After my first vaginal delivery, I did Kegels religiously. Hundreds a day. Apps. Reminders. I was sure I was doing the right thing.
But I still leaked when I coughed. I still felt pressure. I still couldn’t run without crossing my legs.
I saw a pelvic floor physical therapist. She did an internal exam. Then she said something that floored me: “Your pelvic floor isn’t weak. It’s too tight. Kegels are making it worse.”
I had no idea. I thought tight was good. I thought strength was the goal. But a hypertonic pelvic floor — one that’s in constant spasm — can’t contract effectively. It’s like doing bicep curls on a charley horse. Kegels made my symptoms worse. What I needed was relaxation: diaphragmatic breathing, hip stretches, and reverse Kegels (learning to let go, not squeeze).
After 8 weeks of the right exercises — not a single Kegel — my leaking stopped. I could run again. I could sneeze without fear.
Here’s what you need to know about pelvic floor recovery.
Kegels are not for everyone. Up to 30% of postpartum women have pelvic floor overactivity, not weakness. Signs include: pain with intercourse, difficulty inserting a tampon, chronic pelvic pain, constipation, and — counterintuitively — leaking from a tight, spasming muscle that can’t fully relax. If that sounds like you, Kegels will hurt, not help.
Pelvic floor physical therapy is the gold standard. A PT will do an internal and external assessment. They’ll check for strength, coordination, relaxation ability, scar tissue (from tears or episiotomy), and connective tissue integrity. Then they’ll design a program just for you. This might include: diaphragmatic breathing, coordination exercises, manual therapy for scar mobilization, biofeedback, electrical stimulation, or — yes — Kegels if you need them. But only if you need them.
When to see a PT. Don’t wait. If you’re leaking at 6 weeks postpartum, see a PT. If you have pelvic pain, see a PT. If you’re afraid to have sex, see a PT. If you feel pressure or a “bulge,” see a PT. Don’t accept “it’s normal.” Some things are common but not normal.
One of my patients, “Kate,” was still leaking at 18 months postpartum. She’d been doing 200 Kegels a day, following a popular app. Her symptoms were getting worse. When she finally saw a pelvic PT, the diagnosis was overactivity with poor coordination. Six weeks of breathing, stretching, and neuromuscular reeducation — not a single Kegel — and her leakage stopped. She told me, “I’m angry I wasted 18 months on the wrong thing.”
What you can do at home. Even before seeing a PT, you can try:
- Diaphragmatic breathing: Lie on your back, knees bent. Breathe deeply into your belly, feeling it rise. On the exhale, imagine your pelvic floor softening and opening. Do this for 5 minutes daily.
- Hip stretches: Child’s pose, happy baby, figure-four stretch. Tight hips often correlate with a tight pelvic floor.
- Reverse Kegels: Sit on a birthing ball or toilet. Take a deep breath. On the exhale, imagine your pelvic floor dropping open, like a flower blooming. You’re not squeezing — you’re releasing.
- Posture awareness: Avoid clenching your glutes or holding your breath. Relax your jaw. A relaxed body supports a relaxed pelvic floor.
Don’t ignore C-section recovery. People who deliver by C-section can also have pelvic floor issues. The pregnancy itself stresses the pelvic floor, regardless of delivery mode. Scar tissue from the incision can cause pain and dysfunction. A PT can help with scar mobilization.
If you’re postpartum and struggling, please seek help. Pelvic floor PT is covered by many insurance plans. You don’t need a referral in most states (though check your plan). The average person waits 6-12 months after symptoms start before seeking care. Don’t be average. Go now.
Your body did something amazing. It deserves expert care to heal.
This article reflects personal experience and clinical guidelines. Always consult a pelvic floor physical therapist for an individual assessment.
— Emily Carter, RDN