Pregnancy SmartShop formulas

Comparison · Pregnancy Smart

Kegels vs Pelvic Floor Physical Therapy After Birth

Assigned clinical reviewerSharyn Harrison· CNM, NPDraft · pending clinical reviewUpdated

How do the options compare?

This comparison looks at what postpartum-specific and closely related research has actually measured for each approach, technique confirmation, symptom improvement, and continence rates, rather than convenience alone.

OptionStudied pregnancy doseGuideline supportNotes
Self-directed kegel exercisesCommonly a few sets of 8 to 12 contractions daily, self-paced and needing no appointment; exact protocols vary by source since no clinician confirms technique.A postpartum-specific education study found real improvements in sexual function and pain with structured self-directed kegels versus general counseling alone, though no significant difference in overall pelvic floor dysfunction score.Free and private, but correct technique is never confirmed. A quasi-experimental study found muscle strength improved similarly in supervised and unsupervised groups, yet only the supervised group saw significant symptom improvement, suggesting many people contract the wrong muscles without feedback.
Supervised pelvic floor physical therapyA course of appointments with a pelvic floor physical therapist, often including biofeedback or internal assessment to confirm correct muscle contraction; total sessions vary by clinic and symptom severity.A postpartum-specific systematic review found supervised training produced significantly larger gains in vaginal squeeze pressure and muscle endurance than unsupervised kegels, and one supervised multimodal trial reported over 70% continence after 8 weeks versus 0% in the comparison group.Requires an appointment, referral, and often a copay, and overall evidence certainty is still rated moderate to low by GRADE criteria due to small trials, so the edge over self-directed kegels is real but not overwhelming based on today's research.
  • In one trial reviewed by a postpartum-specific systematic review, supervised pelvic floor training produced a change in maximal vaginal squeeze pressure of about 19 mmHg versus about 3 mmHg with unsupervised training, and a change in muscle hold time of about 11 seconds versus about 6 seconds, both differences reported as statistically significant. 1
  • A separate trial using supervised multimodal pelvic floor training, cited in the same review, found more than 70% of participants achieved continence after eight weeks compared with 0% in the comparison group, though the review's own GRADE assessment rates the overall certainty of evidence as moderate for incontinence outcomes and low for quality of life and muscle function, reflecting small trials and short follow-up across the field. 1
  • A Cochrane review found structured pelvic floor muscle training begun during pregnancy reduced the risk of urinary incontinence in the mid-postnatal period, more than three to six months after birth, by 29% (moderate-quality evidence), but it was unclear whether the same training reduced incontinence beyond 6 to 12 months postpartum (very low-quality evidence), and it specifically flagged that how much training women in either group actually completed was poorly documented across trials. 2
  • A separate quasi-experimental study, not limited to postpartum participants, found supervised kegel exercises with biofeedback significantly reduced incontinence frequency and severity and improved quality-of-life scores compared with unsupervised kegels over 12 weeks, even though measured muscle strength improved in both groups, suggesting correct technique, not just effort, is what supervision adds. 3
  • A postpartum-specific study of structured kegel education, compared against a general-counseling control group rather than against supervised physical therapy, found significant improvements in sexual function and pain scores with a large effect size, but no statistically significant difference in overall pelvic floor dysfunction score between groups, showing that even well-taught self-directed kegels have real but uneven benefits. 4

Which option makes sense?

Starting with self-directed kegels is a reasonable, free first step, but if leaking, pressure, or pain hasn't meaningfully improved after a few weeks of consistent effort, the evidence favors moving to supervised pelvic floor physical therapy, where a clinician can confirm you're actually using the right muscles.

Disclosure: Pregnancy Smart is a supplement maker. The options compared above sit outside our own product line; this page describes their pregnancy evidence on its own merits.

Frequently asked questions

Are kegel exercises effective after having a baby?

They can be. A postpartum-specific study of structured kegel education found real improvements in pain and sexual function with a large effect size, though it did not find a significant difference in overall pelvic floor dysfunction score compared with general counseling alone.

Is pelvic floor physical therapy actually more effective than kegels alone?

In the studies reviewed here, yes on several measures. A postpartum-specific systematic review found supervised training produced significantly larger gains in vaginal squeeze pressure and muscle endurance, and a related trial found over 70% continence after 8 weeks with supervised multimodal training versus 0% in the comparison group.

How do I know if I'm doing kegels correctly?

Without feedback, it's genuinely hard to know. One study found muscle strength improved in both a supervised and an unsupervised group, yet only the supervised group saw a significant reduction in incontinence symptoms, which points to technique, not just effort, as the likely difference.

When should I move from self-directed kegels to physical therapy after birth?

If leaking, pressure, or discomfort hasn't meaningfully improved after a few weeks of consistent, correctly performed kegels, that's a reasonable point to ask your provider for a pelvic floor physical therapy referral rather than continuing to guess at technique on your own.

Does starting pelvic floor exercises during pregnancy help reduce the chance of postpartum incontinence?

A Cochrane review found structured pelvic floor muscle training started during pregnancy reduced the risk of urinary incontinence in the mid-postnatal period (more than 3 to 6 months after birth) by 29%, based on moderate-quality evidence.

How much does pelvic floor physical therapy typically involve?

It's a course of appointments with a pelvic floor physical therapist, often including biofeedback or an internal assessment to confirm you're contracting the right muscles. The exact number of sessions varies by clinic, insurance, and how severe your symptoms are.

Can kegels help with more than just leaking urine?

In a postpartum-specific study, structured kegel exercises were linked to significant improvements in sexual function and reported pain, alongside the more commonly discussed goal of reducing urinary leakage.

Is it too late to start pelvic floor exercises months after birth?

No, though the evidence for how much benefit to expect gets less certain over time. A Cochrane review found it was unclear whether pelvic floor muscle training reduced incontinence beyond 6 to 12 months postpartum, which is a good reason to get a proper evaluation rather than rely on generic exercises alone at that point.

Related in the library

References

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.