To kegel or not to kegel?
To kegel or not to kegel, that is certainly the question.
Some folks will tell you to do 3 sets of 1 million kegels daily for optimal pelvic floor functioning.
Some will tell you don’t even think about the word kegel because that’s how terrible they are for your pelvic floor.
My take on kegels?
Well, it depends. 😉
Before I explain my very vague answer, let’s break this down. What exactly is a kegel?!
A kegel is an exercise where a person purposefully contracts their pelvic floor muscles. The entire musculature (from clitoris to anus) contracts and lifts internally. A cue I like to give folks is to “scoop and lift” from the pubic bone down, pulling the entire area up and into the body.
Our pelvic floor naturally does a “kegel” all the time because our pelvic floor is in a constant state of contract, relax, contract, relax – over and over all day and night. When we inhale, our pelvic floor naturally lengthens and relaxes, when we exhale, our pelvic floor naturally lifts and contracts.
We can then further intensify the contract phase by performing a kegel exercise.
Circling back to my vague answer:
I do think kegels are thrown out way too often as a blanket fix for any type of PF issue.
Leaking pee while running? Do 100 kegel contractions every day!
Prolapse giving you feelings of heaviness and bulging? Do a kegel with every single rep of an exercise.
Painful sex? Kegel, kegel, kegel baby.
And while for some, kegel contractions are going to be immensely beneficial, I do think we need to be more tailored in who does them and how they do them, because as you may remember, symptoms of a pelvic floor with too much or too little tension can often be the same.
Example:
Having every single person with a pelvic floor symptom just crushing out 50-100 reps of kegels probably isn’t going to transfer over into real life too well.
But if we have the person take some deep breaths, purposefully move between relaxing and contracting their pelvic floor, in a multitude of positions (laying down, side lying, seated, on hands and knees, etc), then this may start to shift someone’s awareness and brain body connection, which will carry over into real life movements and exercises.
Because what’s the point of being able to do a rock star pelvic floor contraction laying down if you pee your pants a little bit every time you go to pick up your kiddo? If we're going to do the work of exercising, we want it to work for us, in all areas of life.
If the person suffering from symptoms knows they hold a lot of tension in their pelvic floor already, then kegels probably aren’t necessary, especially not in the “quick 100 reps daily” category. This person needs more practice with fully relaxing their PF, not contracting it.
Because here's the thing: some folks are going to respond really well to purposefully contracting their PF before doing certain movements while others need to really just ignore their PF while they are exercising in order to feel relief.
So you may be feeling frustrated by my answer because there is a lot of “we just don't know until we know” when it comes to the pelvic floor, so I will try to summarize a bit for you.
Sometimes kegels are helpful, sometimes they aren’t. It helps to know whether you carry too little or too much tension in your pelvic floor. A trusted physical therapist who is well versed in the pelvic floor can be a great resource here to help you figure out your body’s tendencies.
If you find kegels to be helpful, try to treat them like any other exercise, where you want to move well, breathe big, and take your time. Quality is certainly more powerful than quantity. Don’t worry about hitting 100s of reps per day – a more mindful approach will transfer over into real life much more successfully.
At the end of the day, kegels won't be the end all be all of pelvic floor recovery and symptom relief. They might be one of many tools in your toolkit that help you move through life easier.
