Beyond The Kegel

In 1948 Dr. Alfred Kegel developed the pelvic floor contraction exercise for women that we now call Kegels. It was a pretty big deal because before that it was surgery or nothing for women who were dealing with incontinence and prolapse. His exercise gave women options and empowered them with something they could do to restore function to their body.

But, kegels have become a bit of a hot button issue in the fitness and women’s health world. Some people say you should absolutely NOT do kegels. Some say you absolutely SHOULD do kegels. Some say you only need to squat and not to kegels.

The whole debate will leave you wondering, will kegels help me? Should I be doing them regularly? How exactly do I do a kegel? Please, FTLOG, someone just stop me from wetting my pants!

Pro Tip: Save yourself the pain of googling “how to do a kegel” because you will get 95,000 answers, each one a bit different.

Here’s what I have gleaned about Kegels and you can make an (hopefully) informed decision about their role in your life and the health of your pelvic floor.

Kegels are a targeted, spot treatment, focusing on the musculature of the pelvic floor. The theory behind them being that the reason incontinence is happening is due weakness in the muscles of the pelvic floor and therefore the muscles have too little tone. Of course, what we need to do when something is weak is strengthen it, right?

I attended a conference where Women’s Health PT (WHPT) after WHPT was interviewed and shared that they see far more hypertonic (too much tone) pelvic floors than hypotonic (too little tone) pelvic floors (especially in those in the fitness world, interestingly enough). Those pelvic floors that are too tight will still register as weak if they are tested because the muscles are already tightened to their max and they can’t engage MORE than they already are. So, kegeling in those cases is no bueno because it will just further add tension to tight muscles.

For some women kegels are enough to solve the problem, though there is some research out there showing the long term viability of kegels is questionable – meaning it might shore you up for several years, but after that things can start to go downhill. Sometimes we forget that it is equally as important to release muscles as it is to engage them. Kegels are also not always great for prolapse either. If you are prolapsed and squeezing the pf muscles, you may just be strangling (for lack of a better word) the organ that is prolapsed and that can make things worse.

Every moment of training I have received in yoga and movement over the last 18 years has emphasized that the places where we experience pain and problem in the body are only a small part of the whole picture.

Solutions to problems in the body come when we consider the WHOLE body, the breath and the brain.

I have seen and experienced the truth in that statement in my own body and in other bodies.

When we apply that to the issue of pelvic floor weakness, we get this: when you have a group of muscles like the pelvic floor that are meant to engage in response to the information (loads) they are receiving from the rest of the body via movement and breathing we will find a long-term solution when we engage in practices that address all of the following: upper body tension, calf tension, rib cage position, core strength and how the breath impacts all of that. After all, over 34 muscles in the body are sending input to the pelvic floor. And, believe it or not, how you think can also impact how the body functions and how you perceive pain. So, your belief in your body’s ability to heal will impact the rate and level to which you get better. Plus, a group of muscles that are meant to fire reflexively will simply not do well when we try to spot treat them by isolated movements.

Might kegels be a part of what you do? Maybe, if a WHPT determines that you have pelvic floor muscles that will benefit from them, but I would hope that he or she has you do them in conjunction with being mindful of the position of the body, the breath and the movements you are doing.

Might kegels be a good thing to do if you are seeking to reconnect to your pelvic floor (like soon after birth or if you have disconnected due to years of pain and discomfort). Yes, they can help your brain re-establish a connection to the pelvic floor.

Might using a kegel-type exercise like the pelvic floor ruler be a useful way to assess how much control and ability to engage you have in those muscles? Yes, it can be very useful to track how well you can engage and release the muscles.

Can you solve your pelvic floor problems without doing a kegel per-se, because you are recoordinating your body through a whole body approach where the pelvic floor might go along for the ride when you are breathing and moving? Absolutely.

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