To Kegel or Not To Kegel?

By
By Lakeview Physio
Gayle Hulme
,
BScPT, Acupuncture, Certified Gunn IMS, Pelvic Health Physiotherapist
on
Pelvic Health
May 2, 2016

We are no longer asking women to just do Kegels (PFMC). But, we do test their ability to perform a PFMC because it lets us know a variety of things.

There is a lot of talk out there these days about using the Kegel as an exercise to stop incontinence or improve a pelvic organ prolapse (POP).  Dr. Arnold Kegel (1894 – 1981) was the creator of the illustrious exercise which has helped many women.  But wait – you just heard that Kegels are BAD!  Whaaaaat?!

Medicine, along with exercises, tends to have fads.  But not all fads are meant to fade away entirely.  Sometimes the pendulum needs to swing in one direction before it can settle into a nice balance.  It is a good idea not to throw out the baby with the bath water!

Yes we are evolving with how we treat incontinence and prolapse.  I have been telling my patients for years that if I were to write a book it would be titled “It’s Not All about the Kegel”.  We are no longer asking women to just do Kegels (we now call it a Pelvic Floor Muscle Contraction – PFMC).  But, we do test their ability to perform a PFMC because it lets us know a variety of things such as:

  • What is the tone of these muscles like?  Too much? (Hypertonic or better said: “Over-vigilant”) or Not enough?  (Hypotonic)
  • Do these tissues move with the natural breathing diaphragm rhythm? Soooooo important!
  • Are there any spaces or discontinuous tissue in the different layers of the PFM?  For example, the levator ani muscles can tear during child birth making it more challenging to contract.
  • What response is there at the PFM when I ask the woman to cough, contract, or relax?
  • Does she know WHAT to do in order to connect with her PFM?  Does she do it wrong such as push down?

The pelvic exam is critical in rehabilitating the pelvic floor whether the concern is incontinence, prolapse, or pain.  If we didn’t examine these muscles like we would any other muscle, we would fall short on improving the entire core system.  Worse yet, if we let her do what she thought was a proper “Kegel” we might be encouraging a faulty strategy which will likely result in further problems.  It’s like having a knee injury but never having the physical therapist look, touch, or get you to move it.  It just would never happen.

So, we evaluate the PFMC and correct it.  But we quickly move beyond the isolated PFMC.  WHY?  Because it most definitely is NOT ALL ABOUT THE KEGEL!  The main goal is to re-connect (mentally, physically) with this group of muscles to make them more responsive to our functional tasks.

How do you successfully accomplish this?

Alignment, breath, coordination

PFMC’s should be initially timed with proper breathing (relax abdomen and allow ribs to move up and out) while progressing into functional positions that optimize the pelvis and thorax.   Over time, you will not need to think about your pelvic floor muscles as it should be doing its natural “thing”.  For example it contracts automatically depending on the amount of pressure it needs to withstand (sneeze, jog, jump) as well as letting go when it needs to (when you pee, when you are resting, when you ask it to!)

This is where your Pelvic Health Physiotherapist is at their best!  We make your exercises relevant to the task that is causing you concern (trampolines or running anyone?)  We may ask you to scale back the exercise in question for a while but the goal is to get you back doing what you love to do – without losing bladder control.

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