Kegels are NOT the Answer to Pelvic Floor Dysfunction

When we hear the term “pelvic floor”, often Kegels are one of the first things that come to mind. Kegels are commonly prescribed by OBs, gynecologists and other doctors to treat pelvic floor dysfunction or help women recover pelvic floor function post partum. “Kegel” is the commonly used term for a voluntary contraction of the pelvic floor muscles. When a doctor prescribes Kegels, they often describe the technique by saying something like “pretend you are stopping the flow of urine”. (Practicing stopping the flow of urine while you pee can actually cause bladder and urinary tract infections, so don’t do that!)

The typical standard of care in western medicine for treatment of pelvic floor dysfunction has not yet evolved into a whole body approach yet, and still attempts to isolate the pelvic floor through Kegels. This doesn’t produce results! In fact, Kegels can do more harm than good in many cases of pelvic floor dysfunction. In this blog, I will explain WHY Kegels do NOT resolve pelvic floor dysfunction.

When I first graduated from PT school and started treating clients with pelvic health issues, I taught all of my patients Kegels. I used biofeedback or manual feedback and trained them to do all sorts of crazy Kegel exercises while they laid on their back, or sat in a chair, or stood. As a new PT, I was discouraged becuase my patients were not resolving their pelvic floor dysfunction with this Kegel protocol I was teaching them. It took me a few years to really accept this reality and start to explore why this was not working, because I was thinking, “How could my expensive doctorate level education possibly have taught me an intervention that didn’t work!?” Well, this is medicine. Medicine evolves, and is not an exact science. We are always learning new and better ways to elicit that healing power in our patients. After my realization about Kegels, I was blessed with some incredible mentors and teachers, and I learned new ways to treat pelvic floor dysfunction that really work!

Unfortunately, Kegels are still implemented as one of the primary treatments for pelvic floor dysfunction. Here are the six key reasons why Kegels are NOT the answer to resolve pelvic floor issues.

99% of pelvic floor dysfunction is related to pelvic floor muscle spasm.

The most common problem that occurs in the pelvic floor muscles during pelvic floor dysfunction, is muscle spasm. When the pelvic floor muscles are in a spasm, that means they are stuck in a contraction (a kegel) and can’t relax. Contracting a muscle that can’t relax can often make matters worse. Kegels actually exacerbate pelvic floor muscle tension, and can increase the symptoms of pelvic floor dysfunction. Most of the time, when someone has pelvic floor dysfunction, the first course of treatment is to “un-kegel” their pelvic floor, by teaching them how to relax it.

80% of the pelvic floor muscle fibers are involuntary.

Only 20% of the pelvic floor muscle fibers are voluntary. Kegels are voluntary pelvic floor muscle contractions and therefore only target 20% of the pelvic floor muscle fibers. Failing to target the involuntary fibers of the pelvic floor muscle misses the majority of the muscle. The pelvic floor needs to do its job (support your organs, spine and hips; signal bladder and bowel urgency; prevent leaking; allow voiding to occur; circulate blood and lymph in the pelvis; assist in breathing) without you having to think about it! Therefore pelvic floor muscle rehabilitation needs to target the INVOLUNTARY muscle fibers of the pelvic floor, not the voluntary ones. Targeting the voluntary muscle fibers of the pelvic floor does not translate to improvements in pelvic floor FUNCTION.

The pelvic floor is 70% fascia and 30% muscle.

Since the anatomical characteristics of the pelvic floor are quite unique, in that it is mostly fascia, rehabilitation of the pelvic floor must take those characteristics into account. Fascia responds very differently than muscles to loading. When fascia is chronically loaded without proper muscular support, it will stretch and weaken. In order to rehabilitate weakened fascia, it must be un-loaded, then progressively exposed to with gentle eccentric forces to strengthen it. To resolve pelvic floor dysfunction, the interventions need to unload and strengthen the fascia of the pelvic floor. This is done through training of the diaphragm and posture. Kegels fail to address the pelvic fascia, are concentric in nature, and certainly do not unload the pelvic floor.

Resolving pelvic floor dysfunction starts way above the pelvic floor muscle.

Ultimately, true pelvic floor muscle rehab creates an environment in your body where the pelvic floor muscle can be reflexively triggered through your posture and breathing, without your conscious thought. Since the pelvic floor muscles are primarily involuntary, and you should not have to consciously think about them in order for them to perform their function, rehabilitating them must take that into account! The diaphragm is the secret to pelvic floor rehab. The respiratory diaphragm and the pelvic diaphragm are intimately connected. They mirror eachother. What ever the diaphragm does, the pelvic floor will follow. When the diaphragm is has optimal mobility and function, that will be mirrored in the pelvic floor. So you can do all the kegels you want, but if you dont train the diaphragm to function properly in unison the pelvic floor, you wont get anywhere.

Pelvic floor dysfunction involves so much more than just the pelvic floor muscle.

Pelvic floor dysfunction is actually more complex than just an isolated muscular problem. It involves dietary and behavioral factors; it has everything to do with how you breathe; it is impacted by your exercise choices and your common daily postures; it is related to the management of pressure in your abdomen and the position of your organs. Pelvic floor dysfunction is impacted by spinal and pelvic alignment, hip strength and mobility, abdominal muscle function, and glute strength. Any impediments of blood, lymph, or nerve flow to the pelvis will negatively impact pelvic floor function. All of these factors need to be taken into consideration and addressed to truly rehabilitate the pelvic floor. Isolating the pelvic floor muscle with kegels will not fix pelvic floor dysfunction.

The answer lies in the involuntary nervous system.

You can’t fix a problem in the involuntary nervous system (i.e. pelvic floor dysfunction) with voluntary muscle isolation training (i.e. Kegels). Just like we talked about in part one of this series, when training your pelvic floor, it is important to understand that we don’t have voluntary control over the great majority of it. So in order to train and strengthen 100% of the pelvic floor, we must involve reflexes that activate those involuntary muscle fibers of the pelvic floor. And that’s exactly what I teach my clients in The Core Recovery Method®.