Is Kegel a Dirty Word?
Most physical therapists prescribe the Kegel—named after the gynecologist who popularized it—to moms suffering from incontinence or mild prolapse. Doctors and educators also routinely recommend them for general pelvic floor strengthening. So, Ladies, get going with your Kegels!
Some fitness and health professionals have cried foul. Put that Kegel away.
Maybe you’ve already heard some of these refrains:
* We need full body movements that activate the pelvic floor, not a localized exercise band-aide!
* We need squats, squats, with a side of squats!
* We need to relax!
* We need correct alignment, the precise lordotic but not too lordotic pelvic tilt!
* We need to stop telling women to Kegel their way to health!
They teach courses with titles like No More Kegels and vow to never utter the word Kegel again.
My Vagina is Confused
In one camp the Kegel is savior; in the other, the devilish Kegel makes us pee.
What are we supposed to believe?
What are we supposed to do?
I struggled with this question for a long time. I even gave up Kegels for a YEAR, the year right after birthing a ten and half pound baby.
That was a really bad idea.
After physical therapy, I started them again, properly this time, and apologized to my pelvic floor for the neglect.
Are the Naysayers Wrong?
I believe those who ban Kegels are wrong. But those who quibble about the way we do Kegels, and who tell us pelvic floor disorder needs to be addressed via many means are right, sorta.
We should look at our pelvic tilt.
We should do full body movements.
We should learn how to relax the pelvic floor.
But those Shoulds don’t make the Kegel a de facto Shouldn’t. In fact, the Kegel is the only evidence based Should of the bunch.
How to Kegel
Before I defend the Kegel, we should agree upon how to do one.
It’s not super complicated. However, many “Kegelists” gloss over the instructions. Not all Kegels are created equal.
- Breathe in. Expand your ribs and relax the pelvic floor by feeling a small descent in the perineum.
- Breathe out. Picture lifting up a string that runs through your vagina to your belly button, pulling all the contents upward. You can choose from many images. You’ll notice that different images cause slightly different contractions (Check out 10 Kegel Cues). Try out a few visualizations to feel what works best for you. They all have the same goal—to get you to contract your pelvic floor muscles around your anus and vagina and imagine pulling them in and upwards.
- Your lower abdomen joins in the fun, just slightly. You can hold the contraction for around 3 – 8 seconds, or you can try a “quick flick”— a strong and quick contraction.
- Finally, breathe in to relax the pelvic floor. Keep breathing and imagine the perineum opening like a flower. After your pelvic floor has relaxed sufficiently, start over.
And that’s it.
Why the Pushback?
Why would contracting a group of muscles incite ire? Probably because many women do them incorrectly and think tighter is always better (Strong is good, but tight is not the same as strong).
On the cusp of motherhood, I took a twelve week birthing course (I overdo things). The layperson birth teacher demanded we do Kegels ALL THE TIME: in the shower, at a stop light, waiting in line.
This teacher didn’t mention the possibility of a too tight pelvic floor. She didn’t explain that relaxing the pelvic floor was an essential Kegel step.
If your pelvic floor is too tight, doing loads of Kegels before learning how to relax will just make it tighter.
Some women think tight and vagina should go together. That is a fantasy of Cosmo magazine. Contrary to popular nonsense, a too tight pelvic floor won’t give you a great sex life. It will make inserting anything into your vagina a literal pain and could even contribute to incontinence.
This oversight was especially ludicrous in a birthing class. Kegels can be great for learning how to control the contraction and relaxation of your pelvic floor, but not so great if you only focus on the contraction part. That’s like trying to jump as high as you can, but starting with pin straight legs while standing on your tippy toes. You won’t get very high.
Even health practitioners who ban the word Kegel prescribe them. They just call them something else, like “pelvic lifts” or “pelvic contractions” or “pelvic floor muscle training”. It doesn’t matter what you call it. A rose by any other name…
Embracing the Kegel
Doing a Kegel/pelvic lift doesn’t mean you won’t do other exercises to activate the pelvic floor. That’s like saying doing an isolated bicep curl is a bad idea because it doesn’t work the entire body. True. It doesn’t. But isolating a muscle is often the best way to strengthen it. If I had particularly weak biceps, I’d do isolated contractions in combination with full body moves.
The same is true for the pelvic floor. Carrying a baby in your womb can weaken the pelvic floor. Pushing a baby out the vagina can weaken the pelvic floor. Instead of abandoning the Kegel aka pelvic lift aka whatever you want to call it, I wholeheartedly embrace it as a valuable part of the postpartum toolbox.
Doing it Right Matters
If you can’t perform a pelvic lift without exerting downward pressure on the pelvic floor (some women push down rather than pull up), the Kegel is worse than useless. It is harmful.
A women’s health physical therapist can evaluate your Kegel technique. You might also try something called The Educator. This nifty piece of plastic can help you literally see if you are pulling up (good) or pushing down (bad).
If you suspect your pelvic floor is overly tight, you need to spend most of your Kegel time focusing on step 4. Someday, I’ll do another post on how to relax your pelvic floor.
Also, if your pelvic floor is really weak, you need to do more than the oft recommended 8–10 Kegels. You may even consider contracting against resistance via things like a Gyneflex.
This is why physical therapy is helpful. The Kegel itself isn’t complicated, but the application is case dependent.
Indulge me a final metaphorical flourish: Think of the Kegel as part of the alphabet for the sentence that is movement. You can’t read or write a sentence if you never learned your letters.