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Pelvic Floor Physiotherapy vs Kegels: What’s Clinically Right for You?

Updated: Aug 12

Women are often encouraged to do “Kegels Exercises’  for pelvic floor muscle health. However unless your pelvic floor health has been assessed by a Women's Health Physiotherapist - You may be doing the exercise incorrectly (many women are doing Kegel exercises wrongly!) and or they are making their symptoms worse. Kegel exercises are not for everyone! 


"Kegel Exercises Aren’t for Everyone"


Many women:


  • Do Kegels daily and still leak

  • Have pain or urgency that worsens with Kegels

  • Clench their pelvic floor or other associated muscles unknowingly


"Kegel exercises are strength based exercises and not all pelvic floors need strengthening."


What Does Your Pelvic Floor Actually Do?


Your pelvic floor muscles support your pelvic organs, assist in controlling continence, and work with your diaphragm and core to manage intra-abdominal pressure. Your pelvic floor must be:


  • Strong

  • Responsive

  • Able to relax and release (especially during birth or bowel movements)


What Does Research Says?


Kegels are effective for:



But:


  • 40% of women perform them incorrectly without supervision (Bump et al., 1991, PubMed)

  • They are ineffective (or even harmful) for overactive pelvic floors (Fitzgerald et al., 2003)

  • Individualised physiotherapy shows better results than generic Kegels (Dumoulin et al., 2020, PubMed)


When Is Kegels Not Suitable For You?


If you have an overactive pelvic floor. Signs: 


  • Pain with sex or tampon use

  • Constipation, straining, or incomplete emptying

  • Frequent urgency

  • Leaking despite “a strong core”


Doing Kegels if you're experiencing any of the above signs may be reinforcing your pelvic floor dysfunction.


When Do Kegels Actually Help?


  • A thorough assessment has shown underactivity or weakness

  • Labour prep (with guided contractions + release)

  • Stress incontinence and other bladder dysfunctions

  • Post-surgical rehab - post hysterectomy, post prolapse surgery  (But only when prescribed and performed correctly!)


What Does A Women's Health Physiotherapist Actually Do?


Your pelvic health physiotherapist will assess:


  • Internal tone and control

  • Breath mechanics and pressure regulation

  • Core-pelvic floor coordination

  • Tension holding patterns (jaw, glutes, abs)


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Your treatment may include:


  • Real-time Ultrasound biofeedback - as shown above - no internal is required. 

  • Breathwork and down-training

  • Manual therapy - a vaginal examination if required and appropriate for you. 

  • Functional retraining (e.g. squats, lifting toddlers)

  • Then Kegels, if clinically appropriate


In Singapore - we will often assess and treat women of all ages, stages of life (pregnancy, perimenopausal and menopausal women) and professionals, with varying pelvic floor dysfunction. We see:


  • Desk-based workers with poor breathing and posture

  • New mums returning to work quickly

  • High-achieving women with over-gripping pelvic floors

  • Women at different hormonal stages in life 


They don't have weak pelvic floor muscles, they have high tension, overworked, and often under-recovered pelvic floor muscles. Doing more Kegels may make things worse.


Final Takeaway: You Need More Than “Just Kegels”


Pelvic floor health is about balance, not just strength. Kegels can help, but only with: 


✔️ Proper assessment 

✔️ Clinical reasoning 

✔️ Supervised guidance


Book a pelvic floor assessment with our team of Women’s Health Physiotherapists!



Cheers

Xan, Claire and Danielle at Physiomatters


Contact Information


Phone: +65 9352 9067

Address: 360 Orchard Road #10-07 International Building, 238869

 
 
 

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