Do Kegels Really Work? The Evidence Around Women's Pelvic Floor Exercise
October 30, 2020
Kegels (or pelvic floor exercise) for women is a surprisingly loaded subject (at least online), considering that many people don’t even know what they are. Some people see them as the Holy Grail of pelvic health and wellness, and a silver bullet that can deliver anything from better sex to an end to leakage and urinary incontinence issues. There are also those, on the other hand, who argue that they’re useless or even counterproductive.
If you’re not familiar with the pelvic floor in general, a quick look at our Pelvic Floor 101 primer is a great place to start. Because in this article, we’re going to jump right into trying to answer the question: “do Kegels really work?”.
(Note that men have a pelvic floor too, and it has many of the same responsibilities as the female pelvic floor (specifically around sexual function and urinary function). But in this article we’re only considering pelvic floor exercise for women).
Why Do Kegels Matter?
If you’re trying to decide whether Kegels work, it kind of begs the question: “work for what?”. So before we look at any evidence, let’s try to figure out why they matter and what the claimed benefits of Kegel exercises are.
Generally speaking, a Kegel routine is performed as a remedy for pelvic floor weakness that might occur either without a specific cause or as a result of any number of factors, including pregnancy, aging, and even athletic activity like running or other impact sports. A strong pelvic floor is claimed to have a number of benefits.
The most well-known use case is basically therapeutic -- doing pelvic floor exercise to prevent or address any of a number of types of pelvic floor dysfunction, from urinary incontinence / bladder control issues to pelvic organ prolapse.
A close second in terms of why some people undertake this kind of exercise is less about being therapeutic and more about being fun -- Kegels are commonly credited with leading to better sex and improving sexual dysfunction (in multiple ways, from arousal to orgasm quality and frequency).
Lastly, they are also alleged to be useful as a preventative measure, for instance against age-related deterioration of bladder control or other pelvic floor muscle function, or in preparing for a healthy pregnancy and delivery.
With such a broad array of claims about their value to women’s health, it’s really not surprising that there is some skepticism about whether they are really all they’re cracked up to be.
What is the evidence for (or against) Kegels?
Since pelvic floor exercises were first developed in the 1940s, they have been quite exhaustively studied. So there is a lot of peer-reviewed literature to draw on. Below, we highlight a few papers (of hundreds) that tried to answer specific questions about pelvic floor exercise, along with their conclusions.
Does pelvic floor exercise help prevent or treat incontinence during pregnancy?
Yes (“The 6-week supervised PFME program was effective at preventing stress incontinence and decreasing the stress incontinence severity in pregnant women who reported stress incontinence at late pregnancy.”)
Is pelvic floor exercise effective in treating urinary incontinence in women?
Yes (“The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence.”)
Can Kegel exercises enhance sexual arousal for women?
Yes (“The present study provides empirical support for the prescription of Kegel exercises to normal women as an enhancer of sexual arousal.”)
Can pelvic floor muscle exercise have a positive effect on sexuality?
Yes (“Pelvic floor muscle exercises had a positive effect on sexuality. Sexual enjoyment, body image, self-confidence, and sexuality were enhanced.”)
Can pelvic floor muscle training help with pelvic organ prolapse?
Yes (“Pelvic floor muscle training is without adverse effects and can be used as a treatment for prolapse”.)
Can Kegels Fix All Pelvic Floor Problems?No. This is the root of the disconnect we mentioned at the start of this post. There are indeed situations where Kegels will not be helpful to your pelvic floor health and can even be harmful.
Generally speaking, pelvic floor strengthening exercises can be helpful for:
- Stress urinary incontinence or overactive bladder
- Pelvic organ prolapse
- Improving sexual function
- Enhancing core strength by strengthening the pelvic floor muscles, particularly in the case of postpartum recovery or healthy aging
On the other hand, Kegels / pelvic floor muscle strengthening is not going to help if you have an overactive or high tone pelvic floor, where your muscles are too tense (this is a case where Kegels can make things worse). Also, pelvic pain of any kind but particularly caused by vaginal insertion is often a sign that Kegels may not be right for you (seeing a pelvic floor physical therapist is the best way to find out specifically what’s right for your situation and whether physical therapy can help).
And, it may go without saying, but there isn't much value in exercising any muscle, unless you are going to use the correct muscles and the correct technique. If you're not using the right muscles, it's a bit like going to a buffet and standing around looking at the food.