To Kegel or Not To Kegel…

 The Kegel exercise is the cornerstone of pelvic floor (PF) rehabilitation for incontinence and prolapse.  Some have called Kegels a worthless activity or a waste of time.  Nothing could be further from the truth.  Kegel exercises are highly effective if performed correctly and that is where women need more direct instruction.  Today, I will give you that direct instruction. 

Let me begin by telling you a proper Kegel or PF contraction is a two-step process.  The first step is to squeeze your PF muscles as if to stop the flow of urine or the passing of gas.  Usually, this step is the only one women are instructed in and the second most important step is left out.  That critical second step is to draw your PF up into your pelvic outlet, as if there is a string attached from your belly button to you PF and you are attempting to pull it up into your abdomen.  This elevation takes your pelvic floor from a bowl shape to a flattened, tighter position within your pelvic outlet. 

You can confirm that you are doing the first part of the Kegel correctly by inserting your finger tip into your vaginal opening.  You will feel a light squeeze on your finger when contracting your PF.  The second part – the PF elevation - cannot be felt with palpation since the muscles that are working are internal.  You can, however, feel your belly button draw in as you work to elevate your PF.  The movement you are feeling is the contraction of your TA (Transversus Abdominis) muscle which cinches up your midsection and works in a coordinated fashion with your PF.  One final cue is to remember to keep breathing as you elevate you PF.  If you are holding your breath to draw your belly button in, you are using the wrong muscles.  Therefore, focusing on continuing a steady breathing pattern is important.

It’s important to note that PF elevation is not easy as you first begin.  It requires concentration and visualization because this is a contraction that you cannot see, but can only feel.  Initially you should perform this exercise lying on your back with your knees bent.  Work to hold your PF elevation for 8-10 seconds (remember to keep breathing normally!) before releasing and allowing your PF to completely relax. 

 

On our Hab-It: Pelvic Floor DVD, I then instruct patients to follow this long hold with four “quick flicks” which are actually quick contractions of your PF or simply part one, outlined above, of a Kegel contraction.  These don’t require a longer hold.  Rather, they are performed to a rhythm of “contract-relax-contract-relax…” and so on.  You can visualize these quick contractions being important for strong and fast reactions of your pelvic floor as you cough, laugh, or sneeze.  The elevation of your PF that is the second part of the Kegel contraction works the muscles of your pelvic floor that have endurance roles.  This includes supporting your bowel, bladder, and uterus, and giving effective compression to the pathway extending from your bladder to your urethral opening.  It is this compression that will help to completely resolve your incontinence symptoms.

Simply performing the first part of the Kegel and just tightening the muscles around the three openings of your pelvic floor will NOT help with prolapse issues and usually will not completely resolve incontinence.  It is this incomplete exercise instruction that is giving the Kegel a bad rap.  Many women blog that they performed 40 + Kegel exercises per day for weeks and saw no results.  My message is to try it again, focusing on a 2-step process and let us know the changes you experience after four weeks.

So, back to our initial question…”To Kegel or Not To Kegel?”  I give an emphatic “YES”, you must Kegel but you also must do it right!

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17 Responses

06.22.09

Hi! I like your srticle and I would like very much to read some more information on this issue. Will you post some more?

06.22.09

Stay tuned for future blogs. I will be addressing the kegel again in combination with another posture blog! Any specific questions are welcome as they will direct me and help our readers.

Tasha

06.22.09

Great post! I’ll subscribe right now wth my feedreader software!

06.22.09

Excellent site. It was pleasant to me.
hab-it.com – cool!!!!

06.22.09

Just wanted to say HI. I found your blog a few days ago on Technorati and have been reading it over the past few days.

06.22.09

There will be more Kegel blogs to come. It’s so important to get the message out about how important our pelvic floor muscles are to our low back health, our hip strength, and of course in remaining continent and free from prolapse symptoms.

06.22.09

Hi Tasha,
I was recently fitted for a pessary which I’ll receive in about ten days. Can Kegel’s and your other exercises be done with a pessary in? Will the pessary ultimately widen the vagina? Or does the resistance it provides make the Kegel’s more effective? I’ve read conflicting opinions on this. I hope I won’t need the pessary forever. I’m very dedicated to your dvd, have a stage 2 cystocele, and hope I can resolve it. But did you use a pessary when you were working to resolve your prolapse? What is your advice?

