Why You (Maybe) Shouldn't Do Your Kegels
For a really long time now, kegels (I’m going to write it with a small “k” because I don’t think it really warrants capitalisation every single time throughout this article, despite convention) have been the magic fairy dust in pelvic floor health.
Incontinence? Do your kegels. Prolapse? Do your kegels. Pelvic pain? Do your kegels. Had a baby? Do your kegels. Have a vagina? Do your kegels.
But can it really be THAT simple? That all ailments “down there” can be either solved or avoided by squeezing your va-j-j (how do you spell that??).
There are people who study for years and years to specialize in pelvic health – it always seemed to me that this hugely simplistic approach kinda suggested that all those Masters in Pelvic Floor Physiotherapy, all those doctorates and studies – were all just a waste of time. Pretty much everyone with a vagina knows how to squeeze, so what are these people learning and studying all those years?
On top of that, I had always found kegels frustrating – it made me feel tense and uneasy when I did them.
So a couple of years ago I started my journey to figuring this out and understanding this body part.
Before we start, a few statistics to get us in the mood:
• A full 40% of female athletes that you see on TV competing in the Olympics suffer from SUI, or Stress Urinary Incontinence and wear some form of adult diaper while doing their amazing stuff. Say what? Read that again. FOURTY PERCENT! THAT’S ALMOST HALF! These highly trained, insanely gifted humans – why aren’t they doing their kegels?
• "If you’re incontinent at 12 weeks postpartum, you're 92% likely to still be experiencing incontinence at 5 years postpartum if no training or intervention is done.” (Jessie Mundell). Well that's depressing. So… are these women not doing their kegels??
I’ve come to be known in many circles as “anti-kegel” but that’s not entirely true. I just don’t accept that it can fix EVERYTHING. Much academic research has been done around kegel-ing and the overwhelming conclusion is that kegels DO work and that it is the ONLY thing that works. But that doesn’t account for all these women that have problems DESPITE doing their kegels. Some women do kegels and it just works, problems go away. Awesome. Done. But then there are soooooo many more whose symptoms don’t go away no matter how many kegels they do. They don’t understand what they are doing wrong.
So what gives?
First of all let’s bust a few myths:
1. If you have any kinds of symptoms (incontinence, pain), that means your pelvic floor is WEAK
WRONG. It is very much the case that women can (and do) have weak pelvic floors. But there is also something called a hypertensive pelvic floor. This means that the muscles are tight and constantly under tension. This often causes pain and urinary frequency (because the bladder can’t empty fully) but can sometimes (in severe cases) cause leaking.
What you need to know here is that if you have a hypertensive pelvic floor and you insist on repeatedly contracting it, you will make it worse. You actually need to learn to relax it. On top of that, you will have trigger points (or knots) in the muscle which won’t release without intervention (and that involves a trained physio sticking her fingers up your hoo-ha and manually releasing theses knots - without this treatment, it just won’t go away.)
2. If you know for sure that you have a weak pelvic floor (and not a hypertensive one), kegels will fix it.
Well not so fast. Kegels MAY fix it, or at least be a part of the puzzle. But it’s a little more complex than that. The pelvic floor is made up of lots of different muscles that are all woven together like a wicker-basket. There are lots of different parts, and there are lots of different variations of a “weak” pelvic floor. For example, you could have one side that is weak and isn’t contracting, but the other side is too strong (or hypertensive) because it is trying to compensate for the weak side. You can have knots in the muscles because other parts are weak. Until you get those knots “removed” by a pelvic floor physio, you’re just going to be making them worse (imagine you have a piece of string with a knot in it and you keep tugging on each end – you’re not going to get the knot out – you’ll just make it tighter and tighter). Even if this isn’t the case, you will only be strengthening the strong bits, and not the weak bits.
What you need to know: if you have a weak pelvic floor with imbalances, doing kegels alone probably won’t produce results (and could make things worse).
3. If you have NO pelvic floor dysfunction, kegels will help prevent any misfortune.
Ok, I get the rationale, I do – we don’t only workout when we have problems in our body, we need to strengthen the muscles and move even when we are healthy and functional and mobile. But I see a lot of women coming from Pilates (and sometimes yoga) who have bashed away aggressively at their kegel exercises for years and given themselves a hypertensive pelvic floor.
What you need to know: if you don’t have any issues, kegels probably won’t prevent them from happening and “keep your pelvic floor strong” and could potentially cause you problems.
So WTF should I do instead??
Well that depends – but it’s pretty simple.
If you have pelvic floor problems (whether weak or hypertensive) you need to get yourself asap to a very good pelvic floor physio. Don’t fuck around with this one ladies, despite what your doctor and granny say, it’s not going to “go away on its own” (see statistic number 2) and you really don’t have to live with it. If you have a weak pelvic floor, the physio (if she’s good) will address your imbalances and she may give you kegels as part of your strengthening program. That’s fine, as long as it’s after muscular tightness and imbalances have been taken out of the picture.
On the other hand, if you have a hypertensive floor, you will NOT be given kegels (and if your pelvic floor physio does give you kegels, run for the hills with your arms flailing and come and ask me for a rec for a GOOD physio). You will be taught how to release and that will be the focus of your rehabilitation (along with breathing exercises to strengthen your core and relax your diaphragm, but that’s another blog post).
And if you don’t have pelvic floor problems? The short answer is: leave it alone. If it ain’t broke don’t fix it. The long answer is, you should identify the muscles, ensure that you know how to contract AND relax them, learn proper breathing mechanics that set up a piston breath (yet another blog post that I have not yet written, but if you're interested, you should google Julie Wiebe) and address any posture imbalances. You should probably do some exercise too that involves some resistance training and lifting relatively heavy weights with impeccable form and ideal breathing mechanics, which increases intra-abdominal pressure, therefore increasing the demand on the pelvic floor and causes it to adapt, strengthen and hypertrophy (increase in muscle size) – but that is yet another blog post to be written.
Long story short is that if a group of 10 women get together and do kegels for 20 minutes, the variation in the state of their pelvic floors and what they are doing will be enormous. In any such group there will probably be a mix of weak, hypertensive and near-perfect pelvic floors (you would be simply ASTOUNDED by just how common these problems are – hence my fascination with the topic), and giving them all the same exercise is a bit like trying to fight a cold, a broken leg and a headache all with a sledgehammer (or something like that).
There is so much more I have to say about this topic and I am uber excited to be starting this conversation. I’d love to hear your stories, questions and thoughts – and we can keep the conversation going and educate more women about this amazing, inconvenient and ubiquitous phenomenon. Please comment below or send me a message!