I remember back in the early 2000s, everyone was talking about the importance of doing pelvic floor exercises and various women’s magazines promised amazing sexual experiences and the answer to all post partum woes, with no more prolapses. Kegels were the answer to anything and everything down there.
Go for a pap smear, you would be asked if you do your pelvic floor exercises. Pregnant? “It’s really important to do your pelvic floor exercises”. Just had a baby? “Don’t forget to do your pelvic floor exercise?” Endometriosis and extreme period pain, “what do you expect if you haven’t been doing your pelvic floor exercises?”
And if you asked “what is a pelvic floor exercise?” You would be told to stop your pee midstream and that was often the extent of your coaching. Sometimes, you would be told to do it 5 times each time you pee but that was it. In yoga today, I see a lot of instructions on mula banda lock which are not always appropriate for each person.
Thank goodness, awareness is a lot better now but there are a number of people who are still making some mistakes.
Here are the most common mistakes I have come across:
- Assuming you need to do kegels without getting your pelvic floor assessed.
- Incorrect kegel technique.
- Not doing reverse kegels.
- Only doing kegels and not doing any other appropriate exercises for your pelvic floor, pelvic and abdominal organs.
Let’s take a look at these in a bit more detail.
Assuming You Need To Do Kegels
Kegels are a specific exercise for certain pelvic floor dysfunctions. Usually they are recommended for hypotonic patterns, eg “too loose” in layperson’s terms. However, there are a number of people in the health and wellness world who have overdone their kegels and now have hypertonic pelvic floor (too tight) causing a number of issues from pain, urinary issues, and pain during sexual intercourse and orgasm. Even worse, now we get people who mistake these symptoms for being a sign of a hypotonic pelvic floor and do even more or the same, making their issues worse.
Also, guessing whether you are too tight or too loose based on symptoms may give a general overall impression of your pelvic floor tissue status, however, the most common presentation is a combined. Some people will have bits that are too tight, other areas that are too lax or overstretched and one set of symptoms will win out, but that doesn’t mean that that is the full picture.
Incorrect Kegel Technique
Most people are just instructed to activate their pelvic floor by stopping pee mid stream, or there are apps that tell you when to “hold” and when to “release”.
This is an extremely simplified explanation. It is missing a few things. You don’t just engage these muscles by turning them on or off, or holding them. They are not a switch with two positions. Proper kegels are a progressive technique such as imagining a marble rolling up the vagina and doing so in a controlled way.
This is a very different sensation to the “on or off” binary we are often told to do.
Not Doing Reverse Kegels
As well as doing that steady controlled gradual, progressive kegel action, there should also be a controlled release, imagine rolling the marble back out the vagina. Again this needs to be done in a controlled deliberate way.
Hopefully you can see that this technique is far more subtle than simply just on and off.
Not Assessing Or Working On Other Muscle Groups That Affect the Pelvic Floor & Organs
The pelvic floor muscles on their own are already a very intricate set of muscles in three layers that interweave around the pelvic bowl and interact with other muscle groups. But they don’t just work on their own. Other tissues that affect the pelvic organs include, 8 ligaments that hold the womb and ovaries in place, the glute muscle groups of each buttock, and the abdominal muscles.
Which ones should be worked and what should you do to help these areas? That’s a great question. Let’s look at what you can do.
What You Need To Do About Your Pelvic Floor
The absolute gold standard is to get an assessment by a qualified professional in this area. In the UK we have Womens Health Physiotherapists. These are qualified and experienced physiotherapists who have done extensive specialist training in the pelvic floor, overall pelvic and genital health.
The US equivalent is a Pelvic Health Physical Therapist. The differences between these professionals is very small and whatever you find in your country out of either of these is fine.
These professionals are used to dealing with all sorts of potentially embarrassing issues, assessing genital tissue for health and creating an environment to help you feel safe and at ease with them. They can do various assessments and make diagnoses that other gynaecological or urogenital professionals can also make and they can have the awkward conversation with your doctor on your behalf.
My personal opinion is that these professionals should be a key part in the life of all woman and those who have or have had female reproductive parts. In my ideal world, we would be referred to them and have their assessments and treatments funded when we experience period or pelvic pain, during the pre pregnancy period, during pregnancy, post partum, perimenopause, post menopause, throughout the hysterectomy process and throughout any other invasive surgical process such as surgery for ovarian cysts or endometriosis.
In many cases they are a rare jewel and not easy to find, but if you are experiencing any pelvic floor symptoms or in any of the life stages I mention above, if you can see one, please do. Since Covid, many of them now offer online consultations in which they ask you to perform exercises and help to interpret results of those tests.
They can give you exercises that are specific to your circumstances, give you the appropriate cues and ensure that you can do these exercises correctly and safely. They can also direct you as to how often to do them.
If you have other issues such as struggling with your pelvic floor or incontinence post surgery or post partum, they can tell you how to support yourself when you need to sneeze, cough or toilet so that you optimise your healing process.
As a side note, does anyone else think it is bonkers that normally with extensive deep pelvic surgery, the ideal treatment plan would include pre-hab and re-hab, but when someone has a C section, all that goes out the window, and not only do they not get re-hab, they have to care 24/7 for a little human who is completely dependent on them too?
Other Alternatives To Seeing A Specialist
OK, so you may not be able to find or afford treatment with a Womens Health/Pelvic Health PT, what are the alternatives available?
Some massage therapists, yoga teachers and personal trainers with very specific advanced training are taught how to assess these different areas and are allowed to share the tests of how to assess these areas with you, and you can report your results back.
They can then tell you what exercises are appropriate for each result but there is no diagnosis and the exercises or massage are based purely on the results you report.
This option can be great and anecdotally, I have had great results with a number of clients, but I would be remiss if I didn’t say that the gold standard is a specialist womens health/pelvic health physiotherapist.
It is also worth noting that mixing these services such as getting an initial evaluation from a physical therapist and combining it with a massage therapist, yoga teacher or fitness professional who has some specialist training can be a great option too.
When To Avoid Or Be Careful With Health & Wellness Professionals
I want to preface this with, it’s not that people have any ill intention, but the basic training for body work therapies such as fitness instructor, yoga teacher training and massage therapy, do very little training for specialist areas, it is more general training that is suitable to overall health and wellbeing rather than for targeted areas. This training on its own is very in depth as it literally has to cover the whole body at a general level and ensure a solid base before anyone goes on to specialise.
As a result, some professionals will give generic cues and prompts such as “tuck your tail under” or to imagine holding your pee in when it isn’t appropriate for you. And if you are generally well and don’t suspect any issues, or even if you do suspect you have pelvic floor issues, sticking to most of the general prompts is fine.
However, if you are being asked to do things such as pelvic floor exercise or anything that exacerbates an injury or painful area, this is a sign you need to see someone who is specialised in that area.
Final Thoughts On Kegels
Kegels are great exercises when done properly and appropriately. The issues come about when kegels are done incorrectly, inappropriately or without proper assessment of the area. If you can, get a proper assessment before indulging if you have any existing or suspected pelvic floor issues. And if you really do want to go it alone, look at programmes that help you work all the relevant tissue groups, not just the pelvic floor.