Kegel exercises – which involves repeated contracting and relaxing the muscles that form part of the pelvic floor – have often been recommended and given as a blanket prescription from various healthcare professionals, exercise therapists, magazines, talk shows and blogs etc as the solution to strengthen pelvic floor, manage urinary incontinence or improve their sex lives.
From Kris Jenner famously saying “A family that kegels together, stays together” on hit reality series Keeping Up With The Kardashians, and Samantha from Sex and the City joking about kegels, to Oprah Winfrey inviting kegels experts on her talk show to dispense advice to her zillions of viewers, my experience in getting folks to stop doing kegels without a proper assessment has been an uphill battle as it has already been seeped into mainstream consciousness.
Despite its popularity and “harmless” portrayal in our culture, it’s important to understand that kegels should not be prescribed for certain conditions.
Kegels should never be done on a tight pelvic floor muscle
It particularly frustrates me when health professionals prescribe kegels for patients with vaginismus without a thorough assessment of the physical state of their pelvic floor.
For some of these women, their pelvic floor muscle could already be in a state of heightened tension, more taut than normal with a higher muscle tone. This is why this condition of vaginismus is known as hypertonic pelvic floor muscle dysfunction.
Many women with vaginismus also have vestibulodynia, a condition where there is hypersensitivity of the vulva to even the slightest touch, particular in the area near the vaginal opening. A very common cause of vestibulodynia is tightened pelvic floor muscles.
Here’s a common misconception that I’d like to correct:
Often, people equate a ‘tight’ muscle to a toned muscle. A tight muscle is not necessarily a toned muscle. A toned muscle is desirable and a good thing. When the pelvic floor muscles are tight, they harbor active trigger points, which are hot spots for bad inflammation that increase pain sensation, swelling and restrict movement in the connective tissues surrounding the muscles. These types of tight muscle are undesirable.
The repeated contraction and tightening of the pelvic floor muscles that occur during kegels will make an already tight pelvic floor worse, adding more fuel to the fire.
Our pelvic floor muscles deserve more respect than other voluntary muscles in our body like our thigh muscles or our bicep or tricep muscles. When we overdo a particular exercise, the muscles of our leg, bum or arm may feel really taut and tight, but they usually slowly relax after resting for a couple of days.
Your pelvic floor muscles, however, do not have the privilege of rest. They are constantly working and contracting to keep the contents of our pelvis like our bladder, rectum and vagina held in place and functioning appropriately. If they were to be a state of complete relaxation, then we would be incontinent of urine and faeces and even suffer prolapse of our pelvic organs.
Kegels are NOT a one-stop solution for all your pelvic problems – be it urinary frequency, urinary incontinence, pain during sex or constipation. Kegels should not be prescribed or started so free-handedly, as the above pelvic problems can also be caused by a hypertonic tight pelvic floor.
So, when are kegels useful?
Kegels are extremely useful when your pelvic floor is overstretched (which happens in pregnancy as the growing foetus occupies the space in the pelvic cavity) and during vaginal delivery.
Before you start kegel-ing away, it’s best to get a proper assessment to ensure that the symptoms you are experiencing are not related to a tightened pelvic floor. A tight pelvic floor requires treatment to relax it and undo the active triggered points in these muscles before you are safe to perform kegels.