KEGELS VS. REVERSE KEGELS
The term kegel was first coined by Arnold
Kegel in 1948 (1). Although it seems like Kegels are relatively new, kegels were
an important part of Chinese Toaist exercise programs for the last 6000 years
(2). Kegel exercises are best described as, squeeze like you are stopping the
flow of urine.
These exercises were found to be helpful in
reducing urinary symptoms, pelvic organ prolapse symptoms and in some cases
improving sexual function. Studies have found that more than 30% of women with
pelvic floor problems are unable to contract the pelvic floor muscles correctly
on their first consultation (3). So 3 out of every 10 ladies who are performing
kegels are doing them incorrectly.
Women after childbirth are typically told
to perform kegels daily, some might be provided a sheet with instructions but
it is not common practice to actually check if this exercise is being performed
correctly.
The Kegel itself is an inward lift and
squeeze that occurs around the urethra, vagina and anus (3). The pelvic floor
muscles contract as a whole but attention can be given to focus awareness to
different parts of the pelvic floor.
When I assess the pelvic floor muscles I am
looking to see the quality of contraction from left to right and from the
front, middle and back muscles. I test for endurance to determine how long you
can contract and how many times you can contract to 10 seconds before your
muscles get tired. I also test for speed.
The 30% of women that do not perform kegels
correctly are usually squeezing around the abdomen, butt muscles or inner
thighs. These muscles are around the pelvis but play no part in preventing
urine leakage. Another thing I often see is a lack of coordination between the
pelvic floor muscles and the diaphragm (our breathing muscle).
You may be wondering why that’s even
important. Well, because the diaphragm and pelvic floor move together firstly.
Secondly they both are part of the “core” muscles. But let’s look at the first
part. When you inhale, the diaphragm muscle flattens downward creating pressure
on your abdomen and intestines. To release this pressure generated by the
diaphragm and lungs the pelvic floor relaxes so the intestines have more space
and therefore less pressure. When you exhale, the lungs deflate and the
diaphragm moves upwards allowing the pelvic floor to lift back up.
In the beginning just performing kegels
without breathing is fine, but then it needs to be coordinated with breathing.
We need to train the “brain” that on exhale the pelvic floor needs to contract.
What is a cough or a sneeze? Well it’s a high pressure exhale! What do we need
the pelvic floor to do during an exhale? We need it to contract and lift up so
we don’t leak.
For those ladies looking to get back into
fitness and high impact exercise: regular kegel practice may not be enough for
that. With exercise the kegels need to be coordinated with the rest of the core
which is made up of the diaphragm, pelvic floor, transverse abdominis (TA) and
multifidus a deep back muscle. These muscles turn “on” before movement occurs.
They need to contract before a jump, contract before a dead lift, etc.
Ok, so let’s say you’ve been practicing
your kegels, but they don’t seem to be helping. What might be some of the
reasons.
- Performing them incorrectly
- Exercise program not specific enough for your needs.
- What I mean by this is that the intensity, frequency and duration of your kegel training may not be enough. Exercise programs can vary from 30-360 contractions daily. Length of the hold can vary from 5-30 seconds and programs can run from 6 weeks to 6 months (2). Also the coordination thing I mentioned above, may apply here too.
- The pelvic floor is too tight!
I have been talking a lot about kegels and
they are important, BUT, they are NOT for EVERYONE. In some cases kegels can
actually make your symptoms worse. Researchers were curious why in some cases
women got worse with kegels. They had weak pelvic floors, so naturally kegel
training would help. What they found was that women can have “short” pelvic
floor muscles which can make them weak and painful (4). By “short” we mean
tight/tense.
So why would that matter? If the pelvic
floor muscles are tight they will have limited ability to move. If the muscles
cannot move through the full range of motion, the muscles cannot generate enough
force a) to stop the activity/contraction of the bladder b) generate enough
contraction to close the urethra during a cough or sneeze and c) if the muscles
cannot move well, you can’t strengthen them well.
Kegels should never be painful when you are
performing them. This may be an indication that you are tight and should stop
kegels and seek help. If you have to pee a lot and feel that urge to go all the
time, you may be too tight. If you are doing kegels and are not getting better
you may need to learn the REVERSE kegel.
In some cases, once you learn to relax the
muscles properly, strength and endurance comes back on its own. If not, then
kegels may need to be re-visited.
To find a therapist local to you for
assessment and advice, go to www.pelvichealthsolutions.ca
Thanks,
The Pelvic Health Lady
References:
1.
Wikipedia. 2017. Kegel exercise. Accessed on August 10, 2017
from https://en.m.wikipedia.org/wiki/Kegel_exercise.
2.
Bø, Kari. 2004. Pelvic floor muscle training is effective
in treatment of female stress urinary incontinence, but how does it work? Int
Urogynecol J, 15: 76-84.
3.
Bø, Kari. 2012. Pelvic floor muscle training in the
treatment of female stress urinary incontinence, pelvic organ prolapsed and
sexual dysfunction. World journal of urology. 30:437-443).
4.
Fitzgerald, MP and Kotarinos, R. 2003. Rehabilitation of the
short pelvic floor. I: background and patient evaluation. Int Urogynecol J. 14:
261-268.
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