Clarifying the role of the kegel in Pelvic Floor physical therapy

Ok so there is A LOT of information about kegels out there.  Some people tell you to never to do kegels; some providers will say do 100 a day so, what are we supposed to do? What is the right thing?  Well I’m a Pelvic Floor Physical Therapist here to say, IT DEPENDS.

First let’s talk about what the kegel is; it is a pelvic floor muscle contraction. Just like you contract your bicep to bend your elbow, your pelvic floor muscles can also contract and relax just like any other muscle. Have you ever tried to do one? Some cues that can help are:

• Think about stopping the stream of urine or holding in a fart

• Imagine picking up a blueberry with your vagina

• And my favorite, imagine sucking up a smoothie through a straw in your vagina

A kegel isn’t just a squeeze but a squeeze AND a lift up.  They are muscles that are deep inside the body so when you do one, no one should be able to tell. Your glutes shouldn’t contract; your abs shouldn’t tighten, your inner thighs shouldn’t contract. And although kegels may not be apart of your specific pelvic floor physical therapy plan, it is important that you are able to understand and coordinate how to do one. 

Generally, we don’t need to think about contracting our pelvic floor muscles, they are considered “anticipatory muscles” which means they contract before, or in anticipation, of a movement. They are active when you walk, run, workout, sneeze, cough, lift without you even needing to think about it.  They are muscles that are vital to movement and pressure management.

If you are experiencing pelvic floor issues like leakage or heaviness AND we find that your pelvic floor muscles need some strengthening and coordination work this is where kegels might be a part of your plan.  No, you shouldn’t be just laying down and doing 50 kegels or just have a machine inserted vaginally to contract the muscles for you; this is NOT functional. If kegels are needed it is best to incorporate them into movement; this not only helps to strengthen the muscles but helps them coordinate and support as they are supposed to.  This will not be the case forever and eventually you should be strong enough to do movements without having to do or think about kegels.

On the opposite end of the spectrum, we may find your pelvic floor muscles are holding a lot of tension. This tension will make it difficult for your pelvic floor muscles to contract to their fullest and give you a false sense of weakness.  In this case doing kegels may make symptoms worse and is not the best course of care.  We would want to focus on lengthening the pelvic floor and strengthening muscles surrounding the pelvic floor (hip muscles, lower body strength, core strength and coordination). In doing this the pelvic floor symptoms will improve without ever having to do a kegel.

I hope the information above was helpful! If you are having pelvic floor muscle issues like leakage, heaviness, pain, constipation, urgency I HIGHLY recommended seeing a pelvic floor physical therapy BEFORE you turn to kegels.  Knowing what specifically your pelvic floor muscles are doing in combination with the rest of your body will allow us to give you a plan to help get rid of those symptoms for good!

By: Dr. Katie Ihlenfeldt, PT, DPT