Why Kegels Haven’t Fixed Your Pelvic Floor
Katie Doran 
If you’ve ever been told to “just do your pelvic floor exercises” and found yourself thinking I have been… and nothing has changed, then you are very far from alone.
Most of the women who eventually find their way to me have already been trying quite hard to do the right thing. They’ve followed the advice they were given, downloaded the apps, squeezed faithfully while brushing their teeth or waiting for the kettle to boil. Some of them have been doing pelvic floor exercises for years.
And yet the leaking still happens.
The heaviness is still there.
The sudden urge that appears out of nowhere hasn’t gone away.
By the time they arrive in my clinic, many of them feel quietly disheartened about the whole thing. They assume they must be doing the exercises wrong, or that they simply haven’t been consistent enough. Occasionally someone will say, half joking but half not, that perhaps their body is just “too far gone”.
But the truth is usually much simpler than that.
The problem is rarely that someone hasn’t tried hard enough.
More often, it’s that the advice they’ve been given about the pelvic floor is only a very small piece of a much bigger picture.
For many years the dominant message around pelvic health has been that if something isn’t working properly, the answer must be to strengthen the pelvic floor. And strengthening, in this context, has come to mean squeezing. Lifting. Holding.
Which sounds logical enough on the surface. If a muscle is weak, you strengthen it. That’s how most people understand exercise.
But the pelvic floor is not quite the same as the muscles you might train at the gym.
It is not simply a muscle that switches on and off on command. It is part of a much wider system that manages pressure, movement and support throughout the body. It needs to contract at times, certainly, but it also needs to relax, lengthen and respond to the forces moving through you all day long.
When we reduce that complexity down to “just squeeze”, we risk missing the real reason the system isn’t working well in the first place.
And that’s often the moment when women begin to feel stuck. They have done exactly what they were told. They have squeezed diligently, sometimes for years, and yet their body has not translated those efforts into real-life change.
From an osteopathic point of view, that isn’t particularly surprising.
Because when I look at pelvic floor symptoms, I’m not just thinking about the pelvic floor itself. I’m thinking about breathing mechanics, pressure management, how the pelvis moves, whether the hips are giving the body enough options, whether the feet are able to absorb load well, whether the glutes are contributing properly, and whether the nervous system has learned patterns of bracing that are quietly interfering with everything else.
In other words, I’m thinking about the system the pelvic floor lives inside.
And once you start looking at the body that way, it becomes much easier to understand why Kegels alone often fall short.
Not because pelvic floor exercises are useless. They can absolutely have their place. But because the pelvic floor rarely struggles in isolation.
More often it is responding, sometimes quite sensibly, to something else going on in the wider system.
Understanding that tends to shift the whole conversation.
Instead of asking whether the pelvic floor is weak or strong, we begin to ask why it is behaving the way it is. Instead of assuming the answer is more tightening, we start looking at how the body manages pressure, movement and load.
And that is where things usually begin to get interesting.
Why hips matter far more than most people realise
Another reason Kegels so often fall short is that they reduce the pelvic floor to a sort of isolated hammock at the bottom of the pelvis, as though it exists and functions entirely on its own. But the pelvic floor does not live in isolation. It is part of a moving, responsive system, and one of the body areas that has a huge influence on it is the hips.
This is something I find myself explaining a lot, because once women understand it, a great many things suddenly start to make sense.
If your hips are stiff, your pelvic floor is going to struggle to move well too.
That does not mean that every woman with tight hips will automatically have pelvic floor symptoms, and it certainly does not mean I think we can explain everything away with a stretch. Bodies are never that simplistic. But if the hips are not giving the pelvis the movement options it needs, then the pelvic floor often ends up carrying more load than it should.
A healthy pelvic floor needs to be able to lengthen as well as lift. It needs to adapt to changes in position and load. If you go down into a squat, for example, and your pelvis is able to move well, then the pelvic floor has a chance to lengthen under load in a useful, functional way. That is what we mean by eccentric loading. It is not just about strength in the sense of clenching harder; it is about tolerance, adaptability, and the ability to absorb force.
