Kegels: Not a one size fits all.

So in our first ever blog post, can we get a whoop whoop, we very boldly said “Don’t do kegels”. However, we very clearly said add an asterisk to that statement. So why?! If you didn’t follow our advice, you likely Googled and found hundreds of articles, websites, and opinions of mixed evidence behind performing kegels. If you did take our advice, you were either patient enough for this post OR even better, sought out the care and advice of a Pelvic Health PT. Good for you either way. Guilty of having one of us in each category when it comes to our own health. So no judging!

Ok, well let’s back up. For those of you who didn’t Google the word kegel. We did it for you. According to the search, one of the first things that comes up is the Oxford Dictionary definition. So here goes:

Kegel

/ˈkāɡəl/

noun

1. denoting exercises performed by a woman to strengthen the pelvic floor muscles, involving repetitions of both sustained and rapid voluntary contractions of the muscles and used especially to treat urinary incontinence and improve sexual function."she recommends women do Kegel exercises two to three times a day"

   • Kegel exercises.plural noun: Kegels "the best part about Kegels is that you can do them whenever and wherever you want to”

Yep. Another copy and paste action. And another crapshoot of a definition. This is terrible. Seriously. First of all, a kegel can be done by ANYONE with a pelvic floor. Which is EVERYONE. Did you not learn anything from the first post?! So like how sustained or how rapid?! I mean is your vagina sending Morse Code?! It is just enough info to make you start messing stuff up.

Here is why we said “don’t do kegels”. As mentioned before, your Pelvic Floor Dysfunction can be from one of many things. Most commonly (but certainly not limited to), A) you are weak or B) you are “tight”. Hopefully by the end, you won’t roll your eyes that we put “tight” in air quotes and visualize us rolling our eyes as we have to continue to give it air quotes. Because your pelvic floor is a group of muscles, they can get “tight” just like any other muscle. Most people think of their hamstrings being tight, but your pelvic floor can be “tight” as well. Typically when your pelvic floor is “tight”, it is actually what we as therapist refer to as hypertonic. This easily translates from fancy medical word to “over tensioned”. This truly is a more accurate description of what is happening, rather than tight. So this tensioning, what is happening? Well, if a muscle is wanting to perform an action, it is actually being contracted, aka shortened on purpose. Your bicep contracts and shortens to bend your elbow, your quads contract and shorten to straighten your knee, so on and so on. So when your pelvic floor contracts on purpose, it can perform the variety of tasks from our first post: STABILITY, SUPPORT, SPHINCTERIC, SEX, and the forgotten SUMP PUMP. When the pelvic floor is contracting constantly, it is constantly shortened. It then gets the reputation of being “tight”. And that is no bueno mis amigas — and sorry, I have no clue if that is accurate, just feeling festive from all the guac’ I consumed today.

So what’s the big deal?! Why does it matter if it is tight all the time? Isn’t that supposed to be a good thing? Isn’t it already doing what is it supposed to do?!? Well, no. And here is why. Picture an accordion. As you can probably tell, I (Allison here) am a very visual person. And as mentioned before, I HAVE to understand something before I can commit it to memory. So this accordion—to make it work you have to pull and squeeze, back and forth, lengthen and shorten to make somewhat attractive music. Not our favorite style of music. But not here to judge if it’s yours. Well now you adjust it and this accordion’s folds are removed and it is now much shorter. There is not as much room to lengthen and shorten. But when you do move this new accordion back and forth, it actually manages to forcefully squeeze a scratchy and high pitched sound out that only dogs can hear. Not sure if that is accurate either: 1) We are not dogs, so not sure if they can hear it— and 2) We don’t actually know anything about playing an accordion. You get the point. So that is your pelvic floor, and really any muscle for that matter. If you don’t have the full length to contract because it has already been shortened, you can’t make as much beautiful music (ie. those 5 S’s or just general muscle power) and that high screeching sound that is forced out, is often your pee. In your pants. BAM!!! How’s that for a visual?! Or sadly, just a dose of your daily reality.

