There is a question in our Yoga Therapy Institute exams that almost every student answers incorrectly.
Should all women do pelvic floor strengthening exercises?
The expected answer is usually an emphatic "yes, of course".
The correct answer is no.
Why "every woman should do their Kegels" is the wrong recommendation
For some women, strengthening the pelvic floor is not simply unhelpful – it is genuinely contraindicated.
If that surprises you, you are in good company. It surprises many yoga professionals too, and that is precisely why it deserves a place in our Yoga Therapy Toolbox.
For decades, the message surrounding women's pelvic health has been remarkably consistent. If the pelvic floor isn't functioning well, the answer is to strengthen it. That advice appears in postnatal care, fitness classes, magazines and social media until it begins to feel like established fact rather than a recommendation. Yet, as those who have studied at The Yoga Therapy Institute know that every recommendation should be questioned against the individual in front of us.
The pelvic floor is simply too complex for a one-size-fits-all approach.
Thinking beyond "weak" and "tight"
Public discussion about pelvic floor health often presents a simple spectrum. At one end sits the "weak" pelvic floor, assumed to need strengthening. At the other sits the "tight" pelvic floor, assumed to need relaxation.
Reality is far more nuanced.
A healthy pelvic floor depends on several qualities working together: resting muscle tone, the ability to contract when needed, the ability to release afterwards, reflex speed and coordination with breathing and movement. These are separate capacities. A woman may function well in one area while experiencing difficulty in another, and performing well in one tells us very little about the others.
Another misconception is that the pelvic floor is a single muscle behaving as one unit. In reality, it consists of several layers, paired muscles and different compartments, each capable of functioning differently. One side may be overactive while the other is not. One area may release well while another remains guarded.
"Tight" is not the same as "strong", and "weak" tells us very little on its own.
The pelvic floor also responds continuously to the wider body. Hormones, breathing mechanics, posture, movement, pain, stress, connective tissue and different life stages all influence how it behaves. Chronic stress, for example, often increases resting muscle activity, creating a pelvic floor that is guarded rather than weak. Viewed in this context, blanket recommendations become increasingly difficult to justify.
Symptoms don't identify the cause
The complexity of the pelvic floor is only part of the picture. Symptoms are equally misleading.
Leaking, urgency, heaviness, pain, incomplete emptying and pain during penetration can each arise from several different mechanisms. The same symptom in two women may require completely different approaches.
A woman who leaks when she coughs may benefit from improved support and strength. Another woman with exactly the same symptom may have an overactive pelvic floor that cannot coordinate or release effectively. The symptom is identical. The underlying physiology is not.
The same applies to many pelvic floor conditions. Prolapse involves connective tissue support as well as muscle function. Urgency may originate primarily from the bladder. Pain may be muscular, neurological, joint-related or visceral in origin.
The important question is not, "Which symptom does she have?" It is, "What is driving that symptom in this particular woman?"
The physical picture is only half the story
Objective findings are only one part of assessment. Equally important is how a woman experiences her own body.
Some women struggle to sense their pelvic floor at all. Others experience it intensely but misinterpret what they are feeling. "Tight" may actually describe pressure, stretching, fatigue, pain or fear. Clinical findings and lived experience do not always correspond. A woman may feel unbearably tight yet assess as entirely unremarkable, while another with significant prolapse may notice very little until she is examined.
The pelvic floor also carries meaning. Pregnancy, childbirth, surgery, menopause, chronic pain and trauma can all alter a woman's relationship with this part of her body. Anticipated pain creates guarding, guarding contributes to pain, and the cycle reinforces itself. What a woman believes is happening in her body is therefore clinically relevant, not simply psychological.
Likewise, the degree of bother matters. Two women with similar findings may experience very different levels of disruption to their daily lives. One may have stopped exercising, travelling or enjoying intimacy, while the other rarely thinks about her symptoms. They do not have the same problem simply because they share the same diagnosis.
What does this mean for yoga?
Yoga has, perhaps unintentionally, developed its own version of the "everyone should strengthen" message.
Mula Bandha is frequently taught as a sustained, low-grade lift of the pelvic floor throughout practice, often to beginners, often in large classes and often without any real understanding of who is present in the room. The physical instruction many students receive is simply to maintain a gentle pelvic floor contraction.
Yet this was not the original purpose of Mula Bandha. Traditionally, it referred to an energetic lock rather than a universal programme of muscular strengthening. Over time, these concepts have become blurred, and the result is that many practitioners are routinely encouraged to contract muscles that, in some cases, may already be working too hard.
Layer this interpretation over vigorous asana, breath-holding and our wider cultural tendency to grip the abdomen, and we may inadvertently reinforce the very patterns that some women need to release rather than strengthen.
The lesson is not that Mula Bandha is inherently wrong. Rather, like any therapeutic intervention, it should be applied thoughtfully, with an understanding of the individual rather than as a universal instruction.
So when are Kegel or Mula Bandha practices contraindicated?
Routine pelvic floor strengthening or sustained engagement may be inappropriate – and sometimes counterproductive – for women who:
- Have high resting pelvic floor tone, particularly dancers, gymnasts, climbers, Pilates practitioners and long-term yoga practitioners.
- Have never had penetrative sexual intercourse, where increased pelvic floor tension or protective guarding may already be present.
- Experience pelvic pain conditions such as vaginismus, dyspareunia, vulvodynia, pudendal neuralgia, coccydynia or chronic pelvic pain syndrome.
- Live with bladder pain syndrome (interstitial cystitis), urgency-frequency syndrome, hesitancy or incomplete emptying.
- Experience chronic constipation and habitual straining.
- Have a history of sexual trauma or invasive medical procedures, where protective guarding has become established.
- Live with chronic anxiety or habitual breath-holding, where gripping has become the body's default strategy.
- Are in the immediate post-surgical or early postnatal period, or where complications are suspected.
The same exercise may be entirely appropriate for one woman and entirely inappropriate for another. Context is everything.
Knowing where our role begins – and ends
It is not the role of a yoga professional to assess pelvic floor tone, laxity or function. Those assessments require specialist clinical training and, in many cases, internal examination.
That distinction matters because practices are increasingly being offered in the name of yoga that fall well outside professional competence. These include internal pelvic techniques delivered by unqualified teachers, hands-on pelvic adjustments without meaningful consent, jade or yoni eggs promoted as tone-building devices, vaginal steaming, and claims that yoga alone can correct prolapse or resolve incontinence.
Recognising the limits of our scope of practice does not diminish Yoga Therapy. It strengthens it.
The value of a good referral
When in doubt, refer. A GP, gynaecologist or, ideally, a pelvic health physiotherapist can assess directly and determine what this particular woman's body actually needs.
A good referral is not a failure of expertise. It is expertise.
Clinical assessment identifies the mechanism behind the symptoms. Yoga Therapy complements that work by addressing the wider picture: breathing patterns, movement habits, nervous system regulation, pressure management, body awareness and the confidence to move well again. It is this broader therapeutic perspective that allows us to support women safely while remaining firmly within our professional boundaries.
The next time someone confidently states that every woman should strengthen her pelvic floor, perhaps the most accurate response is simply:
It depends.
Because no two women are the same. And neither are their pelvic floors.
