Disclaimer: Information in the post is for educational purposes only. Not intended for diagnose, treat, cure or prevent any disease.
So you have a Pelvic Floor problem (which is very common) such as leakage or prolapse or you just had a baby. Now what? Do you do Kegels? Well if you google it (which I do not recommend) you would probably find different suggestions: Yes Kegel, no never Kegel, hold a Kegel at every stop light, Kegel the entire time you are running, don’t Kegel during a work out, Kegel when standing or walking, etc. But generally there are two opposing schools of thoughts. Yes to Kegels. No to Kegels.
Kegels or not to Kegels is one of the most googled question when it comes to pelvic health and female health. You can understand the frustration when someone so desperately seeks quick advice on the internet but finds 10 different responses to the same specific question. And it’s not a slight difference. It’s not a Tangerine to a Mandarin variation. It’s apples to oranges!
But I think the question itself is the wrong question to ask. Instead the question should be ‘When do I start Kegels?’ Kegels are excellent pelvic floor strengthening exercises but needs to be introduced at the right time. That is why paying a visit to a good pelvic floor therapist can definitely make this journey painless. But there are times when we don’t have immediate access to one. This blog will help fill in the holes and hopefully enlighten you to look at Kegels differently.
First we need to go over what a Kegel is. Then identify some symptoms that indicate when you should kegel and when you should not kegel. I will go over a simple at home test to see what your pelvic floor is capable of. I will also answer questions like should you Kegel if you have a pelvic organ prolapse? And should you Kegel when you are pregnant?
What is a Kegel?
A kegel is like any other strengthening exercise. It is a controlled contraction of the muscles in our pelvic floor. Like other muscles in our body, the pelvic floor muscles can get weak, tight, inflamed, fatigued, sore and achy.
Now let me ask you this. What would you do if you had weak muscles in your arms? Like your biceps for example. You would try to strengthen your biceps with your physiotherapist or personal trainer. Strength exercises involve contraction of the target muscle or muscles.
How about if you have a very tight muscle? A muscle that is in spasm? For example your calf muscles. Will you start off with strength exercises and try to contract the tight muscle even more? No! You are probably going to make it worse. Instead you will try to stretch or massage the tight muscle. But once the tightness in the calf goes away, you will then start to slowly introduce strength exercises to get the calf muscle (and surrounding muscles) stronger.
Ok now let's get back to our Kegels. Kegel is a contraction of the Pelvic Floor muscles. We established that. So would you want to contract a tight pelvic floor muscle or a weak one? If you contract an already tight pelvic floor muscle you probably will make it tighter but also there won’t be much muscle to contract. Because the muscle is already contracted. It’s already short.
How about a weak and loose pelvic floor muscle? When you contract a weak pelvic floor muscle the purpose is to strengthen it. So Kegels will be beneficial.
So tight Pelvic Floor, No Kegels. Instead you want to learn how to fully relax the Pelvic Floor. Yoga and meditation with essential oils are phenomenal for a tight pelvic floor. You can introduce Kegels later once your pelvic floor has learned how to relax, both on demand and subconsciously.
With a weak and loose Pelvic floor, Kegels are amazing. But with Kegels you want to coordinate it with your breathing and you want to learn how to relax fully from a Kegel contraction. Kegels are more than just holding a contraction all day (which can be harmful). You must coordinate it with your breathing so you do not end up causing more harm.
Do I have a weak or tight pelvic floor?
Ok so you probably are wondering How do you know if you have a tight or loose pelvic floor?
Well one way is to go to a pelvic floor therapist and they will be able to tell you instantly.
But I find certain symptoms can sometimes give you a clue. For example you probably have a tight pelvic floor if there is pain during intercourse, persistent arousal, any numbness or tingling in the vaginal or clitoral area, problems with voiding. You know when you have to pee in a cup for a urine test at the doctors and when you stop your pee mid stream you have a hard time to start it again and it takes you a few seconds to get the stream starting again. Or also women who have that second pee. Where you think you are done peeing and you get up and you have to pee again!!
So what about a weak and loose pelvic floor? I find this usually comes with age. Especially after menopause when estrogen levels begin to drop. Also during pregnancy, trauma during delivery and a long pushing time during the delivery can cause tears or weakness in the pelvic floor muscles. I find women with a loose pelvic floor are unable to stop their urine midstream. They are most likely to suffer from urinary incontinence and leakage.
Baseline testing of the pelvic floor
Note: Never practice Kegels on the toliet.
With a full bladder start your urine and after a few seconds quickly stop your urine mid stream instantly without thinking about it. It should be an abrupt stop with no trickling. Now see if you can start your flow again without thinking about it. The first half of the test is testing the strength of your pelvic floor and the later half checks to see if you can fully relax your pelvic floor after a contraction. Try and see what your pelvic floor can do.
Should you kegel with a pelvic organ prolapse?
Pelvic organ prolapse is when your organs in the pelvis start to descend downwards into your vaginal canal because the pelvic floor muscles failed to keep them in position. Now both a tight pelvic floor and a loose pelvic floor can cause prolapse.
A loose pelvic floor we know means it is weak and unable to produce a strong contraction. A tight pelvic floor on the other hand is also weak. What happens when you hold a 20 pound weight overhead for a long period of time. Your muscles fatigue from contracting for a long time and your arm gives up. Same goes for a tight pelvic floor. You are holding sustained contraction of your pelvic floor muscles for so long that eventually what happens is the muscles in the pelvic floor fatigue and give out. And everything the pelvic floor muscles hold in place begin to slowly decend down the vaginal canal and you end up with prolapse. So if prolapse is one of your symptoms and you were told to do Kegels, it may be making it worse if you have a tight pelvic floor.
Kegels during pregnancy
Now what about pregnancy? Kegels or no Kegels? It will depend how your pelvic floor reacts to the change in hormones and increasing pressure. But definitely in the third trimester I would recommend trying to learn how to relax the pelvic floor instead of contracting. We want the pelvic floor muscles and opening to be relaxed and be able to stretch when it comes to pushing the baby. After delivery, you should check with your pelvic floor therapist to see if you can do some Kegels to help strengthen the stretched out muscles.
So should we Kegel or not? It depends! Anyone can do Kegels. The question is when is it safe to do Kegels. If you have a tight pelvic floor, no to kegels initially. Focus more on relaxing the pelvic floor during a deep inhale. A Kegel is usually more beneficial for someone with a weak and loose pelvic floor. But you have to be careful with your Kegels. You should be fully relaxing from each contraction and you should coordinate it with your breathing. Doing a Kegel wrong can cause more harm than good.
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