In thousands of social media posts, women are urged to exercise their pelvic floor—sometimes via musical “squeeze-along” routines or inserting vaginal weights. The posts describe the pelvic floor as a sling below the torso and claim that Kegel exercises can cure problems involving the bladder, bowels, or reproductive organs.
But experts say this two-dimensional vision is too simple. Pelvic floor muscle strengthening does benefit some women with pelvic floor problems, but it doesn’t help every condition or every body.
“You can have the strongest pelvic floor muscles in the world but lack connective tissue supports for those muscles. Or you could have really strong muscles, but the sphincter muscle inside your urethra is not strong,” says Linda McLean, a pelvic health researcher at the University of Ottawa. For example, her research found that women whose bladder sits lower in the pelvis are less likely to benefit from strengthening routines.
Complicating the picture, some women have pelvic pain because their muscles are too taut, not too loose, says Leslie Rickey, a urogynecological researcher at the Yale School of Medicine. “When someone has tightness, strengthening exercises can actually worsen the problem,” she says.
Researchers are now gaining a fuller understanding of just how complex and dynamic the female pelvis is, encompassing extensive muscle groups, nerves, connective tissue, and bones. “It’s a three-dimensional structure. There are areas where muscles are broad, areas where they’re thicker, areas where they’re wrapping around organs, and others where they form a kind of shelf,” says Steven Abramowitch, a bioengineer and pelvic researcher at the University of Pittsburgh. The pelvis is also continually subjected to forces from gravity, movement, stretching, and pressure from the bladder and bowels—not to mention pregnancy and childbirth.