The Limitations of Kegels Alone
For decades, Kegels have been the go-to recommendation for any woman with pelvic floor concerns. While Kegels are not a bad exercise, relying on them as your only strategy is like going to the gym and only doing bicep curls. You would miss the majority of your body — and your results would be limited.
The pelvic floor does not work in isolation. It functions as part of an interconnected system that includes your deep core muscles, your hip rotators, your glutes, and your diaphragm. When you only train the squeeze-and-lift motion of a Kegel, you miss the bigger picture of how these muscles coordinate together during real movements like walking, lifting, coughing, and exercising.
Clinical reality: After 40 years of treating pelvic floor dysfunction, I can tell you that the women who see the best long-term results are the ones who train their pelvic floor as part of a whole-body system — not the ones who do the most Kegels.
The Whole-Body Approach to Pelvic Floor Health
A truly effective pelvic floor program addresses five key areas that work together to support pelvic function. Here is what you need beyond Kegels:
1. Hip Rotator Strengthening
The obturator internus is a hip external rotator muscle that literally passes through the pelvic floor. When you strengthen this muscle, you are providing internal structural support to the pelvic floor from within. Most exercise programs completely overlook this critical connection. Simple hip rotation exercises performed lying on your side or seated can activate this muscle and dramatically improve pelvic support.
2. Deep Core Integration
Your transverse abdominis — the deepest layer of your abdominal muscles — contracts automatically with your pelvic floor. Research has shown that when one fires, the other should respond. By training coordinated core and pelvic floor activation, you build a stronger foundation than either muscle group can provide alone. This is not about doing crunches; it is about learning to engage the deep core stabilizers.
3. Glute Bridges and Hip Extension
Your gluteal muscles are connected to your pelvic floor through shared fascial lines and neural pathways. Weak glutes often accompany weak pelvic floors. Bridge exercises not only build glute strength but also train the pelvic floor to activate during hip extension — a pattern you use every time you stand up, walk upstairs, or get out of a chair.
Key Exercises Beyond Kegels
- Side-lying clamshells for hip rotator activation
- Bridges with pelvic floor coordination
- Deep squat holds with diaphragmatic breathing
- Dead bugs for core-pelvic floor integration
- Standing hip circles for functional mobility
4. Functional Movement Patterns
Your pelvic floor needs to work during real life — not just while you are lying on your back concentrating. Training functional movements like squats, lunges, and single-leg balance challenges teaches your pelvic floor to activate automatically when you need it most. This is where lasting results come from.
5. Diaphragmatic Breathing Coordination
Your diaphragm and pelvic floor move together like a piston. When you inhale, both descend. When you exhale, both lift. Many women breathe in patterns that actually work against their pelvic floor. Learning to coordinate your breath with pelvic floor activation is one of the most powerful tools available — and it costs nothing.
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Why This Approach Gets Better Results
When you train the pelvic floor as part of a complete system, several things happen that Kegels alone cannot achieve:
- Better muscle recruitment — your brain learns to activate the pelvic floor automatically during movement, not just when you consciously think about it
- Improved endurance — the supporting muscles share the workload, so your pelvic floor does not fatigue as quickly
- Functional carryover — the strength you build actually transfers to daily activities like lifting, exercising, and playing with your kids
- Reduced risk of re-injury — a balanced system is more resilient than one strong muscle surrounded by weak ones
A Note About Starting
If you currently have pelvic floor dysfunction, pain, or prolapse, consult with a pelvic floor physical therapist before beginning a new exercise program. Some of these exercises may need to be modified based on your specific condition. The exercises shown in the video above are designed as a general guide.
Frequently Asked Questions
Why are Kegels alone not enough for pelvic floor health?
Kegels only target one aspect of pelvic floor function — the squeeze and lift. But the pelvic floor works as part of a larger system that includes the deep core, hip rotators, glutes, and diaphragm. Without training these supporting muscles, Kegels alone often produce limited or temporary results.
What exercises are better than Kegels for the pelvic floor?
A comprehensive pelvic floor program includes hip rotator strengthening (especially the obturator internus), deep core activation with transverse abdominis exercises, glute bridges, diaphragmatic breathing coordination, and functional movements like squats and lunges that train the pelvic floor in real-world positions.
Should I stop doing Kegels entirely?
Not necessarily. Kegels still have value as one component of a complete program. The key is not relying on Kegels alone. Think of it like going to the gym and only doing bicep curls — you would miss most of your body. Kegels should be part of a broader approach that includes core, hip, and glute work.
How do hip rotator exercises help the pelvic floor?
The obturator internus is a hip rotator muscle that actually passes through the pelvic floor. Strengthening this muscle provides internal support to the pelvic floor from within. Many women see dramatic improvements in symptoms once they start working the hip rotators alongside traditional pelvic floor exercises.
Can I do these exercises at home without equipment?
Yes, the vast majority of pelvic floor exercises beyond Kegels can be done at home with no equipment. Bridges, deep squats, hip rotations, core activation, and breathing exercises all require only your body and a flat surface. Some exercises can be enhanced with a resistance band, but it is not required.
Sheree DiBiase
Sheree DiBiase has been a physical therapist for over 40 years, specializing in pelvic floor rehabilitation. She is the founder of Lake City Physical Therapy and the creator of the Pelvic Floor Pro app. Sheree is a board-certified Pelvic Rehabilitation Practitioner (PRPC) and has helped thousands of women regain pelvic floor strength and confidence.