are kegels making your pelvic floor symptoms worse?
Ever heard of “Kegels” before? Kegels (pronounced like “bagel”), which is a common name for pelvic floor muscle contractions, is a term that was coined by a male gynecologist, Dr. Arnold Kegel, who named pelvic floor muscle exercises after himself.
What are Kegels?
Kegels are a type of exercise that were “invented” in 1948 by Dr. Kegel which placed a focus on pelvic floor muscle strengthening. His research focusing on Kegel exercises showed that pelvic floor muscle contractions could help to prevent different types of pelvic organ prolapse including prolapse of the bladder and bowels (prolapse is when the pelvic organs sit lower in the pelvis than they should potentially causing issues with pelvic pressure and heaviness) as well as stress urinary incontinence (leaking of urine with increased intraabdominal pressure which can occur with different activities like coughing, sneezing, and laughing).
What are the Pelvic Floor Muscles?
If you are wondering what the pelvic floor muscles are and that’s a great question! The pelvic floor muscles are composed of a group of muscles called the “levator ani” muscles and the coccygeus muscle. The levator ani muscles help to support the pelvic organs and prevent leaking of urine, poop, and gas, and can be further broken down into:
The puborectalis muscle (wraps around the anal canal, vaginal canal, and urethra to help facilitate continence or prevent leaking)
The pubococcygeus muscle (runs from the pubic bones back to the tailbone or coccyx)
The iliococcygeus muscle (makes up the back and sides of the levator ani muscles)
The coccyges muscle is located just behind the muscles of the levator ani attaching from the ischial spine to the sides of the sacrum and coccyx. It helps to support the pelvic organs keeping them positioned where they are supposed to be, flex or move the coccyx (tailbone) forward, and assists with keeping us continent so we don’t have any leaking of urine, poop, or gas.
Picture of the pelvic floor muscles including the levator ani muscles and the coccygeus muscle
Kegels and Pelvic Floor Physical Therapy
Upon the invention of Kegel exercises, there was a large push within the physical therapy and gynecology communities for clients struggling with pelvic floor dysfunction as a whole, regardless of symptoms, to perform Kegel or pelvic floor muscle exercises. With more available research and as the field of pelvic floor physical therapy has grown, we have learned more and now know that not every client needs to do Kegel or pelvic floor muscle contractions because not every person or diagnosis is the same. So the one size fits all treatment approach doesn’t exactly work as well as we once thought it did.
So what does all of this mean in terms of whether or not Kegels or pelvic floor muscle exercises are making your pelvic floor symptoms worse? Long story short: if you are doing Kegels without having had a formal assessment from a pelvic floor physical therapist, they may actually be making your symptoms worse, not better!
You may be wondering, “Wait what? I’m doing Kegels. Isn’t that what I need to do when I have a pelvic floor issue?!” In some cases, yes, pelvic floor muscle contractions or “Kegels” can be incredibly helpful and a part of the puzzle with addressing ongoing pelvic floor problems.
But in other cases, such as with pelvic floor conditions or dysfunction like pelvic pain, urinary urgency or frequency, constipation, and different types of pain with pelvic penetration (like vaginismus, vestibulodynia, and vulvodynia) pelvic floor muscle contractions can actually make your symptoms worse.
Usually for clients who are struggling with different types of pelvic pain, constipation, urinary urgency and frequency, leaking of urine with a strong urge to pee (urge urinary incontinence), and pelvic pain with pelvic penetration (such as during pelvic examinations or with tampon or menstrual cup use and with attempted sexual activity vaginally, anally, or both) I usually recommend steering clear of doing a regular regimen of Kegels or pelvic floor muscle strengthening exercises.
Frequently for clients that are struggling with these types of pelvic floor issues, it is not an issue of the muscles in the pelvic region being too weak, but rather, the pelvic floor muscles are too tense or tight and are usually a big driver of their ongoing symptoms.
So my biggest piece of advice is if you are struggling with pelvic floor issues and you have not had a formal pelvic floor muscle assessment completed, please see a skilled pelvic floor physical therapist who can give you guidance on whether or not doing Kegels or pelvic floor muscle exercises is right for you.
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re looking for treatment for pelvic floor dysfunction or are struggling with pelvic floor issues and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor treatment for pelvic floor issues.
Struggling with a pelvic floor condition? Check out my website here to see what conditions I treat as a pelvic floor physical therapist.
Dr. Brook Orvis (she/her) is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
