To Kegel or not to Kegel...


Many of you may not even know what a Kegel is or you may have the misconception that they only apply to women. For those of you who do know what a Kegel is and have done them before, you might automatically be doing one right now as you read this.

Over the years there has been some discussion on whether or not Kegels are effective. And just as my professors from physical therapy school would say….it depends! So let’s dive into this topic and give you some background on Kegels and how they can, and can not be useful.

So what is a Kegel?

A Kegel is an exercise that was named after an American Gynecologist Arnold Kegel in the early 1900’s. He had noticed that post childbirth, his patients had a weakened pelvic floor. He developed a set of exercises along with a machine called a Kegel perineometer as a non-surgical way to strengthen the pelvic floor. The Kegel perineometer was a way to measure the muscle contraction when performed and to provide biofeedback to the patient on if they were contracting the correct muscles. Dr. Kegel had great success with his patients being able to strengthen their pelvic floor and in relation noted that they had decreased problems with incontinence and other related issues.

So what is our pelvic floor?

You, along with every single person you know has a pelvic floor and It is basically the floor of your pelvis! The pelvic floor (PF) is made up of a group of muscles called the Levator Ani and you may also hear it referred to as the pelvic diaphragm. These muscles support the pelvic organs, create closure through compression to assist with continence, aid in respiration, assist with back and pelvic movement and control, and sexual function. When there is a problem with the PF, it can lead to many different issues and we coin these problem/issues as pelvic floor dysfunction (PFD).

Pelvic floor dysfunction (PFD) is actually pretty common, however that does not mean that it is normal and acceptable! It saddens me when I evaluate a geriatric patient who willingly uses absorbing undergarments thinking that it’s just a part of getting older. Or, when I am having a conversation with another mom friend and she states that she doesn’t exercise as much or jump on the trampoline with her children because she leaks.

Although it is true that as we age we weaken and all of our muscles aren’t as strong as they were when we were 20. And women who are post partum do have a lot of changes that their body went through during pregnancy and childbirth which can lead to forms of incontinence. However, it does not mean that this is normal and that there is nothing we can do to change it.

Many factors can create PFD including trauma, pregnancy/childbirth, age, constipation, pelvic surgery and radiation, hormonal changes, poor posture, increased intra-abdominal pressure and/or sedentary lifestyle. PFD can present itself as weakness or excessive tension.

If there is weakness, there essentially is a lack of support and/or lack of closure which can ultimately lead to pelvic organ prolapse and/or back pain and problems with urinary and fecal incontinence. When there is excessive tension, it may be difficult for the muscles to relax causing too much closure which can therefore lead to painful sex, pain throughout the pelvis, and difficulty initiating the urine stream. Overall, there needs to be good muscle length tension along with good coordination and control of your muscles in order to effectively improve the PFD.

Understanding the importance of our pelvic floor and “keeping it in shape” is a great way to prevent dysfunction from happening in the future or at least minimizing the problems associated with it. It is good for everyone to know how to correctly activate, relax and control your PF when it is healthy so if you do have a problem in the future, you are one step ahead of the game and can possibly prevent further dysfunction.

Why a pelvic floor physical therapist is important when you have pelvic floor dysfunction and what does a Kegel have to do with it?

I like to think that exercises are good when done in moderation and when done correctly. The difference between a Kegel and a Kegel done correctly is similar to someone thinking they are doing a bicep curl at the gym and the trainer looks over and they are flapping their arms all around. Of course they are doing “something” with their arms, but they are not isolating and contracting the bicep the way the need to in order to build strength. Or on the other hand they know how to do a correct bicep curl, however the have worked that bicep so much that they are now unable to fully straighten their arm out because they forgot about stretching! It’s great that they showed up, but they are not helping or being efficient with what they had intentions on improving.

As a physical therapist, we are highly trained to teach, implement, and correct how we complete functional tasks. We use therapeutic exercise along with other modalities as a way to achieve optimum ability and the best outcomes with our patients. We understand that each person is their own individual with a set of their own strengths and weaknesses beyond just a physical aspect It is our job to evaluate the whole person and to see where the dysfunction lies and from there we begin to problem solve and work with the patient.

When it comes to Kegels, the therapist is able to determine if the PFD is related to weakness or being overactive through an evaluation. They are able to teach the patient how to complete a Kegel correctly and/or how to relax their PF correctly. Once the patient is able to isolate the correct muscles, the therapist will progress them through a series of exercises depending on what type of dysfunction is present and then they will begin to incorporate them into functional tasks. They may also provide some basic education on nutrition and changes that can be made in their daily habits and living to also improve upon the symptoms that they are experiencing.

So we should do Kegels, right?

Yes, Kegels can be very beneficial for the pelvic health of both females and males if there is weakness, however it is important to know how to do them correctly. If there is pelvic floor dysfunction present, it is best to speak with your healthcare provider and/or be evaluated by a physical therapist.