Reverse Kegels for women: how to do them, and who they help
A reverse Kegel is the opposite of a Kegel: instead of squeezing and lifting your pelvic floor, you let it soften and drop, gently, as you breathe in. It's a relaxation exercise, not a push. To do one, breathe into your belly, and as it rises, let the area between your sitting bones widen and sink a little, the way it does when you start to pee. Then breathe out and let it return on its own.
Reverse Kegels are for a pelvic floor that holds on too much: pelvic pain, painful sex, trouble starting to pee or emptying, straining with constipation, or Kegels that make things worse. They're not a treatment for a weak floor on their own. Below: the steps, how to tell you're doing it right, how many, who they help and who should be careful, what the evidence says, and how to fit them with regular Kegels.
What a reverse Kegel is
Your pelvic floor is a sling of muscles from the pubic bone to the tailbone. Like any muscle, it needs to do two things: contract and relax. A Kegel trains the contraction. A reverse Kegel trains the relaxation, which pelvic physical therapists also call a "pelvic floor drop", "lengthening" or "down-training".
With every normal breath, the pelvic floor moves a little: it drops slightly as you breathe in and the diaphragm moves down, and rises as you breathe out. A reverse Kegel uses that in-breath and adds a deliberate letting go. The movement is small, a few millimetres, and gentle.
It is not bearing down. Bearing down, or straining, means holding your breath and pushing with your belly, as if forcing a hard stool out. That pushes the pelvic organs down and isn't what you want. A reverse Kegel feels like melting, not pushing.
Who reverse Kegels can help
Pelvic physical therapists use relaxation training when the pelvic floor is overactive: tense at rest, slow to let go, or both. Signs of that include:
- Pain with sex, or pain inserting a tampon.
- A deep ache in the pelvis, vagina, tailbone or hips, often worse after sitting or stress.
- Trouble starting to pee, a slow or stop-start stream, or feeling you haven't emptied.
- Straining with bowel movements, or feeling you can't fully empty your bowels.
- Urgency and frequency with pelvic pain.
- Kegels that make pain or symptoms worse.
- Clenching your bottom or holding your belly in without noticing.
Our guide to tight pelvic floor symptoms goes through these in detail, with a table to help tell a tight floor from a weak one. A floor can also be both tight and weak: muscles held tense all day get tired and can't squeeze well when it matters, which is why some women with a tight floor still leak.
How to do a reverse Kegel, step by step
Start lying down; it's the easiest position to feel the movement.
- Get comfortable. Lie on your back with your knees bent and feet flat, or with pillows under your knees. Empty your bladder first.
- Relax the outer muscles. Let your jaw, shoulders, buttocks and inner thighs go loose. Let your knees fall slightly apart.
- Hand on belly. Rest one hand on your lower belly.
- Breathe in slowly through your nose for about 4 seconds. Let your belly rise under your hand and your lower ribs widen.
- As you breathe in, let the pelvic floor drop. Imagine the sitting bones moving apart, the vagina and back passage softening and opening slightly, the way they do in the first second of starting to pee or pass wind. No pushing.
- Breathe out slowly, for about 6 seconds, and let the floor float back up on its own. Don't squeeze it up.
- Repeat for 10 slow breaths.
Cues that help some women:
- "Let your bottom blossom" or "melt into the bed".
- Imagine the floor is a lift that goes down one floor as you breathe in.
- Think of the moment you sit on the toilet and let go, without actually going.
- Picture a sheet in the wind billowing down as you breathe in.
How to know you're doing it right
Because the movement is small, it's easy to push without realising. Check:
| Check | A reverse Kegel | Pushing or straining |
|---|---|---|
| Breath | Flowing, slow, in through the nose | Held, or a grunt |
| Belly | Rises softly as you breathe in | Hard, braced, pushes out |
| Face and jaw | Relaxed | Clenched, red |
| Hand on the perineum (the skin between vagina and anus), over underwear | A slight, soft bulge or fullness | A strong push into your hand |
| Mirror, lying with knees apart | The area softens and moves down a little | A big push down; the vaginal walls may bulge |
| How it feels | Like letting go, warmth, heaviness | Effort, pressure, like forcing |
If you can't feel anything, that's common at first. Try in child's pose (kneeling, sitting back towards your heels, forehead down) where the floor is often easier to feel letting go, or sitting on a firm surface where you can feel your sitting bones. A pelvic floor physical therapist can check with an internal exam or biofeedback and is the surest way to know.