But if the hips are blocked, or the pelvis does not have the movement available to it, the pelvic floor loses some of that freedom. It becomes much harder for it to respond well because the whole area is working with fewer options.
One of the things that is often missing here is rotation, particularly internal rotation at the hip. We are very used to the idea of stretching by opening the knees wide, doing happy baby, trying to “open the hips” in that way, and there can absolutely be value in that. But some of the movement many women are actually missing is the less glamorous stuff. Internal rotation. The ability of the femur to move properly in the hip socket. The subtle mechanics that let the pelvis accommodate load rather than brace against it.
This is why some women feel as though their pelvic floor has a personality of its own. It can seem moody, unpredictable, or strangely reactive. One day it feels manageable and the next day everything feels tighter, more draggy, more irritated. Often that is not random. It is the body’s way of telling us that somewhere in the wider system, movement has become restricted and the pelvic floor is being asked to compensate.
And the trouble with compensation is that it can look surprisingly convincing for quite a while. The body is clever. It will always try to find a workaround. It will grip, brace, shift, twist, recruit other muscles, hold tension somewhere else, all in an effort to keep you functioning. But those workarounds are usually expensive. Sooner or later the symptoms begin to show up. Sometimes as pain. Sometimes as prolapse. Sometimes as leaking. Sometimes as that maddening sensation that you are doing everything “right” and yet your body still feels like it is not coping.
That is why I never look at pelvic floor symptoms and think only about the pelvic floor. I want to know what the hips are doing, how the pelvis is moving, whether there is enough rotational capacity in the system, whether the woman in front of me can actually absorb force well, or whether she is holding herself together with sheer determination and a slightly panicked ribcage.
Because, honestly, many women are.
The foot and ankle link that often surprises people
If you really want to understand how I work, this is probably one of the clearest examples of it. A woman comes in because she is leaking, or feeling heaviness, or worried about prolapse, and before long I am looking at her feet.
This is usually the point where people either become intrigued or mildly suspicious.
But there is a good reason for it.
Every time you take a step, force travels from the ground up through your body. Your foot meets the floor, adapts to it, absorbs load, and helps create the chain reaction that then moves through the ankle, knee, hip and pelvis. That all sounds terribly mechanical when written down like that, but in reality it is beautifully fluid when the body is doing it well. It is not a set of separate parts taking turns. It is a conversation running through the whole system.
The foot needs to be able to pronate in a controlled way. Not collapse. Not wobble around aimlessly. But adapt. Yield. Take in force and pass it up the chain in a way the rest of the body can use.
If the foot is stiff, blocked, or unable to absorb load well, something has to compensate further up. The internal rotation reaction that should move smoothly up into the hip and pelvis becomes less efficient. The pelvis may lose one of the ways it normally accommodates force. And the pelvic floor, once again, can end up trying to deal with more than its fair share.
This matters on every step. Every stumble. Every sudden change in direction. Every awkward turn to answer a child calling your name. Every dash to the front door. Every run. Every jump. Every time you land a little harder than expected because the pavement was uneven or the dog pulled on the lead.
The ultimate goal is not for you to spend all day consciously managing your pelvic floor as if it were a badly behaved toddler. The goal is for it to respond on autopilot. Quietly. Efficiently. Without you needing to think about it. But that can only happen if the rest of the system is giving it decent information and decent support.
If your feet and ankles are not doing their job particularly well, the chain above them is going to have to improvise. And the pelvic floor is often one of the places where we see the consequences of that improvisation.
This is why I find the “just squeeze” approach so frustrating. It skips over all of this. It assumes the issue sits neatly in one area, as though the body is a collection of unrelated compartments rather than a connected, adaptive whole. And it leaves women thinking they are failing at a simple task, when in reality the task they have been given was never broad enough to solve the problem.
