To Kegel or Not to Kegel

The Kegel exercise is the cornerstone of pelvic floor (PF) rehabilitation for incontinence and prolapse.  Some have called kegels a worthless activity or a waste of time.  Notheing could be further form the truth.  Kegel exercises are highly effective if performed correctly and that is where women need more direct instruction.  Today, I will give you that direct instruction.

Let me begin by telling you a proper kegel or PF contraction is a 2 step precess.  The 1st step is to squeeze your PF muscles as if to stop the flow of urine or the passing of gas.  This step is the only step women usually are instructed in, but the 2nd, most important step, is left out.  That 2nd step is to draw your PF up into your pelvic outlet as if there is a string attached from your belly button down to your PF and you are attempting to pull it up into your abdomen.  This elevation takes your pelvic floor from a bowl shape to a flattened, tighter position within your pelvic outlet.

The first part of the kegel can be confirmed if you insert your finger tip into your vaginal opening.  You will feel a light squeeze on your finger when contracting your PF.  The 2nd part requires PF elevation and cannot be felt with palpation, as the muscles that are working, are internal.  You can, however, feel your belly button draw in as you work to elevate your PF.  The movement you are feeling is the contraction of your TA muscle, which cinches up your midsection and works in coordinated fashion with your PF.  One final cue is to remember to keep breathing as you elevate your PF.  If you are holding your breath  to draw your belly button in, you are using the wrong muscles, so focusing on continuing a steady breathing pattern is important.

PF elevation is not easy as you first begin.  If requires concentration and visualization, as this is a contration that you cannot see, but only can feel.  Initially you should perform this exercise lying on your back with your knees bent.  Work to hold your PF elevation for 8-10 seconds before releasing and allowing your PF  to completely relax.  On our Hab It: Pelvic Floor dvd I then instruct patients to follow this long hold with 4 "quick flicks" which are actually quick contractions of your PF or simply part 1 of a Kegel contraction.  These don't require a longer hold, but rather are performed to a rhythm of "contract-relax-contract-relax...and so on.  You can visuallize these quick contractions being important for strong and fast reactions of your pelvic floor as you cough laugh, or sneeze.  The elvation of you PF that is the 2nd part of the kegel contraction works the muscles of our pelvic floor that have endurance roles.  This includes supporting your bowel, bladder, and uterus, and giving effective compression to the pathway extending from your bladder to your urethral opening.  It is this compression that will help to completely resolve your incontinence symptoms.

Simply performing the first part of the Kegel and just tightening the muscles around the 3 opening of your pelvic floor will NOT help with prolapse issues and usually will not completely resolve incontinence.  It is the incomplete exercise instruction that is giving the Kegel a bad rap.  Many women blog that they performed 40+ kegel exercises per day for weeks and ssaw no results.  My message would be to try it again, focusing on a 2 step process and let us know the changes you experience ater 4 weeks.

So, back to our initial question..."To Kegel or Not To Kegel?"  I give an emphatic "YES", you must kegel, but you also MUST DO IT RIGHT!

To Kegel or Not to Kegel