Could Kegels Be Doing You More Harm than Good?
June 1, 2020
What? But kegels (also called pelvic floor contractions) are good for everyone. That’s what the media says. That’s what medical doctors say. It’s common knowledge. Unfortunately, every time we hear about a pelvic floor problem we assume that it is due to weak muscles and that the only solution is to do kegels. But kegels are not a one-size-fits-all fix. They are great for some pelvic floors and not so great for others.
What exactly is the pelvic floor? It’s a bowl–shaped group of muscles that help to support the bladder, uterus in women, prostate in men, and the rectum. These muscles are also responsible for keeping us continent; that is, they keep us from leaking urine and stool. They do this automatically because our nervous system controls their activity. The muscles of the pelvic floor are always “on” (to keep things from leaking out) until we need to urinate or have a bowel movement. Then they relax or shut “off” to let urine or stool out.
Some people have overactive pelvic floor muscles. Basically, this means that the muscles have trouble shutting off. In this case, the muscles of the pelvic floor can become very tense and can’t respond like they are supposed to. I have always used the analogy of an elevator that is stuck on the top floor when describing this to my patients. You can push the “up” button all you want, but you’re not going anywhere. So, no matter how hard those muscles work to contract when they need to (like when jumping on a trampoline), they just can’t get anywhere, and voila, you have urine leakage.
Herein lies the problem with kegels. They can contribute to the tension in those pelvic floor muscles. So, for someone with an overactive pelvic floor, doing kegels can make symptoms worse and even create other issues like constipation, stool leakage, painful intercourse, pelvic pain, and even UTI-like-symptoms.
Here’s a clinical example that I have seen many times over the years: a 40–year–old woman leaks urine with coughing, sneezing, and jumping on the trampoline/jumping jacks (sound familiar?). She then sees her doctor, describes what is happening, and is instructed to do kegels. After several weeks, she starts leaking urine when she is walking. Just WALKING. The patient comes to see me since her problem has gotten worse. An assessment reveals that she has pelvic floor tension and a decreased ability to voluntarily contract the pelvic floor muscles. She has what I call, “a high, tight pelvic floor”. Her pelvic floor muscles are overactive and cannot shut “off”. So, when she started doing kegels, the urine leakage worsened because the kegels created even more pelvic floor tension, which made it more difficult for her muscles to do their job.
I’ve seen the same thing in female athletes (runners, weightlifters), post-menopausal women, young women in their 20’s. The common link in all of these cases is pelvic floor tension or overactive muscles. These patients can present with a myriad of problems. From urine leakage to painful intercourse to constant, chronic pelvic pain. The prescription? Pelvic floor relaxation (which involves pelvic floor physical therapy and patient education), NOT kegels.
Leanne Johnston, DPT has been treating pelvic floor dysfunction since 2007. She treats both women and men and is very passionate about helping her patients overcome issues that impact their quality of life.