Ok. Sorry we got a little excited on that one. But for real. Read that paragraph again. Refer to the original blog about anatomy. Everytime you cough, sneeze, jump, pick something up, etc (try one of those things now), your abdominals and diaphragm contract and cause increased pressure downward in your abdominal cavity and pelvic floor. Seriously, cough and you can see and feel it. Your pelvic floor has to respond to those actions by an equal and opposite contraction, almost as if it is bracing itself for the incoming load. Because it is. Again, if it is hypertonic (the adjective formally known as tight), when it squeezes even more, those dang organs it supports are getting squeezed too. And if you have ever had a baby, you know, any excessive pressure on that squishy balloon of a bladder makes you have to pee.

This constant pressure on your bladder can lead to the dreaded “I” word, incontinence or even worse, the dreaded “P” word, prolapse. ESPECIALLY, if it is also paired with weakness. Get pumped up! We are going to do a special blog post JUST on these items as well. So if you pee your pants, just a dribble or even enough that it runs down your leg, you won’t want to miss it.

So you might be saying, Allison and Lauren, we get it. Your pelvic floor can be “tight”. But why?! Ladies, we don’t have a direct answer. The true answer is, it depends. No pun intended. Often, our pelvic floor is hypertonic from being weak. What?!? So we are tight because we are weak?! So wouldn’t doing kegels actually solve the problem?? Again, no. In therapy, we must identify the WHY and not just the WHAT. There is a laundry list of reasons and combinations of why someone can have increased tone in their pelvic floor: trauma, tightness of other muscles, weakness of other muscles, weakness of the pelvic floor, vaginal scar tissue, c-section scar tissue, low back pain, hip pain, pregnancy, stress, pathological changes in the hip or back, hormonal changes and so on. The reasons for weak pelvic floor are: trauma, tightness of other muscles, weakness of the pelvic floor, vaginal scar tissue, low back pain, hip pain, pregnancy, stress, pathological changes in the hip or back, hormonal changes and so on. Wait?! Did we just copy and paste that list?! Yes. Yes, we did. You are so slick.

Because it is so complicated, whenever we have friends who ask- should I just do kegels?! The response is usually a quick no. But really it depends. GENERALLY, I do not ever give my patients kegels on day 1. There are multiple layers of that brick house that are dysfunctional and not just their pelvic floor. We will be touching on some of these basics throughout the month, but PROMISE to teach you a proper kegel by the end.

So, to better understand, we’ve decided to break down signs and symptoms of Pelvic Floor Dysfunction based on being “tight” and “weak” to better help you find out which category you are likely in. Remember, an evaluation by a provider is best. But just some things to think about to get your wheels turning.

You might be “tight” if:

You have pain. Pain with sitting, specifically in your booty, anal region, vaginal region, or tailbone. Pain with anything being inserted vaginally including your tampon, exam tools by your provider, penetration from your partner, and difficulty or pain removing these items. Pain that is stabbing, burning, or even thought of as heaviness.

Your poop changes. It can be hard, thin, tough to squeeze out, or just won’t come out. Pain in your rectum. Hemorrhoids. Or any feeling like you haven’t quite gone all the way. Feeling pain after a poop.

Your pee pee is cray cray. Any sort of bladder or vaginal pain. Difficulty initially peeing. Difficulty getting all the pee out. Odd tinkles vs steady stream. Burning of any kind.

Your sex is not magic. It is painful with insertion, during, or even after. Sensation that you are being torn or even raw. Having difficulty reaching an orgasm.

You feel tight. As simple as it sounds, if you feel tense or tight in the muscles surrounding your pelvic floor, you likely are. Mind. Blown.

In all seriousness, we definitely stand by our first recommendation of “don’t do kegels”* if you are experiencing any of these things. Strengthening of the surrounding musculature, stretching appropriate muscular and keepin’ your ugly stepsister sized foot out of this glass slipper, because kegels are not a good fit for you.