Why Kegels Aren't Fixing Your Pelvic Floor

"Just do Kegels" gets thrown around as the fix-all solution for pelvic floor problems. The reality is that it's rarely that simple. The pelvic floor is made up of layers of muscles. It has multiple jobs. It does not work in isolation; it partners with muscles around it. 

A Kegel is an isolated pelvic floor contraction which focuses on shortening the pelvic floor muscles. For someone with weakness, Kegels might be helpful to rebuild basic strength. For someone with issues with coordination, learning how to properly contract the muscles might be an important first step. But for someone with too much tension, being told to Kegel over and over is likely to make things feel worse. 

Let's think about the pelvic floor muscles as a trampoline. It's a dynamic muscular sling that helps support your organs. When you jump, cough, sneeze, laugh, run, or have any other sudden change in pressure on your pelvic floor it needs to be able to react to these pressures. Just like a person jumping on a trampoline, the fabric stretches down before it powerfully recoils up. Muscles need to be flexible and strong to be able to lengthen and rebound as they respond to dynamic loads and stresses. 

The pelvic floor is part of the core. It works with the abs and other surrounding muscles to control pressure in our abdomen. Working on exercises that encourage co-contraction between the pelvic floor and other core muscles are often a better way to train. That's why we need to progress off the basic table exercises and onto standing and bigger movements that mimic everyday life. Bringing bands, single leg exercises, ab and hip training into the equation often result in bigger gains!

Kegels alone also fail to consider the impact of other factors like ligament or structure changes (like tears or prolapse), posture changes, and poor body mechanics. Sometimes birth injury, post-surgical changes, or other injuries can cause muscles to lose power or work overtime to compensate. A pessary or support garment may be an important tool to provide the support the pelvic floor needs to function properly. If you are slouching when sneezing or landing hard with jumps your pelvic floor is at a disadvantage and may not be able to compensate. Working on addressing the way we move can help decrease the demands placed on the pelvic floor. 

Lastly, about 30% of people will perform a Kegel incorrectly and bear down when they think they are contracting. If the pelvic floor really is weak or you are struggling with prolapse or leaks, bearing down is unlikely to help your symptoms. It can be helpful to check that you are getting both closure and lift of the pelvic floor muscles using a mirror or feeling for change. 

If you have been doing 100s of Kegels and getting nowhere, if pelvic floor training hasn't progressed off the floor or table, or if you have tried the EMS chair without seeing improvements, Kegels probably are not the fix-all for you. Feeling lost? Skilled evaluation from a pelvic floor PT can be a valuable first step to getting to the bottom of your pelvic floor problems!