Still Leaking? Why Pelvic Floor Exercises Fail & Medical Next Steps

If you're still leaking urine despite doing pelvic floor exercises, you're not alone. These exercises (often called Kegels) are widely recommended for bladder control problems. For many people, they work. But for others, the leakage continues — and that can feel frustrating or even discouraging.

The good news? Ongoing leakage doesn't mean you've failed. It usually means something important has been missed — and there are clear next steps you can take.

Let's break down why pelvic floor exercises sometimes don't work and what to do next.

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First: What Pelvic Floor Exercises Are Supposed to Do

Your pelvic floor is a group of muscles that supports your bladder, bowel, and (in women) uterus. These muscles also help control urine flow.

Pelvic floor exercises strengthen these muscles. When done correctly and consistently, they can:

• Improve bladder control
• Reduce stress incontinence (leakage when coughing, sneezing, or exercising)
• Support recovery after childbirth
• Help after prostate surgery
• Reduce urgency symptoms in some cases

Research shows pelvic floor muscle training is a first-line treatment for many types of urinary incontinence. But it only works if the exercises match the problem — and are done correctly.

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Why Pelvic Floor Exercises Fail

There are several common reasons leakage continues.

1. You're Doing Them Incorrectly

This is extremely common.

Many people:

• Tighten their stomach or buttocks instead
• Bear down instead of lifting the muscles
• Hold their breath
• Don't contract strongly enough
• Don't relax fully between repetitions

Studies suggest that up to 30–50% of people perform pelvic floor contractions incorrectly without guidance.

If the muscles aren't activated properly, strengthening simply doesn't happen.

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2. You Have the Wrong Diagnosis

Not all bladder leakage is caused by weak pelvic floor muscles.

There are different types of urinary incontinence:

• Stress incontinence – leakage with coughing, laughing, or exercise
• Urge incontinence – sudden, strong urge followed by leakage
• Mixed incontinence – combination of both
• Overflow incontinence – incomplete emptying
• Functional incontinence – mobility or cognitive issues

Pelvic floor exercises work best for stress incontinence.

If your main issue is urgency and frequent urination, you may have Overactive Bladder instead — a condition where strengthening alone may not be enough and where understanding your specific symptoms can guide you toward the right treatment approach.

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3. Your Pelvic Floor Is Too Tight — Not Too Weak

This surprises many people.

Sometimes the pelvic floor muscles are overactive or tight, not weak. In this case:

• Muscles don't relax properly
• Bladder emptying may feel incomplete
• Urgency and pelvic discomfort may occur
• Kegels can actually worsen symptoms

If your muscles are already tight, adding more tightening can increase dysfunction.

This is why professional evaluation matters.

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4. You Haven't Done Them Long Enough

Pelvic floor strengthening takes time.

Most medical guidelines recommend:

• At least 8–12 weeks of consistent practice
• Multiple sets per day
• Progressive intensity

If you stopped after a few weeks, you may not have given the muscles enough time to strengthen.

Just like building arm or leg muscles, pelvic floor muscles need consistent training.

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5. The Leakage Is Due to Nerve or Structural Issues

Sometimes leakage is not just about muscle strength.

Possible causes include:

• Nerve damage (e.g., diabetes, spinal issues)
• Severe pelvic organ prolapse
• Prostate surgery complications
• Significant childbirth injury
• Obesity-related pressure
• Chronic coughing

In these cases, pelvic floor exercises alone may not be enough.

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6. There's an Underlying Medical Condition

Ongoing leakage may be related to:

• Urinary tract infection
• Bladder stones
• Enlarged prostate
• Hormonal changes after menopause
• Neurological conditions
• Uncontrolled diabetes

These require medical treatment — not just exercises.

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Signs You Should See a Doctor

While leakage itself isn't usually life-threatening, some symptoms need prompt medical attention.

Speak to a doctor urgently if you experience:

• Blood in your urine
• Painful urination with fever
• New weakness or numbness in legs
• Sudden inability to urinate
• Severe pelvic pain
• Rapid worsening of symptoms

Even if symptoms aren't urgent, persistent leakage is a reason to schedule a visit. You deserve answers and effective treatment.

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What Actually Works When Pelvic Floor Exercises Aren't Enough?

If you've tried pelvic floor exercises and still leak, here are evidence-based next steps.

1. See a Pelvic Floor Physical Therapist

This is often the most important step.

A trained pelvic floor physical therapist can:

• Confirm you're contracting correctly
• Identify tight vs weak muscles
• Use biofeedback for muscle training
• Create a personalized plan
• Address posture and breathing issues

Research shows supervised pelvic floor muscle training is more effective than self-directed exercises.

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2. Bladder Training

If urgency is your main issue, bladder training may help.

This involves:

• Scheduled bathroom visits
• Gradually increasing time between voids
• Urge suppression techniques
• Fluid management strategies

Bladder training is especially helpful for Overactive Bladder.

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3. Medications

For urgency or Overactive Bladder, doctors may prescribe:

• Antimuscarinic medications
• Beta-3 agonists
• Vaginal estrogen (for postmenopausal women)

These treatments target bladder overactivity, not just muscle strength.

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4. Medical Devices or Procedures

If conservative treatments fail, options may include:

• Pessary devices (for prolapse-related leakage)
• Bulking injections
• Nerve stimulation therapy
• Botox injections into the bladder
• Sling surgery (for stress incontinence)

Surgery is typically considered only after less invasive treatments have been tried.

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5. Lifestyle Adjustments That Make a Difference

Even small changes can significantly reduce leakage:

• Losing excess weight
• Managing chronic cough
• Treating constipation
• Limiting bladder irritants (caffeine, alcohol)
• Quitting smoking

These changes reduce pressure on the bladder and pelvic floor.

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When to Reevaluate Your Approach

If you've done pelvic floor exercises consistently for 3 months and:

• See no improvement
• Feel worsening urgency
• Experience pelvic pain
• Notice new symptoms

It's time to reassess with a healthcare provider.

Leakage that persists despite correct technique is a sign that more evaluation is needed — not that the situation is hopeless.

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The Bottom Line

Pelvic floor exercises are powerful — but they are not a cure-all.

They work best when:

• The diagnosis is correct
• The muscles are weak (not tight)
• The exercises are performed properly
• The training is consistent and progressive

If you're still leaking, it doesn't mean you're broken. It means your body needs a more tailored approach.

Start by checking your symptoms with a free Overactive Bladder assessment to help identify whether OAB might be contributing to your leakage. Then speak to a qualified healthcare professional to confirm the diagnosis and discuss personalized treatment options.

And most importantly: if you have concerning symptoms like blood in urine, severe pain, sudden weakness, or rapidly worsening bladder problems, speak to a doctor promptly. Some causes of urinary symptoms can be serious and need immediate care.

You deserve effective treatment — and there are more options available than you might think.