Myths of the Postpartum Body: Part 3 of 4
Myth #3: Kegels will solve all pelvic floor problems.
Kegels are fantastic exercises, but this statement is actually a lot more complicated than it sounds. If you’ve read either of my previous two posts about postpartum body myths (here or here), you might think that my answer is that it depends on the person. You’re totally right.
Everyone’s different, and to get the best results through the fastest means, you need to be doing exercises targeted toward both your body and your specific goals. Kegels seem to be able to brew quite a bit of controversy, so let’s see if we can make things simple.
First, who might need to be doing Kegels?
How to know if your pelvic floor needs attention?
Kegels could be appropriate for anyone having problems with her pelvic floor. If your mother or your friends told you that peeing yourself is a normal part of motherhood, I want you to know that it most definitely is NOT. Incontinence is common after babies, but it is a symptom that should be addressed, not a fact of life to embarrass you forever.
That said, peeing yourself is only one way that your pelvic floor might be letting you know it needs attention. Pelvic floor problems could look like any of these:
- asymmetry in your hips
- symptoms worsen with Kegels
- hip or low back pain
- tampons fall out
But it could also look like this:
- pain with penetration (sex or a tampon)
- difficulty starting to pee or second pee
- increased UTIs (urinary tract infections)
- sex has less sensation than before kids
- heavy feeling in vagina
If even one of these applies to you, it’s probably worth giving some thought to your pelvic floor. Even if you had a c-section.
C-sections and your pelvic floor
You might think that having a c-section means you’ve eluded any issues with your pelvic floor (I certainly thought this until it was my turn). Not true. Effects to the pelvic floor can happen during a vaginal delivery—things like tearing or stretching, episiotomies (cutting by the doctor), or muscles that turn off after prolonged labor—but you can also have effects to the pelvic floor that happen during pregnancy.
Most women drastically change the way they stabilize their spines while pregnant. When not pregnant, this stability usually comes from a combination of abs, breathing, hips, posture, and pelvic floor. But when there’s a baby in there, the baby actually creates stability itself because it takes up space and doesn’t bend as much as a uterus without a growing baby.
Different women will find different strategies to stabilize during pregnancy. But between the stretching that our abs endure, changes in center of gravity, and the stiffness provided by the baby, all women will use a different strategy to stabilize the trunk than before pregnancy. Some go right back to their former strategy after the baby is born. Others don’t.
Want to know if you reverted back to your former strategy? Go back to the bullets above. Do any of those apply to you? Particularly if they are changes from your pre-pregnancy self. If you answer yes, your pelvic floor would probably appreciate some attention.
Now for the what…
What is a Kegel?
Well, the original Kegel was an American gynecologist, who named the exercises for himself in 1948. (If anyone thinks we should come up with a different name for these exercises, I’m totally on board!) But the exercise is generally referring to a contraction of the pelvic floor muscles.
According to research, most women are able to perform a correct contraction of the pelvic floor with minimal training. Teaching you a pelvic floor contraction is beyond the scope of this article, but it’s definitely part of the Mama Made Strong program. The gold standard is always to talk to a pelvic floor physical therapist.
If you’ve tried Kegels in the past and they didn’t work for you, take a look at this checklist. Were you missing any of these components?
- a contraction of both the front and the back of the pelvic floor
- a contraction that includes both a squeeze and a lift
- does not include contractions of any leg muscles (so no one watching has a clue you are doing anything)
- able to both contract and release quickly and contract and hold about 10 seconds
At this point, hopefully, you understand that a Kegel is a contraction of a very specific group of muscles. So why should we practice these contractions?
Why should anyone Kegel?
If your pelvic floor is weak
Repeatedly contracting your pelvic floor is like repeatedly contracting your biceps or any other muscle group. The more you do it, generally, the stronger the muscles become. This is fantastic if the muscles are weak. There are a variety of reasons why a woman might have a weak pelvic floor, but if she does, Kegels are her ticket. These are the women for whom Kegels are the answer.
But, have you ever heard women say that Kegels just don’t work for them? Well, this is basically the equivalent of saying that muscle contractions don’t work for them. As funny as that might sound, the women who feel this way have very legitimate reasons for these feelings.
It would be lovely if all pelvic floor problems were a simple matter of weakness. Then, we could just strengthen them and move on. Unfortunately, our bodies are rarely that simple.
If you’re asking too much of your pelvic floor
Pelvic floor symptoms can also occur because too much is being asked of the pelvic floor. This might occur because a woman unintentionally bears down on her pelvic floor. She may do this because of an altered breathing pattern, a poor sequencing of her abdominals, or an ineffective strategy for stabilizing her spine. Regardless of why she does it, she’s asking her pelvic floor to work too much to constantly overcome this downward force.
Other women overwork their pelvic floors because they have weaknesses elsewhere in their bodies. This weakness is most common in the hips or abdominals and results in the pelvic floor working too hard to try to make up for other muscles not performing to task. (For more information on how the hips need to work with the pelvic floor, take a look at this post.) When the pelvic floor gets overworked in this way, it can have a hard time relaxing. It can even get knots in it like your neck or shoulders.
An overworked pelvic floor can seem like it’s weak when it can’t stop pee during a sneeze, for instance. But in reality, it’s working so hard that the sneeze is just one more thing, and it overloads the pelvic floor, resulting in the unwanted pee (or other symptoms).
In these scenarios, Kegels can seem like they don’t work or even like they make symptoms worse. If this is the case, it’s because other parts of the body are involved and need to be addressed first. An efficient breathing pattern, strong abdominals, and balanced hips can help the pelvic floor to work correctly, and their normalized function will keep the pelvic floor from having to do more than its share.
After these other parts of the body have been addressed, it’s usually still important to go back and strengthen the pelvic floor with Kegels. Overworked muscles are not the same as strong muscles.
Kegels in a nutshell
Kegels are exercises that strengthen the muscles of the pelvic floor. There are several components to performing a Kegel correctly, and it’s more complicated that just being able to hold back pee. They are beneficial for most women to perform after babies, but sometimes, just contracting isn’t enough. For some women, addressing the surrounding muscles and structures might be necessary to allow the pelvic floor normal function.
If this last scenario sounds like you, the Mama Made Strong program can help you to problem solve which other factors might be contributing. If you need personalized advice in a one-on-one scenario, a pelvic floor physical therapist is the professional best suited to answer these questions.
The pelvic floor, its function, and dysfunction aren’t always the easiest things to talk about. But really, these muscles are just like any other group of muscles, only they happen to play important roles in bowel and bladder continence, spinal stability, and sexual function. If you’d like to take a look at the influence posture can have on your pelvic floor, please take a look at this free online course.
And lastly, the more we discuss topics like this the more normal it becomes and the better the information everyone receives. Please don’t hesitate to share this knowledge with the mothers in your life. You might be surprised by how many struggle or by how appreciative they are to have some real answers.