How many reverse Kegels a day
There's no single official dose; programmes vary. A common home starting point used by pelvic physical therapists, and in patient leaflets, is:
- 10 slow breaths with a drop on each in-breath.
- 2 to 3 times a day. Morning, after a stressful stretch, and before bed.
- About 2 to 5 minutes each time.
More isn't better if it makes you strain. If you feel pressure, heaviness, or lightheaded, stop, breathe normally, and make the next drop smaller.
A four-week reverse Kegel plan
| Week | Position | What | How often |
|---|---|---|---|
| 1 | Lying on your back, knees bent | 5 minutes of belly breathing; 10 drops on the in-breath | Twice a day |
| 2 | Lying, then child's pose | 10 drops in each position | 2 to 3 times a day |
| 3 | Sitting on a firm chair | 10 drops sitting; a drop each time you sit down to pee | 3 times a day |
| 4 | Standing, and in daily life | A few drops at the sink, in a queue, after a hard moment; check your floor isn't clenched | Little and often |
Our guide to how to relax your pelvic floor muscles adds four stretches with timings (child's pose, reclined butterfly, happy baby, a supported squat) that pair well with the drops.
Do reverse Kegels really work?
An honest answer: the exercise is part of a treatment with good support, but "reverse Kegels" on their own haven't been tested much.
- Pelvic floor physical therapy for an overactive floor uses relaxation training, breathing, stretches and hands-on release together. In a trial published in the Journal of Urology in 2012, women with bladder pain syndrome given hands-on pelvic floor physical therapy did much better than those given general massage (59% vs 26% rated themselves improved). That's the hands-on treatment, not home drops, but it shows working on a tight floor can help.
- For constipation with straining (when the floor tightens instead of relaxing to let a stool out), guidelines from gastroenterology societies recommend biofeedback, which teaches the same relaxing skill, as the first treatment.
- For painful sex and vaginismus, relaxation training is part of standard physical therapy care, alongside other treatments.
- For stress leaks from a weak floor, reverse Kegels alone are not the treatment. The evidence for leaks is for pelvic floor strengthening.
So: worth doing if your floor is tight, as part of a plan, ideally guided by a pelvic floor physical therapist; not a cure on its own, and not a reason to skip a check if you have pain.
Reverse Kegels vs regular Kegels
| Regular Kegel | Reverse Kegel | |
|---|---|---|
| Movement | Squeeze and lift up and in | Soften and drop down and out |
| Breath | Usually on the out-breath | On the in-breath |
| Trains | Strength, speed, holding | Letting go, range, coordination |
| Helps most with | Stress leaks, urgency control, prolapse symptoms | Pain, painful sex, emptying problems, straining |
| Risk if overdone | A tight, tired, sore floor | Straining, if it turns into pushing |
Most women need both skills: a floor that can squeeze when you sneeze and let go when you pee or have sex. Every Kegel already ends with a full let-go; a reverse Kegel takes that let-go a little further.
How to combine them with Kegels
- If your floor is tight (pain, emptying trouble): reverse Kegels and breathing first, for 2 to 4 weeks, before adding Kegels. When you bring Kegels back, do half as many, and follow each with a full drop. Our guide on relaxing your pelvic floor has the signs it's time.
- If your floor is weak (stress leaks, no pain): Kegels are the main exercise. Add 3 to 5 drops at the end of each session so the floor doesn't stay clenched.
- If you're not sure, or you have both pain and leaks: a pelvic floor physical therapist can tell you which comes first.
