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To kegel or not to kegel... will kegels save my pelvic floor?

Updated: May 16

by Sarah Coombs, MOT, OTR/L, RYT

The #1 thing I get asked as a pelvic floor occupational therapist is: "Should I be doing kegels?"

I also frequently hear admissions of guilt when someone works up the nerve to tell me: “I know I’m supposed to... but I haven’t been doing my kegels!”

I’m officially here to absolve you of any guilt around not “doing your kegels” because even if your pelvic floor muscles do need some strengthening, there are exercises that are much MORE effective than sitting there squeezing your pelvic floor. But let's talk about it.

What is a kegel, anyway?

“Kegels” (like many other things) are named after a male doctor, Dr. Arnold Kegel. Dr. Kegel was a gynecologist in the 1940s. Yep, that’s right, the 1940s.

Needless to say we've learned quite a few things since the 1940s and that includes more information about how the pelvic floor works, as well as how to help with issues like leaking, recovering from childbirth, and pelvic organ prolapse. But at the time, the idea of incorporating a non-surgical technique to address urinary incontinence was probably pretty groundbreaking. (Hint: It’s not anymore!)

A kegel is essentially a muscle contraction. Just like you can contract your biceps or squeeze your shoulders up to your ears, we have the ability to contract and relax the muscles of our pelvic floor.

And while it's important to have the coordination to contract and relax these muscles, here’s the thing: our pelvic floor muscles are largely automatic.

This means that ideally they are working and responding to things throughout the day without you consciously having to do much of anything other than relaxing them when it's time to go to the bathroom.

Again, I do want to acknowledge that it IS beneficial to have the ability to connect to these muscles, so let's breakdown how to do this movement. For reference, here's a view of the pelvic floor muscles from below.

Image used with permission from Pelvic Guru®, LLC

There are two parts to a kegel: a squeeze & a lift. Our pelvic floor muscles on the outside are our “squeezy” muscles and they are the ones that help us have voluntary control over whether we want things to stay in (pee, poop, and gas) or whether we’re ready for them to exit.

The deeper muscles of the pelvic floor give more of the lift action to the kegel and they have more of a role with supporting our pelvic organs and deep core system.

Try this: imagine your pelvic floor is an elevator. We start on the ground floor and the elevator doors start to close (the "squeeze"). Then the elevator starts to go up to the 2nd and 3rd floors (the lift). When you release the elevator, let it come back down with control. That's it. That's a kegel- contracting and relaxing with control. We can add to this action by bringing in things like breathing and coordinating with our deep abdominal muscles, but that's the basic action.

Your pelvic floor is an elevator.

If you're someone who does better with concrete: squeeze like you're trying not to pee or poop, and then pull those muscles into the body. Now go ahead and let them relax with control.

*Note: you should NOT be squeezing your butt, inner thighs, or anything else. You should be able to do a kegel so that someone sitting next to you has no idea that you're doing anything.

So now you might be thinking: okay great! This will totally help me with _____ (leaking, pelvic pain, prolapse, literally any pelvic health issue). Not so fast!

I'm sorry to tell you, but doing kegels on their own are probably not going fix your issue.

Remember, the pelvic floor is largely automatic. Sitting there and being able to voluntarily make the “elevator” of your pelvic floor go up and down doesn’t tell us too much about what’s actually happening when you go to pick something up, or do an exercise, or literally any other action from real life... And my guess is that if you’re having an issue like leaking, it’s probably not happening when you’re just sitting there, right?

Another big thing to keep in mind is that our muscles work together in TEAMS for movements, not in isolation. The pelvic floor is no different.

Think about walking or reaching to pick up a glass of water. You’re not just moving one muscle, a LOT of muscles are having to coordinate to work together to make that action happen.

Your pelvic floor muscles are a part of a team that includes your diaphragm, your deep abs, and the muscles that are deep in your back. (See Team Core below.)

Image used with permission from Pelvic Guru®, LLC

You pelvic floor also works with other team members like the muscles in your butt, your hips, your inner thighs, and even some of the large muscles in your back that connect to your shoulder blades. That's a lot of things.

When a client comes in to see us and they are having an issue such as leaking, we're looking at all of these different muscles and how they're working together, because we have to think about the whole team. The poor pelvic floor could actually be taking on the brunt of the work because other team members aren't pulling their weight!

Back to the original question: Should I do kegels?

The answer everyone hates: It depends.

I don't know if YOU need to do kegels just like I don't know if you need any other specific exercise without taking a look at YOU. What I do know, is that there are much more effective exercises for your pelvic floor, so we don't use kegels a whole lot in our practice. But if you want to do some kegels here and there to try them, go for it!

In summary: as a pelvic floor occupational therapist I DO I think it’s helpful to have an understanding and awareness of how to contract and relax your pelvic floor muscles just like any other muscles. But, if you're having an issue like leaking and you're not seeing a change with kegels, it's most likely because there's more to it than kegel strength alone.

Have no fear, we're here to help! Our expert team is trained in addressing the whole body, so that we can get to the root cause of your issue (and give you way better exercises for your pelvic floor ;) ). Reach out for an evaluation today.



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