by Sarah Coombs, MOT, OTR/L, RYT
The #1 thing I get asked as a pelvic floor 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.
What is a kegel, anyway?
“Kegels” (like many other things) are named after a dead white dude, Dr. Arnold Kegel, who 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 the pelvic floor as well as how to help with issues like leaking, recovering from childbirth, and prolapse. But at the time, the idea of incorporating a non-surgical technique to address these things was probably pretty groundbreaking. 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.
Ideally they are working and responding to things throughout the day without you consciously having to do much of anything other than telling them when it's time to go to the bathroom.
But again, 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.
There are two parts to a kegel: a squeeze & a lift. Our pelvic floor muscles more 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.
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 an 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 a damn thing 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.)
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 me and they are having an issue such as leaking, I'm looking at all of these different muscles, because we have to think about the whole team. The poor pelvic floor could actually be taking the brunt of the work because another team member isn't pulling their weight. (I'm looking at you, glutes.)
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 I don't use kegels a whole lot. If you want to do some kegels here and there, go for it!
*Note: There's some info floating around out there suggesting kegels could be harmful if you have a "tight" pelvic floor, but honestly it's more likely that they probably just won't do much. Doing a kegel is not harmful.
In summary: as a pelvic floor therapist I DO I think it’s helpful to have an understanding and awareness of how to contract and relax your pelvic floor muscles. But when I work with someone, I'm never going to stay there very long because that's not going to help them in real time, in real life when they're picking up their kid, bringing laundry up and down the stairs, or working out. Even though kegels probably won't save you, I hope you learned something new about your pelvic floor today.
If you're having an issue like leaking or something else that isn't getting better, I'm here to help! Book a call and let's chat. I can probably help you with your issue, and I probably won't have you do kegels.