Kegels

Hey, friend, Your Pelvic Bestie here. It’s good to have you. As you know, I’m a pelvic health physical therapist, which means I deal with all things relating to the pelvis (and beyond). There is so much that goes into pelvic health, but the general public seems to think kegels are all that matter. A lot of the time I meet someone and tell them what I do for a living, only for them to immediately respond with “I’m doing kegels right now” as if I’m the posture police and I just caught them with bad posture. Kegels are a wonderful tool, but I personally think they are way over-utilized. Most people don’t need to be doing kegels regularly and in some cases, it can make your symptoms worse! Let’s talk about what kegels are, when they’re useful, and when they’re not.

What are kegels?

A kegel (pronounced “kay-gul,” not “kee-gul”) is a pelvic floor muscle (PFM) contraction. The PFMs are a group of muscles that sit within the pelvic cavity. They form a little bowl-shaped, shelf-like structure and provide support to the organs of the pelvis. Just like the rest of the muscles in our bodies, they can contract and relax. Imagine the bicep muscle that you use when bending your elbow during a bicep curl. When your arm is straight down to your side, your bicep muscle is relaxed, but when you bend your elbow and curl the weight toward your shoulder, your bicep muscle is contracted. A contracted muscle is a muscle that is doing work. Muscles can become shorter, longer, or stay the same length when they contract. A kegel is kind of an old-school name for a PFM contraction. They got their name from Dr. Arnold Kegel who first described the movement in 1948 (1). It’s also a lot easier to say “kegel” than it is to say “pelvic floor muscle contraction,” and so the term has stuck around.

When are kegels beneficial?

Training the pelvic floor has been shown to be helpful in many pelvic floor dysfunctions. For example, pelvic floor muscle training (PFMT) can improve symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), pelvic organ prolapse (POP), erectile dysfunction (ED), fecal incontinence (FI) and many more conditions. It is important to note, however, that PFMT is only beneficial when kegels are performed correctly. Studies show that, while it may seem natural, many people are unable to perform a kegel correctly (2). A proper kegel involves a squeeze and lift of the PFMs and even a slightly forward movement of the PFMs toward the pubic bone. Without accomplishing all of these components, PFMT will be less effective. A pelvic floor specialist will help guide you toward correct kegel performance, also known as a correct pelvic floor muscle contraction. Once you are able to correctly contract the pelvic floor muscles, you will work on increasing strength, endurance, and power, just as you would with any other muscle you are trying to strengthen.  

When are kegels not beneficial?

Kegels are not a one-size-fits-all treatment, but they seem to be perceived as such by the general public. I am constantly seeing TikToks about making sure to complete your “daily kegels.” This is a PSA to STOP DOING KEGELS! Seriously. They have their place, as I just outlined above, but often times they are not a fit. Here are some cases in which I would not recommend kegels:

-       Urinary urgency/urge urinary incontinence (UUI): In folks with UUI or urinary urgency, especially where there is a lack of SUI also present, kegels can do more harm than good. The urgency can be coming from tightness and tension in the PFMs and the solution would be to work on relaxing and lengthening the PFMs. Adding regular kegels can do the opposite and decrease PFM relaxation, therefore making the problem worse. Note that in these cases, I still recommend occasional, quick contractions of the PFMs for urge suppression (which is supported by research).

-       Late pregnancy/preparing for birth: Pregnant gals are often telling me how they want to take care of their pelvic floor during pregnancy and strengthen it before they give birth. There’s nothing really wrong with this, but the reality of birth is that it requires the PFMs to stretch and lengthen a bunch. I think pregnant folks should focus more on the act of bearing down and lengthening their PFMs in order to prepare for the birthing experience. Doing kegels/PFM contractions is just practicing the opposite motion that you will be performing during childbirth.

-       Pelvic pain: This is an extremely general category and kegels might have a place in some cases of pelvic pain. However, in the majority of cases, pelvic pain is only worsened by increased tightness and tension of the PFMs. Kegels can worsen already tight PFMs and put increased pressure on painful structures of the pelvis, such as the nerves. I’d avoid kegels in cases of painful bladder syndrome (PBS)/interstitial cystitis (IC), chronic pelvic pain, constipation, vaginismus, dyspareunia, pudendal neuralgia, and endometriosis.  

If you’re suffering from pelvic floor dysfunction, let this be your sign not to jump directly into kegels. Even if your diagnosis is one that could benefit from kegels, chances are you could benefit even more from talking with a professional to make sure your form is correct and to provide you with a treatment plan. I would highly recommend chatting with your pelvic health professional prior to initiating kegels because they can do more harm than good in some cases. If you’ve done kegels before or if you do them regularly, have they worked for you? Did this chat change your opinion on the topic?

I can’t wait until next time.

XOXO,

Your Pelvic Bestie

References:

1.  Huang YC, Chang KV. Kegel Exercises. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555898/

2.  Welles Henderson J, Wang S, Egger MJ, Masters M, Nygaard I. Can women correctly contract their pelvic floor muscles without formal instruction? Female Pelvic Med Reconstr Surg. 2013 Jan-Feb; 19(1): 8-12 http://doi.org/10.1097/SPV.0b013e31827ab9d0

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives