Why Kegels Might Be Making Your Pelvic Floor Symptoms WORSE!

By Dr. Katie Casto, PT, DPT, PCES

Many women experience pelvic floor related issues like urinary incontinence (leaking urine), bowel dysfunction (constipation, straining, incomplete emptying), pelvic girdle pain, pain with intercourse/penetration, pain with medical exams, needing to use the restroom frequently, etc. 
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Many women are also told just to “do kegels” to help their pelvic floor symptoms. The issue with this blanket recommendation to just “do kegels” is that all too often, the recommendation is made without an actual pelvic floor examination. Let’s discuss what a kegel actually is, and how Kegels may or may NOT be helpful based on the cause of pelvic floor dysfunction.

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What even is a kegel?
A “kegel” refers to a pelvic floor contraction. The pelvic floor is made up of 3 layers of muscles that form a hammock-like or bowl-like shape that support the internal organs of the pelvis (bladder, uterus, and rectum). A pelvic floor contraction is a “squeeze and lift” of the pelvic floor muscles. Importantly, this contraction needs to be followed by a full relaxation of the muscles in order to be effective. A kegel is NOT a butt squeeze or inner thigh squeeze. 

Pelvic floor contractions aren’t always helpful (and can actually make things worse) because there can be many different reasons as to WHY the pelvic floor muscles are weak or not functioning correctly other than simply not being able to contract strongly. “Kegels” are just one of many tools in the toolbox for pelvic floor health.

Let’s talk about 3 common CAUSES of pelvic floor dysfunction, and how treatment strategies differ in each case:
Hypotonic Pelvic Floor
This is the case most of us are probably familiar with. “Hypotonic” refers to pelvic floor muscles that are generally low tone.

• This can look like:
  • Pelvic floor contractions that are weak
  • Ability to relax the pelvic floor, but difficulty contracting 
  • Contractions of the pelvic floor that cannot be held for more than a few seconds, or that fatigue quickly 
  • Tampons falling out, sensation of heaviness 
• Treatment focus:
  • Progressively strengthening the pelvic floor 
  • Isolated strengthening progressing to more functional and specific activities 

Poor Coordination
Sometimes, the root cause of the pelvic floor dysfunction is uncoordinated pelvic floor muscles.

• This can look like: 
  • Difficulty isolating a pelvic floor contraction
  • Using incorrect or additional muscles during a pelvic floor contraction (ie. Squeezing glutes instead of pelvic floor)
  • Poor control of the contraction and relaxation of the pelvic floor
  • Difficulty contracting the pelvic floor in functional positions or with movement (standing vs. sitting vs. laying down, lifting weights, holding a plank, doing lunges, etc.). 
  • Poor timing of pelvic floor contraction or coordination with other muscles (ie. Abdominals)
• Treatment focus: 
  • Learning how to correctly perform a pelvic floor contraction and relaxation
  • Learning how to coordinate pelvic floor contraction with the rest of the core (breathing, abdominals, etc.)
  • Being able to contract the pelvic floor appropriately with different activities 

Hypertonic Pelvic Floor 
​A hypertonic pelvic floor refers to pelvic floor muscles that are generally high tone.

• This can look like:
  • Difficulty lengthening or relaxing the pelvic floor
  • Pain or discomfort with penetration
  • Constipation
  • Pelvic pain
  • Straining to use the restroom 
• Treatment focus: 
  • Initially, lengthening and relaxation of the pelvic floor muscles
  • Starting with kegels could make things worse:
    • Focusing on just pelvic floor contractions will likely worsen pelvic floor dysfunction. Think of your hand as a metaphor for the pelvic floor muscles. Imagine squeezing your hand in a fist for an hour. Then imagine repeatedly clenching your fist for 5 minutes after. As you can imagine, this wouldn’t feel great. Your hand would end up feeling very tired, tight, and possibly painful. After, when you go to grasp something with your hand - it’s going to feel weak.
    • This is a metaphor performing kegels for hypertonic pelvic floor. Performing repeated pelvic floor contractions on top of an already tight and overactive pelvic floor just results in a tighter, weaker, more fatigued pelvic floor (which can increase symptoms).
  • Once normal range of motion has been restored (ie.the pelvic floor muscles are able to relax/lengthen), then pelvic floor contractions and strengthening can be initiated.

In any of these 3 cases, the pelvic floor muscles can be (and likely are) WEAK. However, as you can see that the underlying issue or the “root” of the problem in these 3 cases of pelvic floor dysfunction is entirely different and would require a different treatment approach. This is why blanket statements of “just do your kegels” are largely ineffective and sometimes harmful.

Therefore, it is important to see a Pelvic Floor Physical Therapist for a full evaluation to determine what is causing your individual symptoms. A treatment plan should always be individualized to you and your goals for an effective and long-lasting solution.

Our Physical Therapists are trained in pelvic floor assessment and treatment and are passionate about helping women recover from pelvic floor dysfunction. Contact us at info@pacept.com // 512- 207 -0368 to learn more about our pelvic floor treatment options or to speak with a Pelvic Floor Physical Therapist.

Learn About Pelvic Floor Therapy

Reference: 
Duvall, Sarah. “Postpartum Corrective Exercise Specialist” Course. Core Exercise Solutions (2020)