To kegel or not to kegel?

This is such an important topic because there is so much misconception that we need to do kegels to resolve pelvic floor dysfunction.  Patients come in all the time doing hundreds and hundreds of kegels and their symptoms are not getting better. They purchase kegel aids and trainers, spend hundreds of dollars on devices but once again do they need kegels? There are circumstances where kegels do help and it can be helpful to learn to activate these muscles with coordination of our breath but we want to get off our backs and into functional positions as soon as possible! 

Lying on your back doing biofeedback will not get you to your goal of high level tasks, running, jumping, or lifting your kids without symptoms. 

If we want to do a task like jumping we have to break up this activity into smaller components. To move on to the next step we want to make sure there are no symptoms being produced. This is so vital to get back to full function. For example, to get back to jumping rope we can start in anti gravity positions like a Pilates jump board and work on jumping tasks with pelvic floor coordination, or step drills and then slowly move to small double leg hops and slowly increase speed and height of surface. 

There are times when we typically don’t want to kegel with certain conditions including tailbone pain, vaginismus (involuntary tensing of the vagina which makes vaginal penetration difficult- tampons, pelvic exam, etc), dyspaurenia (pain with intercourse), interstitial cystitis, pelvic pain conditions, or high tone in your muscles.

There are two ways to evaluate:

External: lie on your side and feel the area inward from your sit bone (ischial tuberosity) with your fingers.  As you inhale you should feel this area soften or gently press into your hand causing the pelvic floor to relax.  As you exhale you should feel this area pull up and inwards as you perform a kegel/ pelvic floor contraction. This should give you a sense of what is happening externally. So often this area can get really uncoordinated. 

Internal: A transvaginal or transrectal exam gives the most information on what your pelvic floor is doing, how much tone is present in the muscles, and your endurance for a contraction. This is performed by a skilled pelvic floor physical therapist. One finger is typically inserted in vagina or rectum to perform this evaluation.  We can assess each layer of the pelvic floor muscles, look for trigger points, pain, muscle tightness or weakness. 

A skilled therapist can perform external or internal techniques depending on your specific goals and comfort level. Come in for help and get an evaluation to help decide if you should kegel or not!