Kegel exercises are the most frequently recommended and most frequently mis-performed thing in the whole of urogynaecology. “Do your Kegels” takes a doctor fifteen seconds to say, without an examination — and in a proportion of cases it does harm.
Two different problems, one set of symptoms
Leaking urine, heaviness, pain during intercourse, urgency — these symptoms can come from weak pelvic floor muscles or from overactive ones. From the outside they look identical. The treatment is exactly the opposite.
A muscle held in constant excess tension is weak — not because it is slack, but because it has nothing left to contract from. It is already fully shortened. Adding strengthening exercises is like telling someone to clench a fist that has been clenched for an hour.
That is why the first thing in the practice is a functional examination: resting tone, contraction strength, and — equally important — the ability to release fully.
The most common technical mistakes
Even with a genuinely weak pelvic floor, most women exercise ineffectively:
- Squeezing the buttocks, thighs and abdomen instead of the pelvic floor. There is visible movement, but the wrong muscles are doing it.
- Holding the breath. This raises pressure inside the abdomen and works against the intended effect.
- Only training the contraction. Releasing is half the exercise, and it is the harder half.
- Stopping the flow of urine as training. That is a test, and not an entirely safe one — not a method. Doing it regularly disturbs the mechanism of emptying the bladder.
- Too many repetitions. The pelvic floor tires like any other muscle. Overtrained, it starts to hurt.
How to check whether you can feel them at all
A simple test: in a comfortable position, try the movement of “holding back wind”, without squeezing your buttocks and without holding your breath. Put a hand on your abdomen — it should stay soft. Hold for three seconds, then release completely and notice whether you can feel the difference between the contraction and the rest.
If you cannot feel that difference, or cannot separate the pelvic floor from the buttocks, exercising on your own at this stage makes no sense. First you have to find those muscles, then you can train them.
What a visit gives you
The examination settles which of the two problems you have and shows whether the contraction is even going in the right direction. The programme follows from that: for one patient it will be training, for another manual release, breathing work and trigger point therapy.
Urinary incontinence is not a natural consequence of childbirth or of age, and in most cases it can be reduced considerably. There is one condition: you have to know what you are training.
- pelvic floor
- incontinence