Why Kegels aren’t a cure-all for pelvic health

The pelvic floor consists of a group of muscles and connective tissues comprised of 3 layers, the deepest of which lines the inside of your pelvis and cannot be touched from the outside. These muscles work together as a sling that spans from the tailbone to the pubic bone and from each ischial tuberosity (the bones that you sit on, just under your buttocks).

Pelvic floor muscles perform 5 important functions: they hold up your organs; keep pee and poo off the floor; assist with stabilizing your pelvis and trunk with your core; allow you to orgasm; and act as a sump pump to help send blood and lymph back up towards the heart.

Kegels describe a voluntary pelvic floor contraction. The term “Kegels” was first coined by Arnold Kegel, an American gynecologist, who began using pelvic floor exercises as a conservative means to treat incontinence. Today, pelvic floor exercises are an evidence-based, effective means to treat incontinence, pelvic organ prolapse and a variety of other forms of pelvic floor dysfunction.

Careful with Kegels

Clients frequently ask me about a video they saw on YouTube or a handout they received from a doctor’s office describing various post-partum exercises. Typically, this involves the client performing Kegels by practicing “stopping pee” or “stopping gas” contractions on or off the toilet. There are several problems with this approach.

The Society of Obstetricians/Gynecologists of Canada recommends that pelvic floor training should be done only with digital palpation or biofeedback. There are a few reasons for this:

1. People often perform Kegels inappropriately, even when they’ve been given verbal or written instructions. For example, someone may overuse their abdominal or hip muscles instead of their pelvic floor. You may not know that you are performing the wrong contractions because the pelvic floor cannot be seen. Therefore, the wrong contraction is repeated indefinitely and may create problems elsewhere over time.
2. As pelvic health physiotherapists, the vast majority of the pelvic floors we assess aren’t underactive, but overactive. An overactive pelvic floor can lead to urinary urgency, stress incontinence, pelvic pain, tailbone pain, low back pain, hip pain, and painful sex. Individuals with an overactive floor who practice Kegels risk worsening their symptoms. An internal assessment allows a pelvic physiotherapist to determine whether the pelvic floor requires strengthening or relaxation. Remember that a large percentage of the people we assess actually have great fundamental strength, but lack control and the ability to relax fully.
3. The recommendation to practice “stopping pee” on the toilet is risky as it can increase your chances of experiencing a urinary tract infection. This may be done infrequently to test control.

When to see a pelvic health physiotherapist

In summary, the pelvic floor is an incredibly complex (but often overlooked) system that is integral to our health and wellbeing. Written or verbal instructions are often insufficient for those who suffer from pelvic floor dysfunction. If you have tried Kegels at home with no help or worsening symptoms, this is a good indication that further investigation is warranted.

As to which exercises are good for the pelvic floor versus dangerous for it, again, there is no fixed answer to this question. It can vary from individual to individual, depending on their activity level, pelvic floor strength, history of vaginal childbirth, obesity, etc.

Generally, when trying out a new exercise or exercise program, you can monitor your symptoms to determine if it's the right fit for you. If you experience an increase in or an onset of the following, it's a sure sign that your body isn’t comfortable with Kegels:

• Low back pain, hip pain, abdominal pain, vaginal or rectal pain
• Incontinence (leaking with coughing, laughing or sneezing, leaking associated with urgency)
• Pain with intercourse
• Vaginal heaviness

In general, a good way to protect the pelvic floor during exercise is to breathe and contract the pelvic floor when exerting yourself. Never hold your breath as this creates a strong downwards pressure within your abdomen and pelvis, which can increase your risk of pelvic organ prolapse and incontinence.

For further guidance, check out our Locations page to find a Lifemark clinic near you or book online to schedule an appointment with a pelvic health physiotherapist.