06.22.09

Chris,

These are great questions and I will do my best to answer them. First, the Kegels can be done with a pessary in and it won’t stretch out the vaginal canal. This tissue is very elastic, so it won’t be effected with short term use of a pessary. I don’t, however, recommend you leaving the pessary in for a prolonged period of time. Take a look at my “Weighing your options” blog where I cite the New York Times article, http://www.nytimes.com/2009/05/05/health/05tape.html?_r=1&ref=todayspaper

This article lists all the possible side effects following prolonged use of a pessary. I don’t see the pessary making the Kegels more effective, but certainly use of a pessary for specific activities can make you more comfortable until your muscles are up to speed and able to support on their own.

I did not use a pessary device during my recovery, but it may have made my return to running more comfortable. I will say that by feeling my prolapse as I returned to my workout activities, it motivated me to do my exercises more regularly. Don’t develop a dependence on your pessary. Remember your goal to let your own body and muscles do the work!

Tasha

06.22.09

Tasha,

Thanks so much for your answers. A couple clarifications? When you say ‘prolonged period of time,’ do you mean for many hours in a row during the day, or do you mean in months or years? (I was recommended to wear mine during the day and take it out at night…) Secondly, the link you mention in your comment is actually the one on the mesh surgery option. But when checking your other post about options, the one mentioned in the section of pessaries keeps coming back ‘unfound.’ Is it me or is the site no longer current? Lastly, do you know if women my age (50) have been successful in curing their prolapses with exercise alone (stage 2 cystocele)? If I’m asking too many questions, I apoplogize. But for all my research, both in person and on-line, you seem like the expert. Thanks so much for your time.

Chris

06.22.09

Chris,

Thanks again for your questions. Our dialogue will no doubt clarify many questions that others have as well. To start, my definition of prolonged period of time would be several days in a row, so your instruction to remove the pessary every night sounds in line with what I have learned.

I have included a new link to outline the side effects of pessary use.
http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/578.html#ArticleParsysMiddleColumn0004
The worry is for skin breakdown within the vaginal canal. Certainly bleeding and/or infection are causes for concern.

And finally, as for success in women at the age or above that have successfully controlled a stage II cystocele – I have several women that I have worked with that have found relief with a regular exercises program. Make no mistake, once you have a prolapse, it is never gone for good, never to reappear again. It takes committment to correct your posture and perform the exercise program regularly to remain symptom free.

06.22.09

Thanks for post. Nice to see such good ideas.

06.22.09

The article is ver good. Write please more

06.22.09

Hey Tasha,
I’d like to thank you for the blog, which I’ve just discovered. I’m new to the prolapse world (doesn’t that sound exciting!) and have been going a little mad wading through the often conflicting information around.
Yours is good. Balanced. Well-researched. Positive!
I am off to devour every word on your page and pass it on. x

06.22.09

Hi Rachel,

Please continue to check in with our blog and ask any questions you may have – it is of benefit to us all. There is another great discussion site at http://www.prolapsehealth.com and she links to http://www.moondragon.com as an informational site. I would recommend you read through both of these and gather as much information as possible. You will immediately feel more in control of your body, just by increasing your understanding.

My best to you,
Tasha

06.22.09

Welcome to hab-it.com Please feel free to ask any questions as you read through all of my blogs. Every experience is unique and all discussions may benefit our readers. Thank you for participating!

Tasha

06.22.09

Hi Tasha, i went to the websites you suggested and it directed me to align and well site. The therapist on there says to squat more and to give up on kegels. Ive been doing your Dvd for 9 months and the advanced for about 2 months was feeling great but started feeling symptoms more off and on. i realize how important posture is i reread your blog on how to kegel in april i went to a therapist and she confirmed with an internal that i am doing them correct but she said i should start doing a maintenance kegel program. unless i really think about it i feel like im always contracting my pelvic floor. my main problem is the rectal pressure which feels like my butt muscles are in spasms would you know the quickest way to deal with that to give me fast relief( stretches or something) I’m just hoping in another 3-6 months that I hardly feel this anymore. Its strange because for a good 2 months during this time I was symptom free… Whats your thoughts on align and well and maintenance… thanks again

06.22.09

Deb,
If you feel like your deep glute muscles are in spasm, then be sure to visual yourself lifting your tail bone. This is achieved in neutral spine posture as well as with the multifidi lifts. The squatting that Katy Bowman teaches is a great position to stretch in to lift your tail bone but be cautious with repetitive squatting below 90 degrees.

Also, just 8-10 two step Kegels every day is your maintenance Kegel program. Stick with is and watch your posture to be sure you are not tucking your tail bone under with your Kegels.

-Tasha

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