Why running, jumping and real life are not solved by a stronger squeeze
One of the clearest places this shows up is with women who leak during impact, whether that is running, jumping, lifting, or simply moving quickly through the world. These women are often told that their pelvic floor is weak and needs more strengthening, but what I frequently find is that the issue is not so much raw strength as it is timing.
Timing is one of those things that becomes incredibly obvious once you see it, but it is rarely explained to women in a way that actually helps.
If you go for a run, your pelvic floor should not need a little internal memo every time your foot hits the ground. You should not have to think, right, now squeeze, now relax, now lift, now hold. That would be exhausting, impossible, and frankly a ridiculous way to move through the world.
The pelvic floor is designed to respond automatically. It should sense changes in load and pressure and react in milliseconds, far faster than conscious thought. That is how bodies work when coordination is good. We do not consciously instruct every muscle to behave. We create the conditions for a pattern, and the nervous system handles the rest.
So when a woman tells me she leaks while running, I do not immediately assume she lacks strength. I want to know how she is managing pressure, how she is landing, how her ribcage moves when she breathes, whether she bears down when she exhales, whether her glutes are joining in, whether the hips and feet are giving the pelvis enough support, and whether her body has actually learned a usable reflex for the task she is asking it to do.
This is why so many women can do pelvic floor squeezes lying on their back and yet still leak the moment they go for a jog or do a star jump in an exercise class. The exercise itself may not be useless, but it has not prepared the system for the reality of the task.
It is a bit like practising your tennis swing in the kitchen and then being baffled when the match itself feels completely different. Of course it does. The context matters. Timing matters. Load matters. Coordination matters.
A pelvic floor that can contract in a quiet room is not necessarily a pelvic floor that can react well when you laugh unexpectedly, miss a step, lift a heavy shopping bag out of the boot, or chase a child across a car park.
And this is where many women start to feel deeply frustrated, because on paper they have done everything they were told. They have been “good”. They have practised. They have squeezed. They have stayed compliant. And still their body has not translated those efforts into real-life change.
That is not because they are hopeless. It is because the body learns through context, through movement, through variability, through repetition of meaningful patterns. Not just through isolated contractions performed in a vacuum.
Why some women improve the moment we stop chasing weakness
This is perhaps one of the biggest shifts I see in women when they begin to understand their pelvic floor differently. They stop seeing it as a weak body part that needs disciplining, and start seeing it as a body part that may be overloaded, over-braced, poorly coordinated, or simply working inside a system that is not giving it what it needs.
That change in perspective matters more than people realise.
Because once you stop obsessing over whether the pelvic floor is weak or tight, and start asking why it is behaving the way it is, the whole conversation changes. We move away from blame and into curiosity. We stop moralising symptoms, as though leaking means you have failed to look after yourself properly. We stop acting as if prolapse automatically means your body has “given way”. And we start paying attention to what the body is actually asking for.
Sometimes that is more movement, not more holding.
Sometimes it is better pressure management, not more strength.
Sometimes it is a nervous system that needs to feel safer, because a body that feels under threat is much more likely to grip and brace in unhelpful ways.
Sometimes it is teaching the glutes to contribute properly so the pelvic floor is not doing the work of several muscles at once.
Sometimes it is helping a woman realise that she has spent years holding her tummy in, sucking herself up and out of her jeans, breathing into the top of her chest, and wondering why her pelvis never quite settles.
And sometimes the first improvement is not dramatic in the way people expect. It is not a movie moment. It is small and oddly emotional. The first sneeze that does not make you panic. The first walk where you are not scanning for the nearest loo. The moment you get in the car and realise you forgot your pad and, more importantly, forgot to think about needing it.
Those moments are huge. Not because they make for glamorous marketing, but because they tell me the system is changing in a meaningful way. The body is becoming less reactive. The brain is no longer sounding the alarm quite so loudly. The woman herself begins to trust her body a little more, and that trust is not a fluffy concept. It changes how she moves, how she breathes, how much tension she carries, how willing she is to do things she had started avoiding.
