By now there have been many blogs and articles written to address this question. Despite the additional information, many providers are still prescribing “Kegels” as the best form of exercise postpartum, post-prostatectomy, and post-gynecological surgery. Even worse yet? Sometimes they are not saying anything about preventative and restorative care for pelvic health. This leaves patients with more questions and usually confusion, especially if they are experiencing PAIN!
So, let’s start here. A “Kegel” is simply a muscle contraction of a group of pelvic floor muscles. Dr. Kegel is credited with making this exercise popular, hence, we named it after him. Let’s think of a “Kegel” as a bicep curl of the pelvis. If you wouldn’t walk around all day with your elbow flexed and bicep contracted as firmly as possible, then you probably shouldn’t do this with your pelvic floor either. When you squeeze the pelvic floor muscles too firmly or for too long you tend to tighten surrounding muscles as well. No one needs to be this tight – tightness actually limits strength. Put simply, stop clenching your butt all of the time and give your muscles a little break once in a while.
Look around. We are a world of butt-clenchers. We tighten when we stand in line at the grocery store, we tighten while we hover over the toilet seat (ladies!), we tense while driving, and we squeeze when crossing our legs while sitting in a meeting. Now, just because we have a tendency to squeeze or tighten once in a while does not mean we are actually doing a pelvic floor contraction, or “Kegel”. The key to any muscle contraction that is meant for strengthening is to actually appreciate FULL range of motion. If you just stay tight, you’re potentially weakening the pelvic floor which can lead to further issues down the road.
The pelvic floor muscles are not big; however, they are small and potentially mighty if they work as a team. Did you see the woman who can lift a surfboard with her pelvic floor? If you look closely you can see she is using much more than just the pelvic floor – her legs, back, glutes, and abdominals are all positioned optimally to work hard too. http://www.dailymail.co.uk/femail/article-3429696/Intimacy-coach-lifts-objects-big-surfboards-vagina-teaches-women-technique-claiming-improves-health-makes-look-younger.html When you have the perfect balance of strength, endurance, flexibility, and coordination within these muscles, you have a happy pelvic floor. If these muscles are too tight they will often weaken because they are contracting with a limited range of motion. Tight or shortened muscles will typically benefit best from relaxation, some lengthening, and then strengthening to follow. Muscles that are weakened and too long will often benefit more from strength and coordination training, as well as stability training of the entire pelvis, including the abdomen, back, and glutes – that’s right, you’re butt is important again.
This is just scratching the surface, but what is important to gather here is that a pelvic floor contraction, or a “Kegel” is simply an exercise. We can use it to strengthen but should also be aware of how to relax and lengthen this same group of muscles as well. Your pelvic floor is an important part of your CORE that works well with strong abdominals, glutes, AND your diaphragm. Achieving full range of motion, learning to coordinate the core muscles with simple exercise, and maintaining this balance can make a world of difference for a patient who is experiencing symptoms of pelvic floor dysfunction. Sometimes treatment involves a “Kegel” and sometimes it doesn’t, but it always involves awareness of what these muscles are doing.
Below are some examples of symptoms that can guide you to decide whether or not a pelvic floor contraction MAY be appropriate. It is typically most helpful to have a physical therapist trained in pelvic floor rehabilitation guide you with an assessment and treatment plan for your best results.
Short or tight pelvic floor muscles may lead to: urinary frequency, stress incontinence, incomplete voiding, pain, difficulty achieving orgasm, pain with intercourse, pain during or post-ejaculation, constipation, hemorrhoids
Weak and lengthened pelvic floor muscles may lead to: both urinary and fecal incontinence, pelvic instability, difficulty achieving an orgasm, and organ prolapse
Remember, not everyone is the same and there are many factors that can contribute to symptoms of pelvic floor dysfunction. However, the “Kegel” is not always the answer – your pelvis is about so much more!
Best,
Dr. Sarah Capodagli