick contractions followed by complete relaxation. Work up to 10-20 repetitions.

Stage 2: Functional Integration

Combine pelvic floor activation with movement:

• Leg slides – Lying on your back, engage your pelvic floor, then slowly slide one leg straight while maintaining the contraction
• Heel lifts – Engage and lift one heel off the ground, then the other
• Bridges – Engage pelvic floor before lifting into a bridge position

Stage 3: Real-Life Application

The ultimate goal is for your pelvic floor to automatically engage during functional activities:

• Before coughing or sneezing (engage just before)
• Before lifting
• During exercise (jumping, running, weight training)
• When transitioning from sitting to standing

When Pelvic Floor Physiotherapy Can Help

Pelvic floor physiotherapy goes far beyond teaching you how to do Kegels. A trained pelvic health physiotherapist can:

• Assess muscle function – Determine if your muscles are weak, overactive, or poorly coordinated
• Provide internal assessment if appropriate – This gives the most accurate information about muscle function
• Use biofeedback – Real-time visual feedback showing if you're activating the correct muscles
• Address contributing factors – Postural issues, breathing patterns, or movement dysfunctions
• Create individualized programs – Based on your specific impairments and goals
• Treat pain – Using manual therapy, education, and progressive desensitization if needed

Pelvic Floor Health for Athletes

Athletes, particularly those in high-impact sports, commonly experience pelvic floor dysfunction. Studies show that up to 80% of female athletes in high-impact sports experience some degree of urinary incontinence, yet many don't seek help because they assume it's "normal."

It's not normal, and it's not something you have to accept.

Athletes need pelvic floors that can handle significant load and impact. This requires:

• Excellent coordination with breathing and core activation
• Ability to activate quickly (reactive strength)
• Endurance to maintain function throughout training/competition
• Integration with sport-specific movement patterns

Sport-specific pelvic floor training should be part of any athlete's program, particularly for those returning to sport after pregnancy or experiencing symptoms.

Pelvic Floor Health Across the Lifespan

During Pregnancy and Postpartum

Pregnancy and childbirth significantly impact the pelvic floor. Prenatal pelvic floor training can reduce the risk of dysfunction after birth, and postpartum rehabilitation is crucial for recovery.

Don't wait for symptoms to develop—proactive pelvic floor care during and after pregnancy is important.

During Menopause

Hormonal changes during menopause can affect pelvic floor tissue strength and elasticity. Maintaining pelvic floor function through this transition can prevent problems from developing.

For Men

Men can experience pelvic floor dysfunction related to prostate issues, surgery, chronic constipation, heavy lifting, or chronic coughing. Pelvic floor training before and after prostate surgery can significantly improve outcomes.

Common Myths About Pelvic Floor Health

Myth 1: "Leaking is normal after having babies."
Truth: It's common, but it's not normal, and it's treatable.

Myth 2: "If I have symptoms, I need to do more Kegels."
Truth: You need an assessment to determine what's actually wrong before choosing a treatment.

Myth 3: "Pelvic floor problems are just part of aging."
Truth: While changes occur with aging, significant dysfunction is not inevitable and can be addressed.

Myth 4: "Men don't need to worry about their pelvic floor."
Truth: Men absolutely can and do experience pelvic floor dysfunction.

Myth 5: "I just need to do 100 Kegels a day."
Truth: Quality matters more than quantity. Proper technique, appropriate intensity, and functional integration are what create results.

Taking the Next Step

If you're experiencing any symptoms of pelvic floor dysfunction—incontinence, pain, pressure, or suspecting your pelvic floor might be contributing to other issues like back pain—don't wait. Pelvic floor problems rarely resolve on their own, and the sooner you address them, the better your outcomes will be.

At Bedford Health Centre, our pelvic health physiotherapists provide comprehensive, evidence-based assessment and treatment in a comfortable, professional environment. We understand that pelvic floor issues can be sensitive to discuss, but we're here to help you feel comfortable, informed, and empowered to take control of your pelvic health.

Your pelvic floor is not something to ignore or accept dysfunction in. With proper assessment, education, and treatment, most pelvic floor problems can be significantly improved or resolved.