When Kegels Are Helpful For Pelvic Floor Dysfunction

If you've read any of my blogs or followed me for some time I talk a lot about how pelvic floor therapy isn't just about kegels, because it is true.

I talk a lot about that because the very prevalent message out there is just do kegels for any pelvic floor problem. Patients still come to me saying their doctor said to do kegels, no matter if they have bladder leakage or pelvic pain. That is not the way!

But let's talk about when I do use kegels.

Kegels are an integral part of pelvic floor therapy.

The research shows that kegels are one of the most important treatments for bladder leakage.

Here's the thing, it's never just do kegels. It's do kegels in a specific way or different way. It's do kegels AND do these other exercises. 

Bladder leakage:

Most of my patients who have bladder leakage do some form of kegels as homework.  You need to know how to contract the muscle properly and be able to hold it to prevent bladder leakage.

But, it's also about creating better bladder habits so you don't have a sudden urge and leakage.

Or, for my patients who have bladder leakage with exercise, it's about getting their legs and hips stronger and improving their running and jumping form to help decrease the pressure on the bladder and pelvic floor.

Prolapse:

A lot of what clinicians learn about prolapse lately is that it can be just as much a tight pelvic floor as a weak pelvic floor, and I find that to be true. Often it is a combination.

For my prolapse patients I find that working on kegels in specific positions helps the overall strength of the pelvic floor muscles in order to support the pelvic organs better.

Pelvic pain:

These patients rarely get kegels as homework, but it's not never.  Generally people who have pelvic pain have tight pelvic floor muscles so we don't want to make them tighter with kegels, however, sometimes I give these patients kegels with the emphasis on the muscle relaxation between kegels. It is really difficult to tell your muscles to relax, so we use the contrast of squeezing the muscle and then relaxing the muscle to help the body to get to a relaxed state. It's the same principle as progressive muscle relaxation used for meditation and to help people sleep.

Constipation:

Again, kegels aren't the primary treatment here, but I do use them sometimes. Generally for people who have chronic constipation they often have tight pelvic floor muscles.  Also, the act of pooping is a pushing motion rather than a muscle contraction or tightening, so the opposite of a kegel. 

I do use kegels on occasion for this patient population as well. Like the pelvic pain patients I will use kegels to help them learn what it feels like to relax the muscle, then later on I will use the contrast of a kegel and pushing with the pelvic floor muscles to help them learn the correct muscle activity for pooping.

Pregnancy:

Kegels are not my recommended exercise in pregnancy unless someone has pelvic floor weakness and needs to do them. Like pooping, when it comes time for a vaginal delivery the pelvic floor muscles need to push out, not contract like a kegel.

Occasionally, I will use kegels for a person who has poor muscle coordination to learn where their pelvic floor muscles are and how to use them, but then I focus more on preparing to push the baby out.

Postpartum:

This is a time that many patients will benefit from kegels, however there are always exceptions. For some new mamas they will have pelvic pain after birth from either stitches or scar tissue in the pelvic floor, and for them, kegels are not recommended.  For most other postpartum people, kegels can be beneficial, especially after vaginal birth. Kegels are safe to start doing immediately postpartum to help strengthen the pelvic floor after it got stretched out, but again, only do them if they don't hurt.

Conclusion:

I do use kegels, a lot, but they are never the ONLY thing we do in pelvic floor therapy, and that is the message I want people to understand.

If you need help figuring out if kegels are right for you, schedule an in-person or virtual visit.