Kegel exercises strengthen the pelvic floor muscles that support the bladder, uterus, and bowels. While these exercises improve pelvic health, experiencing pain when performing them is a common concern. Pain during Kegels is not normal; it often signals an issue with technique or the underlying condition of the pelvic floor muscles. Understanding the source of the discomfort is the first step toward correcting the problem and ensuring the exercises are beneficial.
Identifying the Location of the Discomfort
Localizing where the pain occurs during a Kegel contraction provides important clues about its cause. Discomfort radiating to the lower back or tailbone often suggests incorrect posture or bracing during the exercise. This pain usually results from over-recruiting larger muscle groups to compensate for a lack of isolated pelvic floor control.
Pain felt in the lower abdomen or inner thighs signals that accessory muscles, such as the abdominal or gluteal muscles, are being engaged instead of the pelvic floor. When these muscles clench, they create unnecessary tension and strain. Conversely, a deep internal ache or cramping sensation within the vagina or rectum points directly to the pelvic floor muscles. This internal discomfort can indicate that the muscles are already tense before the contraction begins.
Underlying Reasons for Pain During Kegels
The most frequent reason for pain during a Kegel is hypertonicity, or excessive muscle tension, rather than weakness. Hypertonicity means the pelvic floor muscles are already too tight and unable to fully relax, similar to a constant partial cramp. When hypertonic muscles attempt a contraction, the shortened fibers become even tighter, leading to painful cramping or fatigue. Strengthening an already tense muscle only exacerbates the problem.
Pain also arises from incorrect muscle recruitment when the body fails to isolate the pelvic floor effectively. Many individuals mistakenly use the inner thigh, abdominal, or gluteal muscles to initiate the lift and squeeze. This incorrect technique places undue pressure on the pelvic area and prevents the target muscles from working optimally. Furthermore, holding one’s breath during the contraction significantly increases intra-abdominal pressure, contributing to discomfort and strain.
Steps to Adjust Your Kegel Technique
The first adjustment is focusing intensely on the relaxation phase, which is as important as the contraction itself. Ensure the pelvic floor muscles fully release and return to their resting length after each squeeze, perhaps for a count equal to the hold time. Not fully relaxing between repetitions is a common mistake that rapidly leads to muscle fatigue and pain.
Proper breathing coordination can immediately reduce pain and tension. Instead of holding your breath, exhale gently as you perform the contraction, which helps the muscles lift and engage. Inhale deeply, allowing the abdomen and pelvic floor to fully expand and relax before the next repetition. This synchronized breathing encourages the necessary lengthening of the pelvic floor muscles, sometimes referred to as a “reverse Kegel.”
When starting, perform Kegels while lying down with knees supported, as this position minimizes gravity and accessory muscle engagement. Focus on short, gentle holds, starting with a three-second contraction followed by a three-second relaxation, completing only a few repetitions. Over-training is a concern; a high volume of repetitions with poor technique is less effective than a few focused, pain-free contractions.
Recognizing When a Doctor is Needed
If adjusting your technique does not alleviate the pain, or if the discomfort is sharp, persistent, or debilitating, seek professional guidance. Pain that worsens despite technique correction may indicate a hypertonic pelvic floor requiring therapeutic relaxation and stretching, not strengthening. A pelvic health physical therapist is the most appropriate specialist to evaluate muscle function internally and provide a personalized treatment plan.
Other red flags warranting a consultation include:
- Pain during sexual activity.
- Difficulty or straining during urination or bowel movements.
- The inability to fully relax the pelvic floor muscles.
These symptoms can be associated with hypertonicity or other underlying conditions requiring specific medical intervention. Do not delay seeking care if the pain is accompanied by fever, unusual bleeding, or sudden, severe discomfort, as these may signal a medical emergency.