“Just do your Kegels”. This is often a statement told to my clients at some point, whether it be from their Doctor, or from a close friend.
A lot of clients coming to see me report urine leakage: often with activities such as coughing, laughing or higher impact activities like running or jumping jacks. I often hear: “I am doing my Kegels but they aren’t working!”.
Kegels are voluntary, isolated contractions of the pelvic floor muscles, and are named after Arnold Kegel, a gynecologist who invented a device used for measuring strength of the pelvic floor muscles. Research shows that many women incorrectly perform pelvic floor muscle contractions (Talasz et. al 2008, Thompson and O’Sullivan 2003). The most common compensations include: tightening the abdomen, squeezing the gluteals and tensing the inner thighs.
A Kegel contraction is one way to strengthen the pelvic floor and can be a starting point for a patient with an under-active pelvic floor. Sometimes in therapy, we will combine a Kegel contraction with a functional movement (such as a squat) in order to help manage their symptoms. However, isolated pelvic floor muscle contractions do not address why someone is having their symptoms. If the pelvic floor is “weak”, it is likely that there are other muscles that are not functioning properly, and thus need to be addressed. Therefore, Kegel contractions are a start, but should not be the only exercise that a person performs. We must recruit other muscles and tie the pelvic floor in with the rest of the body, in order for the patient to have success at abolishing their symptoms.
There are cases in which Kegels can actually make a patient’s pain or symptoms worse. In cases of pelvic pain, and an over-active, or excessively tight pelvic floor, doing repetitive Kegel contractions will likely worsen the symptoms. If you are performing Kegel contractions and they are making your symptoms worse, then do not perform them and definitely consult with a pelvic floor physical therapist.
The pelvic floor is a delicate area that can be easily affected by other areas of the body. It is important that the pelvic floor is strong, but also flexible. It is very important that before someone routinely does isolated Kegel contractions, they are evaluated by a pelvic PT to ensure that they are doing them correctly, that Kegels are in fact an appropriate exercise for them, and that they are instructed on other ways to strengthen the pelvic floor.