Okay, not really. Kegels can be an important part of pelvic floor treatment, but doctor google would have you believe that it is the only treatment you need for any pelvic floor concern.
First, what is a Kegel?
Kegel is the name of an exercise where you activate your pelvic floor muscles. You can think of stopping the flow of pee, drawing something up into your vagina, or stopping the flow of gas.
It is often difficult to connect to this part of our anatomy and a pelvic floor physiotherapist can let you know if you are doing the exercise properly.
Now, why would we not want to Kegel?
Pelvic floor dysfunction can result from a tight pelvic floor or a pelvic floor that lacks tension. A pelvic floor that lacks tension is most certainly weak, but a tight pelvic floor can be either strong or weak. When muscles are weak, sometimes the body responds to that weakness by tightening the muscles in the area. A tight pelvic floor can also be a strong and overworked area, compensating for a weak core, hips, or legs.
If you have a tight pelvic floor, doing more kegels will not yield good results. In fact, it might make things worse by making the muscles even tighter.
The other reason we may not want to Kegel is in preparation for birth. Your pelvic floor muscles are already getting a really good workout having to support the extra weight. In fact, we need to work on relaxing the pelvic floor to allow for an easier labour.
If not kegels, then what?
So if kegels are not the end all be all, what is? This is why physiotherapists loathe general advice. Everyone is different and one size certainly doesn’t fit all.
As physiotherapists, we look at the entire body: range of motion, mobility, posture, pelvic positioning, movement patterns, and core strength.
For example, a woman who is experiencing leaking during exercise might just have a very relaxed pelvic floor that doesn’t contract very well. This is a person who would do very well with just figuring out how to Kegel properly and that should resolve the issue.
However, another woman might be experiencing leaking during exercise but her pelvic floor contracts just fine. This same woman may have a tight pelvic floor, a weak core, and a tendency to bear down when lifting heavy weights.
For this second woman, a course of treatment would include pelvic floor release, core retraining, and training to manage intra-abdominal pressure during exercise (to learn more about intra-abdominal pressure read my article “How to Activate Your Core For Pain Relief“).
How do I know if I need kegels or not?
The easiest way to determine the best course of treatment for your specific problem is to see a pelvic floor physiotherapist. The therapist will assess your entire body mechanics and movements patterns, as well as perform an internal assessment. An internal assessment allows the therapist to feel the pelvic floor area for weakness and tightness.
If you are unable to see a pelvic floor physiotherapist or you are uncomfortable with an internal assessment, consider checking out my pelvic floor course. It will walk you through each aspect of your pelvic floor function and help you assess and treat your own pelvic floor concerns.