I hear the same story over and over again. Patients come to me bewildered as to why they are not getting relief from their pelvic floor symptoms. After all, they have been doing their Kegels regularly.
People, especially women, do Kegel exercises because that is what doctors, friends, families members, Google and every other resource has assured them will work. They claim that Kegels (or pelvic floor muscle contractions) are the easy and sure fire path from suffering with pelvic floor issues to finding relief.
They are not.
If you have Kegeled yourself until you can't Kegel any more and yet continue to have problems, you are not crazy. You just didn't receive good advice.
Here are just 3 reasons why Kegels don't work. There are many more, but 3 seems to be the number that sticks. Since that is the case, let's talk about what I see as the 3 biggest reasons that Kegels don't work for people.
1) We have never learned about how our pelvic floor muscles work.
Growing up in a conservative part of eastern Kentucky, I will admit that I didn't receive the most thorough education on health. It is no surprise to me that I would not have learned how to perform a pelvic floor muscle contraction (Kegel) properly.
However, I have now been treating people of all genders for over a decade and have yet to find one person who received an instructional lesson on how to contract the pelvic floor muscles. In fact, none have even claimed to have had any knowledge whatsoever that these muscles even existed until they had to learn.
How is it that we expect people to just naturally understand how to correctly identify, isolate and contract a group of muscles in which they have received no education or training about?
It is absurd.
The consequence of this lack of understanding is that many people do not know how to perform Kegels, even though they think they do. Studies have even found that some people perform Kegels in such a way to make symptoms worse. This is the exact opposite of what we want to happen.
2) Kegels may be the exact opposite of what needs to occur to restore health to the pelvic floor and provide relief.
Often, there is an assumption that the pelvic floor muscles are not performing properly because they are weak. While this may be the case, the answer is more nuanced than to just exercise them more.
Pelvic floor muscles can be abnormally partially contracted (hypertonic) which can lead to weakness. Muscles can only contract so much. If they are already in a contracted state, one of the last things you want to do is to encourage excessive contraction by doing Kegel exercises. This can increase they hypertonicity and make things worse.
It is rarely necessary to just do more Kegels. The key is to return the pelvic floor muscles to their normal functioning state.
To be honest, it is very difficult to know how to do that on your own. This is the entire reason that pelvic floor therapy exists.
3) You can't do them everywhere. At least, not at first.
I am going to attempt to shed some light on how difficult it can be learn how to do a proper pelvic floor contraction. Here are just a few of the considerations:
Positioning: some positions are more difficult than others to perform the contraction and also be able to feel it.
Accessory muscle activation: Some muscles are supposed to work with pelvic floor contractions, and some are not. Do you know which is which?
Posterior/Anterior pelvic floor muscle fibers: Not only is contracting the right muscles sometimes very difficulty, but learning how to contract the right part of the muscles is also important. Some muscles control what is happening on the back end, while others are in charge of the front end. They each have different jobs.
This is just the tip of the iceberg.
The idea that you can just do Kegels any where at any time really is too good to be true for most people. By attempting to make this sound so easy, many people become incredibly disillusioned and frustrated when they can't.
Kegels are not always the answer to pelvic floor problems. Even when they are, they must be given the respect that they deserve and performed properly so that you can have the very best results.
If you need more guidance on what can help you with your pelvic floor symptoms, just contact us and we will help you get back to a life without always worrying about your pelvic floor....the way nature intended.
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