To Kegel or Not To Kegel?
Kegel exercises were first discussed in literature in 1948 by a male gynecologist Dr. Kegel. Kegel exercises are meant to close the openings in the pelvic floor (urethra, vagina [if present] and anus) and lift them up. Kegel exercises are commonly thought to only benefit women but men have pelvic floor muscles and can be benefited by kegeling as well. Kegel exercises are often thought of as a cure all to any and all pelvic floor dysfunction. In my opinion kegels are OVER prescribed, usually without any actual muscle evaluation.
I hear it all the time, ‘my doctor, friend, mom, aunt told me to just do more kegels’. I guess because it’s the only exercise most people are aware of for their pelvic floor they just do it for everything and if it doesn’t work they try more of them.
I can’t tell you how many women I treat that are doing 100’s of kegels per day and are no better! It’s crazy to me. If I give someone a shoulder exercise and it’s not helping them 90% of my patients stop that exercise but something about kegels has some patients VERY compliant.
What I see when evaluating patients is that around 50% of women are doing kegels incorrectly. This is validated by research, some studies show as many as 2/3 of women perform kegel exercises incorrectly. Most commonly patients squeeze but do not lift their pelvic floor or have dyssynergia meaning they don’t know pelvic floor lifting from dropping so when I ask them to lower or bulge their pelvic floor they lift it up. Performing the exercise incorrectly may make your symptoms worse and it won’t be effective. This is especially true for women with dyssynergia, this means they are contracting or closing their anus when they are trying to bulge it down and open to have a bowel movement. This makes having a bowel movement very difficult and often leads to straining and constipation.
Kegels are a strengthening exercise. Many women assume they have a weak pelvic floor when they actually have tight pelvic floor muscles. Just like many women have tightness in their upper trap or neck muscles, you can have tightness in your pelvic floor muscles. Kegel exercises are not usually indicated in initial treatment of tightened muscles just as shoulder shrugs are not normally the first exercise given to someone with neck tightness.
Of course there are exceptions but when we are speaking broadly about kegels I would NOT suggest doing them if you are having signs of a tightened pelvic floor: pain with sex/penetration, tailbone pain, constipation or straining to have a bowel movement, urgency to pee or poop, difficult initiating or maintaining a stream of pee, pee spraying to one side and/or pelvic floor spasms. If you have been doing kegels without symptom relief, think you should start kegeling regularly or have any pelvic floor symptoms I highly recommend an evaluation with a pelvic floor physical therapist (PFPT) so that you are doing exercises that will benefit you and you are doing them correctly.
Internal view looking into a cis-female pelvis from above with organs removed so that pelvic floor muscles are visible in red.
External view from below looking up at a cis-female pelvis, pelvic floor muscles are visible in red.
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