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If you're still leaking after Kegels, the exercise usually isn't the failure. A Kegel trains one job, and your pelvic floor has four: squeeze and lift, let go, respond to pressure when you cough, laugh or lift, and work in time with your breath. A leak after faithful Kegels usually points to a job that was never trained. I'm Isa Herrera, MSPT, CSCS, a pelvic floor physical therapist, and I've worked with 22,000 women over 21 years.
Key Takeaways
What topics does this guide cover?
There's a difference between a strong pelvic floor and a pelvic floor that responds.
A strong muscle can squeeze hard when you ask it to. A responsive pelvic floor does the right thing at the right moment, without being asked: when you cough, when you laugh, when you pick up a heavy bag.
Kegels build the first. Staying dry in everyday life asks for the second.
You did them faithfully, and you still leak when you cough, laugh or lift. If that's you, here is what's usually missing.
Because technique matters, and because one movement can't train every job your pelvic floor does.
Let me be clear first: Kegels work. Pelvic floor muscle training is one of the best-studied approaches for bladder leaks in women.1
But they work when they're done correctly, and many women were never taught. Research has found that a brief verbal instruction often isn't enough for a woman to perform a correct contraction.2
In my practice, I often saw women who had taught themselves Kegels and then gave up when they "didn't work." Once they learned proper technique, they were amazed at the difference it made.
The second reason is bigger. Nobody goes to the gym and only does bicep curls. You'd train the opposing muscle, your legs and your core too, because every muscle has more than one job.
Your pelvic floor is the same. It's part of your core, and it works with ligaments and connective tissue to support your bladder.3 It has four jobs.
A real Kegel squeezes and then lifts the pelvic floor upward, and fully lets go afterward.
Job one is the one you know. But a Kegel is more than squeezing your vagina. A proper Kegel involves a lift, a gentle upward draw of the pelvic floor muscles.
Here's how I teach women to find it:
That last point leads straight to job two.
A muscle that can't release can't respond, so the reverse Kegel is as important as the Kegel.
Every muscle needs its opposing move. For the pelvic floor, that move is the reverse Kegel, a deliberate letting go.
A pelvic floor that's held tight all day has nowhere left to go when pressure arrives. Reverse Kegels are just as important as Kegels.
Training the release is as much a part of a complete routine as training the squeeze.
Those moments push pressure down in an instant, and your pelvic floor has to answer on time.
Job three is responding to pressure. A cough, a sneeze, a laugh or a lift drives pressure down onto your bladder in a fraction of a second.
Your pelvic floor has to meet that pressure as it arrives. A strong muscle that answers late can still leak.4
That's why a leak on a cough is a timing and pressure job, not only a strength job. Your muscles, ligaments and connective tissue all take part in holding that pressure.3 A quiet set of Kegels isn't designed to train that timing on its own.
Your pelvic floor and your diaphragm move together with every breath, as part of one core.
Job four is working with your breath. Your diaphragm sits at the top of your core and your pelvic floor sits at the bottom, and they move together.5
Research shows the pelvic floor muscles take part in breathing and posture, not only in bladder control.6 When that teamwork is off, the floor is working against the rest of your core instead of with it.
It goes further than muscle. I teach that your bladder connects to your pelvic floor through fascia, nerve and muscle. It's all connected.
All four jobs, trained together, chosen for your body. One type of Kegel does not fit all women.
A complete routine trains the lift, the release, the response to pressure and the breath, together.
It includes different types of Kegels, core work and breathing techniques. There are more than 13 different types of Kegels, and they're not interchangeable.
Different issues need different work. The woman who leaks on a sneeze and the woman who can't relax don't need the same routine.
The how is different for every woman, which is why I teach it live and not in an article. Save My Free Seat for Saturday's Class.
In The Bladder Confidence Blueprint, my complimentary live class on Saturday, November 14, at 1 PM ET.
This article explains what your pelvic floor's jobs are. Saturday is where I show you how.
The Bladder Confidence Blueprint: 3 Surprising Discoveries About Your Pelvic Floor, Fascia, and Bladder, live on Saturday, November 14, at 1 PM ET. The replay goes out at 6 PM ET the same day.
Here's what I want for you:
Your seat is free.
Save My Free Seat for Saturday's Class
Q: Why am I still leaking after doing Kegels?
A: Usually because a Kegel trains one of your pelvic floor's four jobs. The others are letting go, responding to pressure when you cough, laugh or lift, and working with your breath. Technique matters too: many women were never taught to lift as well as squeeze.
Q: How do I know I'm doing a Kegel right?
A: A correct Kegel feels like a squeeze and a gentle upward lift, like drawing a milkshake up through a straw inside your pelvic floor. Your buttocks stay soft, a gentle draw low in your belly is normal, and there's no hard clenching, sucking in or bearing down. You let go completely before the next one.
Q: What is a reverse Kegel?
A: A reverse Kegel is the opposing move to a Kegel: a deliberate letting go of the pelvic floor muscles. A pelvic floor needs to release as well as contract so it can respond when pressure arrives.
Q: Can I do Kegels every day, and how many should I do?
A: Quality matters more than the count. A few well-made Kegels, each followed by a full release, do more than a long rushed set. The right amount and type differ from woman to woman, which is why a complete routine is chosen for your body.
Q: What if I can't make the class live?
A: Save your seat anyway. The replay of The Bladder Confidence Blueprint goes out at 6 PM ET on Saturday, November 14, so you can watch it that evening.
Learn more about the author, Isa Herrera, MSPT, CSCS, at isaherrera.com.
This content is for educational purposes only and is not medical advice, diagnosis, or treatment. Please consult your qualified healthcare provider about your individual symptoms and before making changes to your care or starting a new exercise.
Isa Herrera, MSPT, CSCS is a licensed physical therapist, international best-selling author, and a leading pelvic floor and women's health specialist.
She holds a BA in Psychology and Biology from Fordham University and a Master of Science in Physical Therapy from Hunter College.
Over the course of her career, Isa has helped more than 21,000 women heal from pelvic floor dysfunction, vaginal pain, incontinence, and intimacy challenges.
She pioneered integrative modalities including Maya Abdominal Massage, Low Level Laser Therapy, Sound Healing, and Andean Energy Techniques at Renew Physical Therapy, her NYC-based healing center, where she has practiced since 2005.
Isa is the author of five books on pelvic health, including the international best seller Female Pelvic Alchemy and Ending Female Pain: A Woman's Manual.
She is the founder of PelvicPainRelief.com, an online school dedicated to helping women and health professionals access evence-based pelvic floor education.
