Kegels don't work for everyone right away, and that's fixable.
If you experience urinary incontinence, the first step is usually a consultation with your physician, and more women are also turning to women's health physical therapy. One of the first things you're likely to be taught is Kegel exercises. But what happens if they don't seem to work for you? Lifestyle, physical activity, and even diet can all affect how effective Kegels are, and while most women benefit from them, a smaller number find they don't work as expected.
Often, the issue comes down to technique: it can be harder than it seems to properly access the deep muscles that support the pelvic organs while upright, and your physician or physical therapist will assess whether you're doing them correctly.
You may be bearing down instead of lifting.
Pushing downward only strains the pelvic floor muscles and weakens them over time. A proper Kegel should feel like you're lifting the muscles upward, toward your belly button, similar to stopping the flow of urine mid-stream. To check your form, sit down and try lifting your vagina and anus away from the surface beneath you without moving your pelvis, that upward lift is the movement you're after.
Full relaxation matters as much as the contraction.
One of the most common mistakes is contracting without fully relaxing in between. A proper Kegel includes total relaxation of the muscles as well as contraction; without it, blood can't flow back into the muscles, which leads to spasms and fatigue, and tight muscles can contribute to pelvic pain and constipation. Breathing plays a big role here: breathe out as you contract for a count of five, then breathe in for a count of five as you relax, picturing the pelvic floor expanding as you inhale and gently constricting as you exhale. And when your muscles are tired, stop, there's no benefit to pushing through fatigue.
Posture changes how effective a Kegel actually is.
Posture is something your physical therapist will emphasize, since it's a basic factor in nearly every exercise. Slouching has a negative effect on the pelvic floor and contributes to back pain, and exercising with poor posture strains the pelvic floor rather than working it properly. Sitting up straight while doing Kegels makes them more effective: when your torso is properly aligned, everything is better supported and the pelvic floor can contract more efficiently.
To set up good posture, keep your buttocks at the back of the chair with your spine lengthened, feet flat on the floor and hip-width apart, weight balanced evenly on your pelvis, and your gaze forward. A posture cushion in a sturdy chair, or a yoga ball, can help reinforce this position while you practice.
Sometimes the muscles need more support to respond.
If your pelvic muscles are significantly weakened, from trauma such as nerve damage related to childbirth, or for other reasons, you may not feel much of a contraction at all, even with good technique. In these cases, your physician, often an OB-GYN, should assess you thoroughly. Beyond Kegels, other exercises, like the clamshell, side step, and child's pose, can help strengthen the pelvic region, and a physical therapist can teach these during a session. There's almost always a path forward; it just takes voicing the problem clearly to your therapist and physician.