To Kegel Or Not To Kegel? The Low Down On The Down Low

Kegels. We all know the word. But do we really know what it actually, truly means to do a Kegel, and why do we even care? I will tell you. And believe me, I have a love/hate relationship with the Kegel, which I will explain.

We have Dr. Arnold Kegel to thank, back in 1948 for coming up with the famous “Kegel” exercise. He was a gynecologist, and was looking for a non-surgical way for women to help “tone” the pelvic floor muscles to help with urinary leaking after they had a baby. I don’t hate him for it. Being a physical therapist, I want all things conservative first, and YAY for starting with exercise. Good on ya, Dr. Kegel!

This opened up a new view on trying to help women after childbirth with staying dry, which is a great step forward in the ever-challenging path of providing comprehensive care for women postpartum (which I am sad to say, leaves something to be desired in this country…more on that in another post). However, Kegels became the blanket approach for everyone who reported any sort of bladder or bowel or pelvic dysfunction. Pain with sex? Kegel. Leaking urine? Kegel. Having increased urge and going to the bathroom all the time? Kegel. Back pain? Kegel. Pregnant? Kegel FOR SURE. Want a tight vagina (cringing as I’m typing this)? Kegel. And the list goes on….

However, I am here to tell you that Kegels are not the answer to everything, and although they are appropriate for some people, they are not appropriate for all, and should not be thought of as such. Mind blown. I know. Stay with me.

A Kegel is a concentric, or shortening action, of the pelvic floor muscles, which sit at the bottom of your pelvis. They lie like a basket, or a hammock, and attach front to back (pubic bone to tailbone) and side to side (sit bone to sit bone). Within these muscles, we find openings. In females, we have the rectum, the vagina, and the urethra. In men, we have the rectum, and the urethra follows the length of the penis and is past the pelvic floor, where it ends at the tip of the penis. The pelvic floor has 3 main functions: (1) Support (holds us and our organs up against gravity); (2) Sexual (aids in orgasm and allowing vaginal penetration for women); and (3) Continence (keeps us dry).

In a perfect world, as the bladder and rectum are filling with urine and stool, the pelvic floor muscles “turn on” to close the sphincters that hold in said urine and stool. We get the signal to either head to the loo to pee or grab our phones for some reading material if we are going in for a longer stretch. The pelvic floor muscles then lengthen, or relax, and the bladder muscle (the detrusor) pushes urine out through an open urethra, all thanks to a relaxed and lengthened pelvic floor.

Now, if the muscles have lost a bit strength, maybe say…I don’t know, going out on a limb here….holding a baby, plus weight, the placenta, organs, gravity, increased fluids, etc, FOR 9 MONTHS, in addition to the force of actually pushing a baby out, and the need to lengthen and stretch to get out of the way to make way for the baby, we may see a bit of an issue with holding in urine or stool. Not to mention if there was any perineal or pelvic floor muscle trauma or prolapse sustained during delivery. So yes, in this case, it is a good idea, probably, to strengthen your pelvic floor by way of the Kegel.

However, in some cases, these muscles can be too short, or too contracted, and adding more contractions on top of an already contracted, or too short muscle, isn’t always the best idea. Think about trying to do a bicep curl when you’re already curled — the elbow isn’t going anywhere, and all that extra curling will prob make your bicep hurt!

Another issue I have with blindly prescribing Kegels…and we’ve all heard this: “just do 200 Kegels a day” or “ do your Kegels while sitting at a stop light”… is that not everyone’s baseline level of strength and function is the same. Also, we don’t go to the gym and do 200 bicep curls everyday, or walk around carrying a 35 lb. pound weight with our bicep all day every day. (Well, I mean, unless you’re a mom.) We shouldn’t be prescribing set parameters without assessing. Because some people may not need to do Kegels; in fact, they may need to work on lengthening or volitionally dropping their pelvic floors. These muscles can be too short or tight, and oftentimes Kegels will, and can, make some symptoms and dysfunction worse.

There have been studies published in the literature that looked at women who were instructed to perform Kegel’s and like 30% of women don’t contract their pelvic floor at their first consult. So..bottom line is this: if you’re not sure, ask for help. Find a pelvic floor PT (yours truly) to assess and get you on the right track. Performing a Kegel the correct way is really hard, actually. The PFM has to work in concert with a host of other muscles and your breath and be on like all the time to keep us supported and continent. It’s not easy to get this contraction going correctly, and I’ve had high level athletes who have amazing body awareness, have been training their bodies at high levels for years, and are no stranger to working with rehab professionals, have a really hard time getting a correct Kegel.

So there you go. Kegels are important, for sure, but in the right context, with the right person and situation. Find a local pelvic floor PT near you to help you get that pelvic floor muscle working the way it should, either Kegel’ing or lengthening.