Why Kegels Aren’t Always the Answer

Kegels are an exercise that strengthens the pelvic floor muscles. Strengthening the pelvic floor can be useful when the muscles are weak. 

But not all bladder, bowel and sexual problems are due to a weak pelvic floor.  

When NOT To Do Kegels

Tension in the pelvic floor muscles, hip stiffness or muscle tension, or other problems in the back and legs could be the cause of symptoms and in these cases kegels would be unhelpful at best and harmful at worst. 

If you were to do kegels and strengthen an already tense pelvic floor you could create more tension and worsen the symptoms. It's a little hard to visualize so think about a trampoline. In order to bounce on a trampoline we need to push the trampoline down. The farther you push down the more rebound and upward push you’ll get. The pelvic floor operates in the same way, lengthening and relaxing the pelvic floor down allows for more squeeze and lift upwards. Now if you have a trampoline that is pulled really tight and you can’t push it down then you won’t be able to bounce very high at all. It’ll be like trying to bounce on the ground. This is what happens when the pelvic floor is very tense or short. The muscles can’t relax or lengthen and so they also can’t squeeze and lift up. 

Typical symptoms of a tense/short pelvic floor: 

• Frequent bathroom trips

• Pain - bladder or pelvic

• Leaking with jumping, running, activities

When To Do Kegels

The reverse is that the trampoline could be worn out and sagging. It doesn’t have very much elasticity and in this case the trampoline falls down with very minimal effort but doesn’t have enough spring to be able to lift back up and propel you upwards. This is how weakness or excessive length in the pelvic floor works. 

Typical symptoms of a weak pelvic floor: 

• Urgency

• Bowel leakage or urgency

• Leaking with jumping, running, getting up from a chair

• Prolapse

In this situation, strengthening could be incredibly helpful. If weakness of the PF alone is truly the problem you’ll have symptom resolution within a month. If that’s not the cause we’d also want to combine the pelvic strength with looking outside the pelvic floor!

What If Kegels Didn’t Work?

The pelvic floor is one group of muscles but they work within a whole system that needs to operate well in order for pain, bladder leaking, bowel urgency and other symptoms to resolve. 

Going back to our trampoline example - The pelvic floor with the part you jump on. The frame is your pelvic, hip and spine bones. The springs that connect the two are the other muscles around the pelvis, hips and trunk.  If you have springs that are not connected or have worn out and aren’t springy anymore then the middle part of the trampoline won’t work. You’ll jump and even though the stretch and strength in the trampoline middle is perfect you’ll fall straight to the ground if the springs are too weak.  

The hip muscles work the same way. They support the pelvic floor by providing a foundation for the pelvic floor muscles to pull on. If the hip muscles are weak they won’t be able to support the pelvic floor and if the hip muscles are short or tight then you’ll have too much tension preventing the pelvic floor from lifting up. 

This is more often the case and we find that treating the hips, back, ribcage and other parts of the body create a better framework for the pelvic floor to function and when every part is working optimally individually the whole system can come together beautifully and you can jump and backflip and laugh without worry!