Symptoms shrink. But often, just as importantly, life expands again.
What I wish more women were told at the start
If I could go back and rewrite the standard pelvic floor advice that so many women are given, I would not start with “squeeze”. I would start with context. I would explain that the pelvic floor is not a naughty muscle at the bottom of the body waiting to be whipped into shape. I would explain that it is part of a pressure system, a breathing system, a movement system, and a nervous system.
I would explain that yes, strength can matter, but strength without coordination is limited. Strength without release is often counterproductive. Strength without timing will not necessarily help you when real life happens at speed.
I would explain that your body is not broken because Kegels have not worked. Quite often, Kegels have not worked because they were never the full answer for the pattern you have.
I would want women to know that there is a difference between a pelvic floor that is weak and one that is overwhelmed, between a muscle that cannot contract and one that has forgotten how to let go. I would want them to understand that breathing is not just a relaxation tool you do on a yoga mat. It is one of the most practical, mechanical, foundational ways of changing the pressure environment your pelvic floor lives in all day long.
I would want them to know that their hips are relevant. Their ribs are relevant. Their feet are relevant. Their walking pattern is relevant. Their history is relevant. Their habits are relevant. The way they rush, brace, hold, clench, anticipate and protect is relevant.
Because once you see that, pelvic health becomes both more complex and more hopeful. More complex, because there is usually more to the story than one weak muscle. More hopeful, because if the issue involves a whole system, then there are more doors into change than you may have been led to believe.
And honestly, I think that hope matters.
So many women arrive feeling flat, embarrassed, and quietly resigned. They have reached that awful point where they are getting on with life on the outside, but inside they have already started accommodating around the problem. Not booking things. Not running. Not jumping. Not staying out too long. Not laughing too freely. Always knowing where the toilet is. Always carrying a pad. Always thinking about it, even when they pretend they are not.
That is a heavy way to live.
And it is one of the reasons I feel so strongly about challenging the narrative that pelvic floor recovery begins and ends with squeezes. Because for some women, yes, pelvic floor strengthening is useful. But for a great many others, it is only a tiny piece of the picture, and sometimes not even the first piece we should be focusing on.
The real work is often in teaching the body how to move, breathe, adapt and respond again. How to share load better. How to stop bearing down every time it tries to stabilise. How to use the glutes, the ribcage, the feet, the hips. How to find space where there has only been gripping. How to build reflexes that work in real life rather than only in theory.
That is why I work the way I do.
Not because I think Kegels are evil or because I enjoy being contrary for the sake of it, but because I have seen too many women blame themselves for the failure of an approach that was too narrow in the first place.
And once you have watched a woman go from planning surgery to cancelling it, or from structuring every outing around pads and toilet stops to suddenly forgetting to think about either, it becomes very hard to keep pretending that “just squeeze” is enough.
A different way of understanding the pelvic floor
When women start to see their pelvic floor through this wider lens, there is often a very noticeable exhale. Not always literally, although sometimes that too. But emotionally. Mentally. The relief of realising that perhaps the problem was never that they were lazy, sloppy, weak, or bad at exercises. Perhaps the problem was that no one had properly explained the bigger picture.
And that bigger picture is this: the pelvic floor sits in the middle of a whole system. It is influenced by breath, pressure, posture, load, movement options, timing, tension, fear, habit and history. It needs to be able to contract, yes, but also to release, adapt, recoil and respond. It needs support from the muscles around it. It needs room from the joints around it. It needs a nervous system that is not permanently acting as though danger is just around the corner.
Most of all, it needs us to stop reducing it to a simplistic instruction.
Bodies are clever. Symptoms are rarely random. And if Kegels have not fixed your pelvic floor, that does not mean your body is failing. It may simply mean that your body has been asking a more interesting question than the one those exercises were designed to answer.
Categories: : To Squeeze or Not to Squeeze