In 1948, Dr. Arnold Kegel published a study about exercises to increase the strength of the pelvic floor muscles to treat women with incontinence (leaking pee) after childbirth. Scientists are super original so the exercises were named after him. Thus the birth of Kegels (Get it!? Birth... Kegel!? Just LOL silently for me ok?)
Since then Kegels have become a magical, fix all cure.
Peeing when you laugh? Kegel.
Want to improve your partner's sexual experience?! Kegel!
If you want to take care of your ladybits, ya better Kegel!
If they are so widely known and effective then how come there are people living with pelvic floor dysfunction?
Yep I said people. Men have pelvic floor muscles too and they can have similar problems!
Pelvic floor dysfunction has different underlying causes
Arnold Kegel was a pioneer and thanks to him we have an awesome treatment technique for certain groups of patients. The latest research continues to support Dr. Kegel's findings - strengthening exercises work when the problem is a result of weak muscles.
But now we know now that some conditions such as constipation, incomplete peeing/pooping, and pain with sex may be associated with overactive muscles (muscles which can't relax). This may be an issue with tone or coordination. Every muscle in your body is slightly active, even at rest. That's what we call muscle tone. Problems can occur if your resting tone is too high or if you cannot relax the muscles when you use the bathroom or have sex.
In these cases, treatment would begin by teaching the person how to relax the pelvic floor muscles. Once the person can relax on command, they may still need strengthening exercises. Overactive doesn't equal strong!
Learning to Kegel properly is tough
In a 2015 study of 250 female patients getting treatment at a specialist's office, researchers found that 60% of these women performed pelvic muscle exercises (i.e. Kegels) incorrectly, even though they reported knowing how to perform these exercises!
Now think about how much trouble someone may have if they have never been taught to do the exercises in the first place. The good news is that once the patients received better instruction and had someone to check their form they were able to perform the exercises correctly!
The best way to know if you are doing these exercises the right way is to have a trained provider check internally as you do them. Pelvic floor therapists can even assess the strength of those muscles and how well they relax!
No one can look at you with your clothes on and say "Yep you're doing it right." No one.
So why shouldn't I Kegel?
First and foremost, kegels are only one of many treatment options! A treatment plan may include relaxation training, biofeedback, trigger point release, alignment of the pelvic bones, coordination training, and stretches for the hip and low back muscles. Not every treatment needs to be used for every person with pelvic problems.
This leads us to the bigger issue - you can't assess yourself to decide what treatments are right for you. In order to do a thorough evaluation you would have to take special course work in anatomy, physiology (how the body works), and how/when to use certain treatment techniques.
So don't assume that you should kegel for the heck of it!
Ok Monika but how is that an issue?
Well let's say you leak whenever you laugh. And you've been practicing those Kegels the wrong way. One day you're laughing really hard and you try to Kegel to prevent leaking but end up peeing yourself anyways. You didn't use the right muscles so you never stood a chance! And off you go to change.
On the flip side, if you are someone who has an overactive pelvic floor (i.e. you are unable to relax it completely) then Kegel exercises aren't for you!
OMG, how do I know if I have an overactive pelvic floor!?
This can only be accurately assessed by a trained provider. Without a thorough history of your symptoms and an exam, the best anyone can do is make an educated guess. If you have absolutely no issues or concerns in the three areas (pee, poop, sex), then you shouldn't worry!
I don't have problems with that stuff, but I want to "make sure it's tight" so how do I Kegel?
I get this question SO OFTEN. And just to frustrate you I've learned to answer it with another question. Why do you think you need to work on that?
I've spent a lot of time talking to women and thinking about this and these seem to be the true underlying causes:
- Option 1: You are worried because of all the jokes we hear about "being loose" and your perception of what your partner(s) think. This is a quick fix! Ask him/her point blank. You're probably stressed out for nothing.
If you would rather wander the Sahara desert naked without sunblock than have that conversation... then perhaps you need to have some other open conversations about sex in general with your partner.
- Option 2: You actually are having some problems and you want to treat them by yourself. Not to beat a dead horse but the best thing to do is to work with a qualified healthcare professional. Don't be afraid to get a second or third opinion if you feel uncomfortable with your provider or their treatment plan. And always ask them how many other patients they have treated with the same problem.
Keep in mind that a team based approach works best and may include your MD, a specialist (such as a urologist, gynecologist, obstetrician), pelvic floor physical therapist, and perhaps even a nutritionist, endocrinologist, etc.