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What’s the deal with Kegels?

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By Jessica Reale, PT, DPT, WCS

“All pregnant women need to be doing Kegels every day”

“Kegels are no longer important. Squats are much better for the pelvis”

When I first moved into the field of pelvic health, it seemed like every person coming in thought they needed to be doing tons of Kegel exercises. And I mean tons. Some of my patients would be squeezing their pelvic floor muscles up to 300 times a day, as often as they could think about it. Then, there was a paradigm shift, and now, I frequently find patients who have read somewhere along the line that “Kegels are bad,” and seem to believe that no one needs to do them. So, where’s the truth? Are Kegels really a thing of the past?

Well, the answer is actually a bit more complicated. First, let’s talk in a little more detail about what a Kegel really is. The term Kegel comes from Dr. Arnold Kegel, a physician who initially back many years ago pioneered the role of the pelvic floor in healthy functioning. Although he is no longer with us, his name has lived on in the “Kegel” which typically refers to a contracting of the pelvic floor muscles. Now, for those of you unfamiliar, the pelvic floor muscles refer to a bowl of muscles in the pelvis running from the pubic bone in the front to the tailbone in the back, and wrapping around the openings of the urethra, the vagina (in women) and the rectum. Because of their location, these muscles have a significant role for our bodies. We call it the 5 S’s:

 

Sphincteric (holding back urine and stool, and opening to allow you to empty)

Sexual (both in stretching to allow for vaginal penetration and rhythmically contracting and relaxing for sexual pleasure)

Supportive (maintaining the position of the organs within the pelvis)

Stability (controlling the movement of the spine and pelvis)

Sump Pump (pumping out blood/fluid in the pelvis)

So, dysfunction in the pelvic floor muscles can impact all of these functions. The problem comes in when we start figuring out what to do about it.  Problems in the pelvic floor muscles can occur because of weak or stretched out muscles, tight/tender or overactive muscles, and/or muscles that are not firing with the right timing. It is also important to remember that the pelvic floor muscles are just one group of muscles in the body, and work together with a team of muscles to do the jobs that they do. So, let’s take a common problem like urinary incontinence as an example. Many people assume that bladder leakage happens because of a weak pelvic floor muscle, and sometimes this is the case. However, a really tender overactive pelvic floor could have just as much difficulty holding back urine as a weak one. Also, if a person has strong flexible muscles, but they do not activate when they should, she could also be leaking urine.  Or, a person may leak urine because of poor breathing strategies that cause too much pressure downward on the bladder, so the problem may not even be with the pelvic floor muscles themselves. Confused yet? It’s actually more simple than you would think.

To determine how to best fix a problem, we must determine what the problem truly is. And the only way to determine that in regards to a pelvic health function, is to be evaluated comprehensively by someone who understands the pelvic floor. A skilled pelvic PT will look at the person as a whole—watch how he or she moves, breathes, walks, sits, and bends; examine the joints and soft tissues around the pelvis and elsewhere where indicated around the body; perform a complete examination of the function of the pelvic floor muscles; and integrate these findings within a comprehensive and detailed patient history. This information will then allow the clinician to work together with the patient to help them truly optimize the function of their muscles and resolve the problem they are having. For some, this may be performing Kegels (pelvic floor strengthening), for others, it may be a treatment approach emphasizing relaxation and lengthening, and still, for others, it may be retraining the pelvic floor to function with the right timing within its “team” of structures.

So, should a person do Kegels? Well, it really depends.

If you are wondering what is happening with your pelvic floor muscles, schedule a visit today with a member of our pelvic health team! We are happy to partner with you to get to the bottom of any problems you have been experiencing and help you get to a better YOU!

 

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