
This past week I was talking with a patient about her chronic pelvic pain and why she has been struggling with this for most of her life. When we did her pelvic floor exam we found a significant amount of tightness and severe pain with internal light touch. Now we usually see this type of problem with someone who has had trauma to the pelvic region such as a bad fall, car accident, or abuse. But when I asked her about these things she said "no" to each. So why was her pelvic floor so stinking tight and painful?
Well, she came to the realization that as a kid she came to the conclusion for an unknown reason that she needed to be doing kegels daily...forever. So by the age of about 8 years old she started doing kegels daily and did this for most of her life. My mind was blown! First off, no 8 year old needs to be doing kegels. Secondly, this is likely the cause of all her issues she is having today at the age of 28. It broke my heart thinking how a young girl can get this bad advice so easily, especially in today's society, and how it can negatively impact her health for decades to come.
This needs to change! We need to do better for girls and women!
When most people think of pelvic floor health, kegel exercises are often the first thing that comes to mind. While kegels can be a beneficial tool for some, they are not a universal solution to all pelvic floor problems. In fact, performing kegels when they are not appropriate can sometimes worsen symptoms and delay recovery as we have seen in my patient example above. Let’s dive into when kegels are helpful, when they might be harmful, and how to determine the best approach for your pelvic health.
What Are Kegel Exercises?
Kegels are exercises designed to strengthen the pelvic floor muscles by repeatedly contracting and relaxing them. These muscles act as a sling to support the bladder, uterus, and bowel in women or persons with a uterus and support the bladder, prostate, and bowel in men or persons with a penis. Properly functioning pelvic floor muscles contribute to bladder and bowel control, sexual health, core stability, and so much more!
When Kegels Are Beneficial
Kegels can be a powerful tool for pelvic floor health when there is a lack of strength or tone in the pelvic floor muscles. Some conditions where kegels might be appropriate include:
Stress Urinary Incontinence: If you leak urine when you laugh, cough, or sneeze, strengthening the pelvic floor muscles can help improve bladder control. Although in some cases, a tight pelvic floor can also cause this issue so be cautious.
Pelvic Organ Prolapse: In some cases, mild to moderate prolapse symptoms such as heaviness, bulging, or pressure can be managed by increasing pelvic floor muscle support.
Chronic SI or back pain: For many people with chronic back or SI pain that has not responded to traditional treatments, the pelvic floor might be the cause of poor stabilization. Kegels may aid in regaining strength and control.
If you have been instructed how to perform them correctly from the guidance of a pelvic health physical therapist: If and only if you have already been to a pelvic PT and they recommended kegels and showed you how to properly perform them.
When Kegels Are Harmful
Not all pelvic floor issues stem from weakness. In some cases, the pelvic floor muscles are overactive, tight, or unable to relax properly. For these individuals, kegels can exacerbate symptoms rather than relieve them. Conditions where kegels may be harmful include:
Pelvic Pain Disorders: Conditions like vaginismus, pelvic floor myofascial pain, pudendal neuralgia, or interstitial cystitis often involve muscle tension or spasm. Adding more tension through kegels can increase discomfort.
Urge Incontinence: This type of incontinence is often related to bladder irritation or overactivity rather than weak pelvic floor muscles.
Dyspareunia (Painful Intercourse): If pelvic floor muscles are already tight or overactive, contracting them further can worsen pain during sex.
Chronic Constipation: An inability to relax the pelvic floor can contribute to difficulty with bowel movements. Kegels might worsen this issue by reinforcing tightness.
Pregnancy: When you are giving birth the pelvic floor muscles need to be able to stretch and completely relax. THE PELVIC FLOOR MUSCLES DO NOT ASSIST IN PUSHING A BABY OUT! So doing kegels in pregnancy might actually create more complications for a vaginal delivery.
If you don't know how to perform them : Most patients I see are terrible at performing pelvic floor muscle contractions (AKA kegels). If you are doing them incorrectly, you are more likely to cause a problem than see the benefits.
How to Know If Kegels Are Right for You
The best way to determine whether kegels are appropriate for your situation is to consult a qualified pelvic health professional, such as a pelvic floor physical therapist. A thorough assessment can identify whether your pelvic floor muscles need strengthening, relaxation, or a combination of both.
Some signs that kegels might not be the right choice include:
Persistent pelvic pain.
A sensation of tightness or pressure in the pelvic area.
Difficulty starting or stopping the flow of urine.
Painful intercourse.
Chronic constipation.
A history of trauma.
On the other hand, if you experience symptoms like leaking with activity, difficulty holding in gas or stool, or a feeling of heaviness in the pelvis, kegels might be helpful when performed correctly and under the guidance of a pelvic PT.
What to Do Instead of Kegels
If kegels aren’t suitable for you because of pelvic floor tightness, other approaches can improve pelvic floor function, such as:
Relaxation Techniques: Deep breathing, yoga, or guided relaxation can help release tension in overactive pelvic floor muscles.
Manual Therapy: A pelvic floor physical therapist can perform hands-on techniques to address muscle tension or restrictions.
Movement-Based Exercises: Gentle core and hip exercises that promote coordination and mobility can support pelvic health without overloading the pelvic floor.
Lifestyle Changes: Addressing dietary factors, bowel habits, stress management, and/or posture can sometimes improve symptoms without direct pelvic floor work.
The Bottom Line
Kegels are not a one-size-fits-all solution for pelvic floor dysfunction. Understanding the unique needs of your body is key to achieving optimal pelvic health. If you’re unsure whether kegels are right for you, seek guidance from a trained professional who can create a tailored plan that meets your specific needs. Remember, motion is lotion—but only the right kind of motion for your body.
Call our office today to schedule a pelvic floor evaluation and take the first step toward personalized care and lasting relief.
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