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To kegel or not to kegel that is the question

What are Kegels?
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Has someone (your doctor, nurse, midwife, physio, exercise leader) told you that doing “Kegels” is a good idea? Many of us have received these words of wisdom. At that moment, this was our best advice! But, time has moved on and so has our best practice recommendation for restoration of your pelvic floor.

What are Kegels? During WW II, Dr. Arnold Kegel helped women greatly by advancing the world of gynecological medicine by researching women’s pelvic floor muscles. He developed an instrument to measure pelvic floor activation and strength. His goal was to help women recover from the delivery of their babies and to prevent prolapse. Wonderful! But, time is up. We’ve advanced so much further since 1942.

Here are the facts:

• The word Kegel doesn’t mean anything. Thousands of women in the UK were asked what “do your Kegels” meant to them and there was a huge variability in their answers. The word hasn’t held its value over the years.

• Studies estimate that 70% of women given verbal instruction to “do their Kegels” do it wrong. That is to say, they do it with poor timing, wrong muscles (using their buttocks, groin or deep belly muscles), variably (sometimes good/sometimes bad) or paradoxically (upside down, creating prolapse of their uterus, bladder or bowel).

• The pelvic floor (the focus of Kegel exercises) is the base of your core. The front wall is the deep abdominal muscle system (Transversus Abdominus and friends). The back wall is the deep back extensor muscle system (Multifidus and friends). The roof is the respiratory diaphragm. It’s like an enclosed cylinder (think round cookie tin). If you try to isolate the muscles of the floor, you don’t help the core synergy work well. It’s about learning to activate and release your whole system so that the pelvic floor works in perfect timing and synergy with the rest!

• All women have a Diastasis Rectus Abdominus after they’ve been pregnant and given birth. That is to say, they have a break in the middle line down their abdominals, a split in their Linea Alba. It’s normal. Expected. Isolating a pelvic floor muscle contraction can stress the abdominal structures, delaying or preventing the restoration of the deep core and healthy pelvic function (bladder, bowel, pelvic organ support and resuming intimacy).

• Most women (about 70%) after menopause have a tight and weak pelvic floor. Picture your elbow, bent up past midway, tight but weak. Now think about working at strengthening that elbow in that position. It might get stronger, but it will probably also tighten up. This is how Kegels affects your tight and weak pelvic floor. It can heighten both urge (running to the loo, losing a few drops en route) and stress (a wee leak with a cough, sneeze, effortful work or even bending over) incontinence! In this situation, doing your Kegels makes you worse.

Firstly, find out what your very own pelvic function is doing. Have an assessment. Then learn how to do appropriate, strong, synergistic, organized, timed and lovely pelvic floor contractions AND releases. Learn how your pelvic floor works with the deep core. Learn how to use the perfect amount of pelvic floor activation for what you do each day. Don’t be limited by incontinence, long/slow/weak urine flow, poor bowel release/constipation, poochy tummy/poor core control, pain with intimacy, dropping off your organs/prolapse or poor recovery from pregnancy.

Your pelvis and deep core are like a ballerina – strong, supple and brilliant. They want to work well and serve you for a lifetime of lovely pelvic function.