When people hear pelvic floor they often think of Kegels, an exercise that involves contracting and relaxing the pelvic floor muscles. For some reason, this exercise is believed to be the end-all-be-all for pelvic floor health and that it is the only exercise for anyone experiencing pelvic floor dysfunction.
Well, I am here to set the record straight. Kegels are not the only pelvic floor exercise, and more importantly, there are other exercises that can help you even more.
That is often shocking to hear since Kegels but in reality, Kegels are often over-prescribed. Furthermore, people are usually told to do Kegels without undergoing an examination to determine if they can actually perform a Kegel correctly. This is important because some people are not able to do a Kegel correctly with verbal instruction alone.
Instead of squeezing, relax!
A pelvic floor examination is also important to determine what the pelvic floor muscles feel like. If a person has guarded, tense or hypertonic pelvic floor muscles, then doing Kegels would not be an appropriate exercise. A tense muscle usually needs to learn to relax before it can try to contract.
Imagine if you had a stiff neck and shoulder, doing a bunch of pull-ups is probably not a great idea and may make the situation worse. Sometimes people may feel like doing Kegels aggravated their symptoms if they are experiencing pelvic floor muscle tension. Contracting an already guarded muscle may be like adding fuel to a fire.
This is why seeing a specialist and undergoing a pelvic floor examination prior to doing Kegel exercises is important. It can help determine the appropriate treatment and exercise program. Many people with pelvic floor muscle tension may benefit from skilled manual therapy to address myofascial restrictions of the pelvic floor and surrounding muscles. Another treatment may include neuromuscular re-education to help a person learn to relax and contract these muscles.
Other exercises that can help facilitate relaxing the pelvic floor include yoga poses like a child’s pose or a happy baby. A clinician may recommend using dilators, which are graduated cylinders that can help teach the pelvic floor muscles to relax and help decrease hypersensitivity. A specialist would be able to determine if dilators are appropriate for someone with a hypertonic pelvic floor.
A tense or hypertonic pelvic floor is often associated with symptoms like pelvic pain, painful sex or vulvodynia. However, people that are experiencing urinary incontinence can also present with an overactive pelvic floor and need to work on relaxing the muscles instead of strengthening them which is what most people assume needs to be done if someone is dealing with bladder leakage. If the pelvic floor muscles are in a shortened position then they are already at their end range of motion and won’t be able to contract further when they need to; like when a person needs to stop urine from coming out. This would be one of the reasons why Kegels should be done after consultation with an expert, because a person may be trying to contract an already shortened muscle.
It is not good to do too many Kegels either. How many Kegels a person should do is unique and may not be the same as your BFF. Again, this is where a physical examination is useful to determine what is appropriate. One person may be able to do 25 Kegels and hold each one for 20 seconds, but another can only do 5 Kegels and hold each for 3 seconds. Everyone is different.
One exercise is not for everyone
Furthermore, some people may need to work on pelvic floor muscle strength while others need to focus on improving their pelvic floor endurance or coordination. Basically, there is no one size fits all when it comes to pelvic floor exercises.
Kegels have a time and a place. But a person can do too many and as mentioned they may not always be an appropriate exercise which is why working with a pelvic floor specialist is strongly recommended especially if a person is experiencing any symptoms of pelvic floor dysfunction.
If you do not have this type of specialist in your country, talk to your gynaecologist about the problem before you start Kegels on your own.
If Kegels are recommended to you by a medical health expert, you may be instructed to use a device such as the Kegel Smart devices for pelvic floor strengthening. This device will measure your strength and “prescribe” an exercise tailored to you.
Dr. Rachel Gelman is a pelvic floor physical therapist. She is the owner and founder of Pelvic Wellness & Physical Therapy in San Francisco which specializes in treating patients with pelvic floor dysfunction including pelvic pain, bowel, bladder and sexual dysfunction. She is an adjunct instructor at Samuel Merritt University where she teaches the pelvic health curriculum in the Doctor of Physical Therapy program.