If you've leaked, felt heaviness, or been told 'just do your kegels,' you're not alone. But for a huge portion of women, more kegels are the exact wrong prescription — and they can make symptoms worse. Here's what the research (and a decade of one-on-one sessions) actually shows.
What a kegel actually is
A kegel is a voluntary contraction of the pelvic floor — a group of muscles that sling between your pubic bone and tailbone. Done correctly, it lifts and squeezes. Done incorrectly (most of the time), women bear down, hold their breath, or clench their glutes and inner thighs instead.
When kegels help
- True stress incontinence with a weak, under-active pelvic floor.
- Postpartum reconnection — learning to feel the muscles again.
- Post-surgical rehab where the muscles need reactivation.
When kegels make things worse
This is the part nobody tells you. A huge percentage of pelvic floor issues aren't from a weak pelvic floor — they're from a tight, over-gripping one. In that case, kegels are pouring gas on a fire.
- Painful sex or tampon use → often a tight pelvic floor.
- Urinary urgency / frequency → often a tight pelvic floor.
- Constipation & incomplete emptying → often a tight pelvic floor.
- Tailbone or deep hip pain → often a tight pelvic floor.
What pelvic floor therapy actually does
A one-on-one session with a pelvic floor therapy isn't 'kegels with a professional.' It's a full assessment of how your breath, ribcage, core, hips, and pelvic floor coordinate under real-life load — lifting a toddler, running, sneezing, standing all day.
- Internal or external assessment to see if the pelvic floor is under-active, over-active, or uncoordinated.
- Breath and pressure management — most leaking is a pressure problem, not a strength problem.
- Hip, glute, and deep core integration — the pelvic floor never works alone.
- Manual therapy to release tight tissue before loading it.
- A progressive home program that fits into real motherhood, not a 'do 100 kegels a day' handout.
How to know which camp you're in
Honestly? You can't always tell from the outside — the same symptom (leaking, heaviness, pain) can come from a weak floor or a tight one. That's the whole point of an assessment.
The bottom line
Kegels are a tool. Pelvic floor therapy is the whole toolbox. If you've been doing kegels for months and things aren't better — or they're worse — please stop guessing and get assessed.
Pelvic floor & postpartum OT in Basking Ridge, NJ
Modern Movement is a women's health and orthopedic occupational therapy practice based in Basking Ridge, New Jersey, serving moms across Somerset County — including Bernardsville, Bedminster, Far Hills, Warren, Bridgewater, Martinsville, Gladstone, and the surrounding Somerset Hills. We work with pregnant and postpartum women on pelvic floor health, diastasis recti, core recovery, low back & hip pain, and return-to-running — in person, one-on-one, for a full hour.
Want a plan built around you?
Book a 1:1 session with Amanda in Basking Ridge for a personalized assessment.