A balanced session might be: 2 minutes of belly breathing, 8 slow Kegels each followed by a full release, 10 quick squeezes, then 5 drops. If you're not sure your Kegels are lifting the right way, see how to know if you're doing Kegels correctly.
Using a reverse Kegel in daily life
- Peeing: sit fully on the seat (don't hover), feet flat or on a low stool, lean forward a little, and do a drop to start the stream. Don't push the pee out.
- Bowel movements: feet on a stool so knees are above hips, lean forward, belly out, breathe out with a soft "shh", and let the floor drop. No breath-holding.
- Before sex or a pelvic exam: a few minutes of belly breathing and drops can make it more comfortable. Go slowly, and stop if it hurts.
- At your desk: check every hour or so whether you're clenching your bottom or belly; do 3 drops.
Who should be careful
- Pelvic organ prolapse: a bulge or heaviness in the vagina. Gentle relaxation is usually fine, but pushing or bearing down can add pressure. Keep drops very soft, do them lying down, and ask a pelvic floor physical therapist to check your technique.
- Recent pelvic surgery or childbirth: follow your surgeon's or midwife's advice on when to start.
- Stress leaks with no pain: reverse Kegels won't fix these; strengthening will.
- Haemorrhoids or fissures: relaxing can help, but straining makes them worse. If it hurts, stop.
Common mistakes
- Pushing instead of releasing. The most common one. If your belly hardens, you're pushing.
- Holding your breath. The drop rides on the in-breath; keep breathing.
- Trying too hard. Effort tightens. Smaller and softer is right.
- Doing them only when symptoms flare. Like any skill, it needs daily practice.
- Going straight back to lots of Kegels. If your floor was tight, build squeezes back slowly.
When to see a doctor or pelvic floor physical therapist
- Pelvic pain lasting more than a few weeks, or pain with sex.
- Trouble emptying your bladder, or a weak stream.
- Bleeding, a new lump or bulge, or a change in bowel habit.
- Pain or burning with peeing, or a fever.
- No change after 4 to 6 weeks of daily practice.
A pelvic floor physical therapist can feel whether your floor is tight, weak or both, and set a plan. In many places you can book one without a referral.
Frequently asked questions
Are reverse Kegels the same as pushing?
No. Pushing means holding your breath and bearing down with your belly. A reverse Kegel is a soft release on the in-breath, with the belly relaxed.
Can reverse Kegels cause leaks?
Done gently with an empty bladder, they shouldn't. If you leak while doing them, you're probably pushing; make the release smaller.
Should I do reverse Kegels if I leak when I sneeze?
Not as your main exercise. Stress leaks need strengthening. A few drops after each Kegel session keep the floor from staying clenched.
How long until reverse Kegels help?
Some women feel less tension within a couple of weeks of daily practice; pain often takes longer and usually needs more than one approach. See a pelvic floor physical therapist if nothing has changed after 4 to 6 weeks.
Can I do reverse Kegels sitting down?
Yes, once you can feel them lying down. Sit on a firm chair so you can feel the sitting bones, and keep your belly soft.
Do reverse Kegels help with painful sex?
They're part of the usual physical therapy plan for pain caused by a tight floor. Pain with sex has other causes too, such as vaginal dryness after menopause, so see a doctor if it persists.
Try ten breaths tonight
Lie down tonight, knees bent, one hand on your belly, and do 10 slow breaths with a soft drop on each in-breath. If your problem is leaks rather than pain, the free 1-minute check shows four facts on why Kegels often don't help and asks when your leaks happen. For more on a tight floor, leaks and urges after 40, see all our pelvic floor guides.
Sources: FitzGerald M.P. et al., Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome, Journal of Urology, 2012. American Gastroenterological Association, Medical position statement on constipation, 2013. International Continence Society, Terminology for pelvic floor muscle function (Messelink et al., Neurourology and Urodynamics, 2005). NICE guideline NG123, Urinary incontinence and pelvic organ prolapse in women: management, 2019. Cleveland Clinic, Pelvic floor dysfunction. Mayo Clinic, Kegel exercises: a how-to guide for women. This guide is education, not medical advice.