Many women and moms have questions about their pelvic floor health. We have partnered with Laura Currens, DPT, PCES. She is a Pelvic Floor Specialist in Ventura, CA and Owner of Dynamic Flow Physical Therapy.
Whether you know what kegels are or not, chances are you have probably heard the word. You may have also heard discussions around women’s pelvic floor. Or you might have heard from your doctor, social media, or friends and family to just ‘do your kegels’ to resolve pelvic floor dysfunction. But what does that actually mean? How do you do kegels exactly? And do they actually help in the long run or can they increase your symptoms?
To Kegel or Not to Kegel?
Patients come into my clinic all the time and tell me they have done hundreds and hundreds of kegels but symptoms are not getting better. They purchase kegel aids and trainers, spend hundreds of dollars on devices but don’t see the results they’re hoping for. This begs the question: Do they even need to do kegels?
There are circumstances where kegels do help. Some examples include if you have pelvic floor weakness, it can be helpful to do a kegel before you cough, sneeze, or laugh to decrease or stop the leakage. If you are postpartum and have a weak pelvic floor, kegels could help get you re-connected with your pelvic floor and build a good foundation to prepare you for return to an exercise program. When we have urinary urgency it can be helpful to calm the brain by doing some kegels followed by full muscle relaxations 3-5 times to stop the urgency signal to the brain (ie retraining the brain and bladder connection). Doing kegels can help with pleasure during sex or orgasm, but for some women we want to focus on relaxing these muscles to help with painful insertion and penetration. If you leak urine when lifting your kids it may help to do a kegel with an exhale prior to the lift. But for some women we actually need to focus on relaxing the pelvic floor prior to the lift to decrease pressure on the pelvic floor which could be causing the leakage. For example, if the person is bearing down or bulging the pelvic floor muscles by accident instead of contracting these muscles.
Overall, it can be good to learn to activate these muscles by coordinating our breath but there are many circumstances where we actually want to relax these muscles and not strengthen them. This may be temporary until symptoms resolve or kegels may never be a recommended exercise for some people.
Not to Kegel
There are times when we typically don’t want to use kegels at all.
This includes dealing with tailbone pain, vaginismus (involuntary tensing of the vagina which makes vaginal penetration difficult, also inserting tampons, pelvic exams, etc), dyspareunia (pain with intercourse), interstitial cystitis, or pelvic pain conditions.
In these instances we want to work on relaxing the pelvic floor muscles or a “reverse kegel” instead of strengthening them. Working on a good inhale with muscle relaxation combined with common yoga poses like child’s pose, happy baby or a deep squat, can also help to lengthen the pelvic floor muscles. It’s always best to get evaluated to make sure you are doing these exercises correctly.
The Importance of Contract and Relax
Even if kegels are an appropriate exercise for you, we still want to make sure we are fully able to relax these muscles after the contraction. This way we are working through full range of motion.
For example, when it comes to our bicep muscles, we don’t tell people to only do hundreds of bicep curls only. Most people would understand that flexing your elbow or biceps and not extending it or letting your elbow straighten would most likely cause shoulder issues over time and is not very functional since we need to do both tasks. The pelvic floor muscles are similar. We need them to contract, but we also need them to relax for urination, bowel movements, sexual activities, gynecological exams, and during labor.
You Need More Than Kegels
Kegels alone are also most likely not going to solve most pelvic floor dysfunctions. For example, lying on your back doing kegels with a biofeedback device (a device with electrodes that has either external or internal sensor and gives feedback on when you’re relaxing or contracting your pelvic floor muscles and how much force you are generating) will not alone get you back to your goal of high level tasks like running, jumping, doing your work out classes, lifting your kids without leaking urine, sneezing/coughing/laughing without leaking, or chasing your kids without symptoms. We need to work on posture, pressure management, breathing, and strengthening in functional positions to gradually load the system towards these tasks.
If we want to do a task like jumping, we have to break up this activity into smaller components. As we progress through each exercise we want to make sure we are not producing symptoms but pushing the body in a safe way. This is vital to getting the body back to full function.
For example, to get back to lifting your child without leaking urine we need to determine the symptom driver first. Is the pelvic floor too tight or are you constipated causing increased pressure on the bladder? Maybe you have pelvic organ prolapse, your pelvic floor is weak, or your pelvic floor is not coordinating well are just a few possible options.
If you’re truly just weak and not coordinating well we could start with breath and pelvic floor connection exercises lying on your back/side/sitting and quickly move to more functional tasks like squats with pelvic floor coordination, lunges, or deadlifts. The next step would be to slowly increase the weight you are holding to prepare your body for the task of lifting a child, and then lifting your squirming child which is an even harder task to accomplish while maintaining good postural alignment and breathing to increase optimal pelvic floor function. The goal is to do these exercises without symptom reproduction.
There are so many options and ways to strengthen without even using kegels at all.
All exercises can become pelvic floor exercises depending on your goals, creativity is the key!
Pelvic Floor Evaluation
There are two ways to evaluate the pelvic floor externally and internally. Since the muscles of the pelvic floor are mostly deep in the pelvis, an internal exam gives the most detailed information of what your muscles are doing.
A transvaginal or transrectal exam gives the most information on what your pelvic floor is doing. This is performed by a skilled pelvic floor physical therapist. One finger is typically inserted in the vagina or rectum to perform this evaluation and we palpate each muscle of the pelvic floor on each side of the pelvis. We take note if the muscles feel tight, the position of your tailbone, and pelvic floor muscle strength/endurance and ability to relax and bulge your muscles. We can assess each layer of the pelvic floor muscles, look for trigger points, pain, muscle tightness or weakness during this evaluation.
Here is one way to assess your pelvic floor externally. Lie on your side and feel the area inward from your sit bone (ischial tuberosity) with your fingers. As you inhale, you should feel this area soften or gently press into your hand causing the pelvic floor to relax. As you exhale, you should feel this area pull up and inwards as you perform a kegel/pelvic floor contraction. This should give you a sense of what is happening externally.
Schedule An Evaluation Today
A skilled pelvic floor therapist can perform external or internal techniques depending on your specific goals and comfort level. There is not one magical solution for incontinence, pelvic pain, postpartum recovery, or pelvic organ prolapse. It’s important to get a thorough assessment to figure out what your symptom drivers are. To do this we have to look at the whole body, not just the pelvic floor muscles. The muscles of the pelvis are only one part of the whole picture. Kegels alone will not fix these issues. Come in for help and to get an evaluation to help decide if you should kegel or not!