Are Kegels the Answer?
Kegels have gotten great PR - they promise to fix your core, eliminate your incontinence, improve your sex life, and prevent prolapse. But are they really the answer for everyone?
Kegels are pelvic floor strengthening exercises involving repeated contraction of the muscles that support the vaginal wall, bladder, uterus, prostate, and rectum. They are often described by cues like “trying to stop a flow of urine” or “trying to stop gas”.
Many people assume that incontinence or pelvic discomfort/heaviness means their pelvic floor is weak and needs more strengthening. But often the opposite is true: the pelvic floor is too tight, and those tight muscles can’t function properly.
Let’s dive into how your pelvic floor functions -
For optimal function and strength, the pelvic floor must be able to both contract and relax! A muscle that lives in a shortened position can’t fully contract or relax. This chronic tension causes fatigue. So, a tight muscle becomes a functionally weak muscle - it is too tight to work well.
If the pelvic floor is already tight, doing Kegels may worsen symptoms. Imagine holding a bicep curl all day while carrying a heavy bag, then trying to lift a weight on top of that. The muscle would be too fatigued to generate more force - so your strengthening won’t be effective! It can also cause further irritation to the tissues and therefore perpetuate the cycle of pain or dysfunction.
Also - When the pelvic floor is tight for long periods, it becomes too tired to respond effectively during activities like coughing, sneezing, or rushing to the bathroom. This can lead to leakage despite strengthening exercises.
A healthy pelvic floor should really function like a trampoline; your muscles should have enough support to catch the load, enough to absorb it, and enough recoil to respond when your body needs them.
In daily life, your pelvic floor needs to constantly adjust. Laughing, lifting, running, breathing, going to the bathroom, picking up your kids - these all require a coordinated dance of lengthening, tightening, lifting and softening with your diaphragm, deep core, hips, and even your feet! Your pelvic floor doesn’t work in isolation, so training your pelvic floor only in isolation doesn’t really make sense.
Common Signs of a Hypertonic (Overactive) Pelvic Floor
● Frequent urination, difficulty starting a stream of urine or the sensation of incomplete bladder emptying
● Urinary urgency and/or incontinence
● Pain with sex, gynecological exam or tampon insertion
● Constipation or diarrhea
● Pain or difficulty with bowel movements
● Pelvic or vaginal pain
● Lower abdominal pain or discomfort
Another sign you have an overactive pelvic floor? Doing Kegels consistently for months with no improvement or worsening symptoms!
So, why are my muscles tight?
Great question! The answer is different for everyone. But, in general, muscle tension and “spasms” can develop due to:
● Pregnancy and delivery
● Strenuous exercise
● Muscle imbalances
● Stress or anxiety
● Trauma
● Aging, hormonal changes, and tissue changes
Core Pelvic Physical Therapy: More Than Kegels
At Core, we pride ourselves in a functional and integrated approach to physical therapy. We aren’t just treating your symptoms; we are looking at the whole picture. That’s why a comprehensive pelvic floor assessment may include:
● Posture and movement analysis - from your head to your toes, remember the pelvic floor doesn’t work in isolation!
● A thorough review of past medical history - any scars we should know about? How about a fall on your tailbone?
● Muscle strength and coordination testing specific to your dysfunction - only have symptoms in standing. Let’s check it out!
● Breathing pattern evaluation - the diaphragm is your pelvic floor’s best friend!
● Internal and/or external pelvic floor muscle assessment - whatever your comfort levels, our expert PTs will ensure you feel at ease.
● Biofeedback assessment
Our goal is to identify your specific dysfunction and design a treatment plan tailored to you. Kegels may be part of the plan for some people, but they are rarely the starting point for those with a tight or overactive pelvic floor - which is most people we see here! Curious, what’s right for you? Come see our group of pelvic specialists at Core PT and let us uncover the why behind your dysfunction and help your body work the way it’s meant to!
