Are Kegels the Answer?
After you have a baby (or maybe just in general), if you report to your doctor any issues related to your pelvic floor, including leakage with coughing/sneezing/lifting, leakage with urgency, downward pressure or feeling like something is falling out, pain with intercourse etc, more times than not, you will be told to do Kegels. But are Kegels really the answer to all of your problems? Maybe, but most likely they are not the only answer. I guess the more philosophical question would be is there EVER only one answer to all problems?
I’m no philosopher, but I’m thinking the answer to that question is no.
Let’s start by talking about what Kegels are. A Kegel (named after an American gynecologist) is an exercise designed to strengthen the pelvic floor. A Kegel would be a squeeze in and lift up of the pelvic floor musculature and the subsequent relaxation (think of an elevator lifting from the basement or the lobby level all the way to level 5 and then returning back to the basement.) The idea is that by improving the strength you can decrease your leakage. (Want to know more about the pelvic floor? Check out this blog I wrote.) Makes sense right? So why can’t you just do Kegels? Of course it seems obvious, but the problem is there are a couple of other things that could be going wrong.
An estimated 30% of women or more are doing Kegels incorrectly. It makes sense since it’s hard to see these muscles and it’s such a small motion it can be difficult to understand the difference between a lift versus bearing down. Common mistakes include bearing down or pushing instead of squeezing and lifting or compensating for weakness with other neighboring muscles (glutes, abs, inner thighs).
Sometimes it’s not that the pelvic floor is weak and needs to be strengthened, but that the timing needs to be improved. Your pelvic floor is a stabilizer of your pelvis during functional daily tasks, so it should often turn on just prior to movement or activity (i.e. coughing/sneezing). If your pelvic floor is turning on too late, that may be the issue versus it being too weak.
Overtraining the muscles could cause worsening of symptoms. This can lead to fatigue of the muscles (like any other muscle in your body) or can lead to muscle spasms and more pain due to the muscle not properly relaxing. Remember earlier when I mentioned a true pelvic floor contraction is not only the squeeze and lift up but also the subsequent relaxation (elevator BACK to the basement)? It’s like holding your arm out in front of you all day without letting it rest; it’d be pretty tough to lift anything at the end of the day if you did this.
Your pelvic floor rarely works in isolation (by itself) in your daily life. My guess is, your symptoms/leakage are brought on by something specific during your day, maybe a certain motion or activity (lifting, coughing, sneezing, etc). While doing Kegels may help some people, often, we need to retrain our pelvic floor to function normally during our daily activities.
As you can see, there is a lot more to curing your symptoms than just doing some strengthening exercises. It involves your posture and alignment, how well your pelvic floor can relax as well as contract, the timing of the contraction, and how your pelvic floor works during functional activities, not just while sitting in your car (the common place I suggest people do their Kegels).
So what can you do? Is doing Kegels wrong? No! Of course not, but if your symptoms don’t seem to be improving, your best bet is to reach out to a pelvic floor therapist near you to get on a plan that is tailored to you and your needs so you can get back to feeling like YOU again ASAP!
Want more tips and tricks for postpartum recovery? Check out my book, The New Mom’s Revival Guide!