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The Truth About Kegels: Should You or Shouldn’t You?

Kegels are fantastic exercises, but just like any other tool, you need to know how and when to use them. They don’t work for everyone and certainly not for every situation. However, when applied correctly, they can be like the magic sauce to solve all sorts of problems. Let’s begin at the beginning.

What is a Kegel?

The original Kegel was an American gynecologist, who named the exercise for himself in 1948. (If anyone thinks we should come up with a different name, I’m totally on board!) But the term, Kegel, generally refers to a contraction of the pelvic floor muscles.

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Pelvic Floor Anatomy

According to research, most women are able to perform a correct contraction of the pelvic floor with minimal training. I’ll go into lots more detail in a minute, but in a nutshell, a good Kegel should include contracting the following:

  • the front of the pelvic floor
  • the back of the pelvic floor
  • the superficial muscles that perform a squeeze
  • the deep muscles that involve a lift

When you contract your pelvic floor, you should be able to do it without contracting any leg muscles. In other words, no one watching should have a clue that you are doing anything. (I’ll elaborate on this point later.) And lastly, your pelvic floor muscles need to be able to contract and release quickly as well as contract and hold for about 10 seconds.

Who should do Kegels?

It’s a good idea for everyone to be familiar with the concept of a pelvic floor contraction. This is a little bit like saying, who needs to learn to use their biceps? Well, everyone. But it might happen a lot more naturally for some people than for others. In which case, the answer becomes anyone who:

  • has pelvic floor issues,
  • needs or wants a strong core, or
  • has reason to believe that significant changes might have occurred to their pelvic floor.

Let’s take a closer look at what might fit in these categories.

Signs of pelvic floor issues

Incontinence is one of the most common symptoms that your pelvic floor needs some attention. Although this is a popular one, it’s definitely not the only symptom. Pelvic floor issues can also look like:

  • constipation/hemorrhoids
  • asymmetry in your hips
  • symptoms worsen with Kegels
  • hip or low back pain
  • tampons fall out

And they can look like:

  • pain with penetration (sex or a tampon)
  • difficulty starting to pee or second pee (stand up after peeing and pee again)
  • 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.

Why you might need or want a strong core

For some people, the idea of being strong is enough incentive, but in case this isn’t you, having a strong core gives you a foundation for all other movement. If you participate in sports or lead an active lifestyle, having a strong core improves performance and increases endurance. But even if you just want to be able to play with your children, having a strong core makes life easier from picking them up to cleaning the house to standing up from the floor.

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Furthermore, having a strong foundation for your movement makes your body more efficient. This puts less strain on smaller muscles and tendons. If you’re dealing with chronic or nagging pain, especially the kind that resulted from no particular event, then strengthening your core can help to redistribute force during your daily activities. It can put the stress back on bigger muscles that are better equipped to handle it.

When significant change occurs

The obvious answer to this one is anyone who has ever been pregnant. The sheer act of growing a human inside of you causes the pelvic floor to undergo major changes. These changes are brought about by hormones, postural compensations, and alterations in pressure to manage the load of carrying another person inside.

Most of these changes occur before delivery, so the type of delivery doesn’t really matter. There are different considerations for c-sections than for vaginal deliveries, but neither prevents effects on the pelvic floor. Additionally, there are specifics for each woman that need to be considered. Not all women will respond to pregnancy or delivery in the same way.

And lastly, pelvic floor changes can occur anytime there is a significant period of decreased weight bearing. This could look like bed rest during pregnancy, but it could also look like a more orthopedic-type of injury. Muscles get weaker when they’re not used, so a significant stint on crutches can impact the pelvic floor. And we shouldn’t ignore the decreased use that comes with a sedentary lifestyle, especially if it’s existed for years.

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Why should you Kegel?

Repeatedly contracting your pelvic floor is like repeatedly contracting any other muscle group. The more you do it, generally, the stronger the muscle becomes. This is fantastic if the muscles are weak. But what about the women who feel like Kegels don’t work?

Well, there are a few possible reasons this happens.

  1. Return to the 1st section on ‘What is a Kegel?’ There are four components that are necessary for a successful Kegel. Missing one or more of these can be the answer when Kegels don’t seem to do their job.
  2. NO muscle works in isolation. And particularly not the pelvic floor. If you have tried Kegels but they don’t seem to work for you, it might be time to consider the effects of other parts of the body. It’s helpful to be able to contract the pelvic floor by itself, but in reality, it doesn’t work like that. The diaphragm, glutes, abs, even feet or rib cage, can impact its function. Sometimes, addressing one or more of these can be the ticket for your Kegels to finally work like you intend.
  3. And lastly, overuse of the pelvic floor might make you think it’s weak. If the glutes or abs are underperforming, some women will try to make up for this by using the pelvic floor more. Further, some postures can put excessive force down on the pelvic floor, preventing it from ever getting a chance to relax. In these cases, it’s less about being weak and more about being over-recruited.

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.

When should you NOT Kegel?

An over-recruited pelvic floor can occur because of weakness elsewhere in the body. It might also happen when breathing patterns or postures or stabilizing strategies put excessive pressure down on it. The pelvic floor can respond to these scenarios by becoming tight or tired or seemingly unresponsive. It can even get knots in it like your neck or shoulders.

An overworked pelvic floor needs a break. Instead of Kegels and further tightening, it needs ways to relax and elongate. It needs strategies to decrease the load on it and to encourage other parts of the body to carry more of their share.

A pelvic floor in this scenario may appear weak, and differentiating between the two can be challenging. The best solution in this case is to find a good pelvic floor physical therapist, who can help you to understand the specifics of your body, how to make use of your pelvic floor, and what strategies can better help you to reach your goals.

Pelvic floor exercise doesn’t need to be complicated or confusing, but unfortunately, it often ends up in this category. At least, in part, because we give such little thought to this part of our bodies. If you’d like more information on how to incorporate your pelvic floor into your life or your workouts, you can find loads more information in my postpartum program.

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