Kegel exercises are performed by contracting and relaxing the pelvic floor muscle. This exercise was originally described by an obstetrician named Dr. Arnold Kegel. The pelvic floor muscle is a supportive structure of the pelvic organs (uterus, bladder and rectum) and plays a key role in helping to maintain continence, facilitate childbirth and assist in core stability.
Pelvic floor exercises can be used to treat a variety of conditions
- Urinary Incontinence
- Fecal Incontinence
- Pelvic Organ Prolapse
- Bladder/Bowel Dysfunction
To Kegel or Not to Kegel? That is the Question…
If you are suffering from a condition, my recommendation is always see your doctor and
physical therapist FIRST before commencing an exercise program. As a physical therapist for over 18 years and specializing in pelvic floor dysfunction for the last 15, I have treated many patients whose condition was made worse by starting Kegels on their own. Although there are many benefits of pelvic floor exercises, knowing how to properly perform the exercise, knowing if it’s the correct initial form of treatment as well as how to retrain the pelvic floor functionally along with other inner core musculature is essential ...and more than just contract and relax!
So, what could go wrong...
Incorrectly Performing Exercises Will Not Help and May Hurt
- According to an article from the American Journal of Obstetrics & Gynecology, “Assessment of Kegel Pelvic Muscle Exercise Performance after Brief Verbal Instruction,” (Bump et al 1991), only 49% of individuals tested demonstrated an ideal Kegel after brief verbal instruction and 25% performed a Kegel in such a way that could potentially promote incontinence.
- A more recent study in the International Urogynecology Journal, “Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review” (Thompson, et al 2003) showed that 43% of subjects depressed their levator plate (verses elevating in a pelvic floor contraction) by adopting a straining strategy which may have negative long-term impacts and 19% had no levator plate movement.
- Kegels performed incorrectly will not help, may make it worse or create a new problem. Please don’t feel out of hope, speak to your doctor or make an appointment with a pelvic floor physical therapist. Things can be very different when getting the proper training by a skilled physical therapist.
Forgetting to Relax
- Many individuals embarking on a strengthening program tend to focus on the strengthening part only. Constantly contracting without relaxing properly can overwork and over tighten the muscle and may result in muscle spasm or pain.
Doing TOO Many Kegels
- I can’t say it enough in my practice, More is not Better! As with any physical therapy condition, an exercise plan is like a recipe for your body. Doing too many pelvic floor contractions can overwork the muscle causing further muscle weakness, a decreased ability to relax, spasm or pain. A stronger muscle is not necessarily a functional one.
Strengthening the Wrong Muscle
- When a muscle is weak, our body will often use compensatory strategies to substitute. Common pelvic floor compensatory strategies may include accessory muscle use of the gluteal musculature, abdominals, inner thighs or breath holding. Attempting to strengthen your pelvic floor muscle or Kegel without addressing compensations, can reinforce strengthening of the wrong muscle, impede progress and may even exacerbate pain.
Reinforce Poor Coordination Patterns and Position Sense
- When a muscle is dysfunctional, your ability to coordinate a contraction properly, in synergy with other core musculature or sense its position or stability may be altered. Again, doing pelvic floor strengthening exercises may reinforce deficits. In physical therapy, we retrain the muscle how to contract, relax and work in the proper synergy with other core musculature. We use manual and tactile cues to assist you and the muscle to function correctly. We have other modalities such as biofeedback which can provide you visual feedback to assit learning.
Kegels for the wrong condition or right condition
- I am a strong advocate for pelvic health and awareness. Having a well-functioning and balanced pelvic floor muscle is important for everyone. WHY? Again, the pelvic floor muscle supports our pelvic organs and plays a key role in helping to maintain continence, facilitate childbirth and assist in core stability. In my previous post, Core Muscle Retraining, I further discuss the importance of the pelvic floor and other inner core musculature as it relates to stability and daily function. Although a well-functioning pelvic floor is important for everyone, strengthening may not be appropriate for certain conditions or in the initial phase of treatment. For example...
Incontinence: If a muscle is weak, strengthening may be appropriate if it's a muscle problem. However, as noted above, a large percent of individuals perform Kegels incorrectly which can potentially promote incontinence. In addition, doing too many exercises in hopes that more can make you better faster, may actually impede progress if the muscle becomes overworked and weaker or non relaxing and in spasm. If the anterior pelvic floor is tight and in spasm, it may affect closure of the sphincter causing incontinence. Therefore manual therapy would be helpful verses Kegels.
Urinary Frequency: This can be from a weak muscle but, it can also be from a tight, short or in spasm pelvic floor muscle...and several other possible factors as above.
Moreover, it is important to see your doctor to rule out any medical condition and a pelvic floor physical therapist FIRST on whether To Kegel or Not to Kegel…
At Evoke, when evaluating your pelvic floor muscle, we look at the ability of your muscle to contract and relax. We evaluate for muscle tone, spasm and myofascial restrictions. We assess for the dynamics of your core and its ability to contract in the proper synergy, timing and amplitude. Sometimes we will find muscle inhibition and developed compensatory strategies. Sometimes a pelvic floor muscle can present as tight and weak or low tone and weak. Sometimes a pelvic floor muscle can be tight and in spasm causing pain or sometimes weak and overused causing pain. Your posture, pelvic alignment and back pain also can contribute to pelvic floor dysfunction and will need to be assessed and corrected to optimize outcomes. With pregnancy, unresolved diastasis recti can also contribute to inhibition and related pelvic floor dysfunction. There are so many other combinations and contributing factors that are taken into consideration when formulating a treatment plan and in determining whether To Kegel or Not to Kegel. Ultimately, the goal of physical therapy treatment is to effectively and efficiently resolve your problem and retrain the pelvic floor muscle functionally in synergy with other inner core musculature; enhancing the body the way it is designed to work — providing core stability for simple day to day tasks and other high body demands such as running or skiing.
Call us today, we’d love to help! We understand the significance pelvic health and how it can impact your quality of life…
Best of Pelvic Health,
Thompson J.A., O’Sullivan PB. (2003) Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:84-88.