Does the thought of jumping on a trampoline with your kids want to make you wet your pants? Jumping (especially on a trampoline!) seems to be the one thing that women with pelvic floor dysfunction don’t even want to try.
Which brings me to kegels. There is a lot of talk about kegels out there these days, and if you are confused, I don’t blame you! Perhaps your doctor told you to do 100 kegels a day to stop those pesky leaks. Maybe you’ve heard whisperings about the latest and greatest gadget that you can insert “down there” for a super strong pelvic floor. Or perhaps you have read online that you ought to ditch the kegels all together and squat like crazy instead. What is a thinking lady to do?!
The truth is that there is no one right answer or one magical solution (unfortunately!).
Every body is different and every system has different needs. Before starting on any kind of pelvic floor training program, it is vitally important to get assessed: if you don’t know your baseline or starting point, you won’t know where to go from there. A pelvic floor physiotherapist should perform a careful assessment of the pelvic floor muscles; and a really good physio will evaluate the pelvic floor within the wider context of the whole person and their life.
When it comes to kegels, you will fall into one of two categories:
- You should be doing them.
- You should not be doing them.
Getting checked will let you know which camp you fall into – if you’re in one camp and ought to be in the other, you will get very frustrated.
Let’s talk about those who should be doing kegels.
We know from studies that about 50% of women perform kegels incorrectly. They either bear down, or hold their breath, or don’t get the necessary lift, or do only a few here and there, or start in poor postures, or use a bunch of other muscles to do the job, or don’t learn to engage the entire inner core system. If you find that your exercises don’t seem to be working, it is likely that you’re doing them incorrectly.
To train the pelvic floor with kegels (ie. pelvic floor muscle contractions), you will need to:
- Connect first to the muscles, engage, then focus on getting a LIFT of the muscles, not just a squeeze, on exhalation.
- Coordinate the action of the pelvic floor muscles with the rest of the inner core – timing and synergy of the entire system is key.
- As soon as possible, get off your back and get vertical when practicing your pelvic floor work – it puts the “fun” in functional training and just makes sense. You want your pelvic floor to work when you’re in upright positions.
- Your focus, positioning/alignment is key when trying to engage the pelvic floor. Don’t do kegels while you’re driving or watching TV since the concentration will be affected. And you’d likely be sitting with tail tucked under which is no good for engaging the muscles.
- Kegels shouldn’t be done in isolation for long. Functional, dynamic, everyday movements or sports specific training must really be the goals of practice. The pelvic floor should be retrained to work automatically and engaged to the right degree as it’s integrated into daily life activities.
- Sometimes the pelvic floor is not the issue – often it’s daily habits, positions, postures, movement patterns or even thought patterns that need to be un-learned to see sustainable change.
The moral of the story? Kegels have their place, but they are not the be all and end all. You need to first get assessed to make sure kegels are right for you. Then you must work with your physio to retrain a robust and dynamic system that will keep you high and dry, pain free, and functioning normally. Perhaps 2017 is going to be your year to focus on optimal pelvic function. If so, we have a great team of physios that would love to come along side you in that journey! Happy kegeling.
* A version of this article has was originally published in the Mom and Caregiver Magazine, Jan 2017 edition.