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When Kegels Do More Harm Than Good

Sit forward, slight inward curving back to prevent a short pelvic floor

Strength Training for healthy muscle is generally good – it thickens the muscle tissue (hypertrophy), increases motor neurons activity for better awareness and reaction time, and improves muscle tone.  Kegels, a specific exercise for the pelvic floor, may help in reversing incontinence, preventing prolapse, increasing sexual pleasure, and stabilizing our core, but they don’t do the full job by itself and can be harmful.   As a pelvic physical therapist treating men and women with pelvic floor dysfunction and pain for 18+ years, I’ve found that the regular performance of Kegel exercises, especially if self-taught, may aggravate or even lead to dysfunction and pain.

How can Kegels do Harm?

Most people who experience leaking, urgency, prolapse, sexual dysfunction and pain in pelvis/groin/hip have short, or “non-relaxing” pelvic floor muscles. A short pelvic floor means just that – instead of returning to a lengthened state at rest, the muscle stays chronically short. Performing repetitive Kegel exercises to these already shortened muscles can further shorten and weaken those muscles leading to pain.  At EMH Physical Therapy, we advocate learning how to relax and lengthen the pelvic floor while recruiting other external muscles to work more effectively for best outcome.

What is the function of the Pelvic Floor?

The pelvic floor muscles attach from the pubic bone in front of the pelvis to the coccyx bone in back. During pelvic floor contraction, the muscle gently pulls the coccyx slightly forward.  The pelvic floor squeezes the urethra shut when not at the bathroom (no leaking), relaxes during urination (no hesitation) and bowel movement (no constipation), and works with the deep lower abdominal and lower back muscles to stabilize our body in preparation for movement (preventing back/hip pain).

A chronically short pelvic floor keeps the coccyx tucked forward, cannot fully relax during urination and bowel movements and because it is weak, can lead to leaking.   Research shows that pregnancy is not the main cause of pelvic floor issues, as teenaged girls, women athletes who have not been pregnant and men suffer from pelvic floor issues.

How does the Pelvic Floor become Short and How to Reverse this Habit?

Think about how you position and use your body during your day.

At the office: are you placing weight backward on the single small coccyx bone (not good) or on your two larger ischial tuberosities (good)?

Is your lower back rounded or flat (not good) or have an inward curve (good)?

At home: Avoid slouching on couches – use back pillows and support your feet.

Here are some Tips to Reverse a Short Pelvic Floor

  • Sit with your spine against the back of your chair, placing a roll or pillow in the lower back.
  • Stand up regularly.
  • Keep your gluteal muscles toned with regular squats, bridging or hip extensor exercises. Gluteal activation helps to lengthen the pelvic floor to prevent chronic shortening
  • Keep your hamstrings and inner thigh muscles flexible. STRETCH or foam roll these muscles. Tight hamstrings and adductors directly refers tension into the pelvic floor.
  • Check your pelvic floor tension throughout the day- gently squeeze this muscle first and then completely release. Feel this release for a few seconds and see if you can relax a bit further.
  • Take a deep slow inhale – allow your abdomen to expand and think of the pelvic floor widening as you inhale. Exhale as you keep the pelvic floor open.
  • Yoga positions such as Childs Pose, Happy Baby and Pigeon Pose help to open the pelvic floor and hips as you slowly breathe.  Maintain each position for 30 seconds.
  • Consult with a pelvic physical therapist for tailored therapy and home exercise program