When Kegels are the wrong exercise for pelvic pain

Kegels can worsen pelvic pain when the muscles already have trouble relaxing. A 2024 expert consensus paper by Michele Torosis and colleagues puts pelvic-floor physical therapy first for high-tone dysfunction, with treatment directed toward relaxation. The paper cites estimates that this dysfunction is present in 60–90% of women with chronic pelvic pain. That range describes a chronic-pain population, not women in general. Torosis and colleagues: A treatment algorithm for high-tone pelvic-floor dysfunction

That changes the meaning of “work on your pelvic floor.” The instruction sounds like a familiar fitness assignment: find the neglected muscles, do the repetitions, become stronger. For someone whose muscles stay contracted, it can send the effort in the wrong direction.

If squeezing makes your pelvis ache, finishing the set is a poor measure of success. Stop the painful exercise. Cleveland Clinic advises checking technique when Kegels hurt and cautions that excessive or unnecessary exercises can increase muscle tension. Cleveland Clinic: Kegel exercises

Release is part of the job

The pelvic floor supports organs including the bladder, bowel and uterus. Its muscles coordinate contraction and relaxation. When they remain too contracted and have difficulty releasing, pelvic pain and problems with urination, bowel movements or sex can follow. Cleveland Clinic: Hypertonic pelvic floor

“Strong” describes only part of that job. Think about gripping something, then putting it down. Practicing a firmer grip tells you little about how easily the hand opens afterward. The comparison illustrates the missing action: release.

The Torosis paper describes muscles that can be tight, weak and painful at the same time. High tone and useful strength are different properties. Its authors warn that strengthening-focused therapy can exacerbate high-tone dysfunction. Torosis and colleagues: Muscle function and treatment

A recommendation based on leakage, an exercise video or someone else’s recovery may address a different difficulty from yours. Before adding repetitions, establish what the exercise is meant to change.

What the treatment is working toward

The Torosis recommendations came from a structured Delphi process involving 11 experts. They represent clinical consensus, rather than a trial comparing exercise programs. The panel recommended at least 8–12 weeks of pelvic-floor physical therapy, tailored to the individual, and identified access to that care as a major barrier. Torosis and colleagues: Consensus recommendations

That time frame can help set expectations for a planned course of care. It gives no reason to persist with an exercise that hurts or wait through worsening symptoms. The useful question during treatment is whether the chosen approach is helping the function being addressed.

Physical therapy can involve learning to relax and coordinate the muscles, including biofeedback that helps make muscle activity easier to recognize. The selection depends on assessment. Cleveland Clinic: Pelvic-floor dysfunction and therapy

For home practice, the instructions should explain the purpose of the movement, the expected sensation and when to stop. A shorter, clearly taught exercise has an advantage over an ambitious routine assembled from unrelated videos: you know what you are practicing and how to judge it.

Access and cost are part of whether a plan is workable. If in-person visits are difficult, discuss whether guided remote care is suitable and how progress would be reviewed. A list of exercises alone leaves much of the interpretation with you.

Check the muscles before assigning them more work

An assessment can examine how the muscles contract and release and whether they are tender. Pain alone cannot establish high-tone dysfunction. Cleveland Clinic: Assessing a hypertonic pelvic floor

You can discuss each part of the examination before agreeing to it. If an internal examination is proposed, ask what information it would add and discuss your comfort with proceeding. Participation in that decision includes being able to pause.

Keep the instructions for any exercise that provoked pain, along with a brief note of when the ache began: during the squeeze, after the set or later that day. This records an observation without deciding the diagnosis in advance.

Severe or worsening pelvic pain, particularly with faintness or heavy vaginal bleeding, needs emergency assessment. Pelvic pain with a possible pregnancy needs urgent medical advice. NHS: Pelvic pain

Until the painful exercise has been assessed, pause it. Avoid adding repetitions or a stronger contraction to try to correct the discomfort.