Doing your kegels and still leaking? Read this.
If I had a nickel for every time I heard someone say, “Just make sure you do your Kegels”, I would have quite a few nickels... But, I also hear women talk a lot about how Kegels AREN’T working for them.
But, why? It’s an exercise to strengthen the pelvic floor, so why wouldn’t it work?
In my opinion, the Kegel is a catch-all exercise for a complicated thing. It fails to take into account the OTHER muscles at play when we’re dealing with weakness, or tightness, of the pelvic floor. Not to mention the actual person the pelvis belongs to, their symptoms, and their history.
The biggest missing piece here is the lack of mention of the core system as a whole and how it works together. The pelvic floor often does not work solo, nor does it work simply to stop the flow of urine; there’s a lot going on down there that we don’t think about. We need to take into account what’s going on from diaphragm to floor, which is sort of similar to a canister.
The top of the canister is the diaphragm, your breathing muscle. In the back, you’ve got the multifidus muscle that stabilizes the low back and pelvis. Up front you’ve got the transverse abdominis (TVA), which also helps in stabilizing the low back and pelvis. Then right there at the bottom of the whole shebang, you’ve got the pelvic floor that spans pubic bone to tailbone and hip to hip. The pelvic floor supports your internal organs, aids in elimination, and plays an important role in sexual function.
All together, the core canister helps support your back, pelvis, and internal organs all the time, but especially during movement.
And it all truly does work together. During normal breathing, the diaphragm expands on inhale. While that is happening, the TVA expands and the pelvic floor relaxes (i.e. drops down). Upon exhale, the diaphragm pulls up, I like to use a plunger as an analogy (but not as forceful), the TVA contracts, and the pelvic floor draws up and IN!
This is a bit hard to visualize, so I filmed this handy video for my Strong Like a Mom Beta Test group using a balloon to demonstrate. Check it out here.
So, as you can see, there’s a lot more to it than just squeezing to stop the flow of urine. The pelvic floor is most effective when it can contract as well as RELAX! A lot of women aren’t just dealing with pelvic floor muscles that are weak, but they may also be too tight or overactive.
In order for muscles to generate strength, they have to both lengthen and contract. If the muscle never fully lengthens, it isn’t generating as much strength as it would if you got a full range of motion. And when you hold a muscle under constant tension, it’s very likely it’ll just turn off and say “see ya!”
Think of it this way- if I held my arm in a constant half bicep curl all the time, then had to do a task that required a full range of motion, like picking up a heavy diaper bag off the floor, the bicep wouldn’t be as effective in that movement. It may not be strong enough to complete that task. Of course, not a direct comparison but you get the point, right?
Adding strength to an area or range of motion that’s already over-recruited is very unlikely to actually fix the problem, the body may just recruit other muscles to help complete the tasks at hand, or it may just go into “bye Felecia” mode- leaving you dealing with pelvic pain, incontinence, or low back pain.
The Kegel focuses only on the “tightening” piece of the puzzle, not the “lengthening” or the “relaxing”. This is how we manage pressure throughout the day, by the muscles not only having the strength to handle day to day pressures, but also being able to relax and release.
When someone comes to me and says “I’m doing Kegels but they aren’t working”, I like to check out what’s going on with their core and floor connection. Because, remember, it all works together as a system. The way I do this is by teaching them a breathing strategy that allows them to properly engage the core and pelvic floor. This is a breathing strategy I learned from my postnatal fitness mentor, Jessie Mundell. It’s something I use often myself and teach to all of my clients. And it’s one of those things that leaves you with an “Ohhhh, wow” feeling, whether that’s good, bad, or just plain confused.
Core and Floor Connection Breath:
1. Lie on your back with your knees bent and feet flat on the ground
2. Place both arms comfortably at your side or rest one hand on your belly
3. Inhale, drawing air into your lungs, belly, and sides- this is a 360 breathing technique- not just a push your belly out breathing. As you inhale, you should feel like the hipbones are moving a little farther apart and the pelvic floor relaxes and drops down
4. Exhale slowly and imagine drawing the belly button gently towards the sternum. As you exhale, you should feel the deep abdominal layer engage, the hip bones move a little closer together and the pelvic floor (from front to back) lift up and in.
5. Don’t use maximal effort! You want to contract the pelvic floor with about 30% of your effort. I tell clients to imagine pulling a tissue out of a tissue box, which is a gentle movement. You want to match that effort.
While performing the core and floor connection breath, you should not be breath holding or sucking in your belly! This could actually cause you to bear down on the pelvic floor.
I find a lot of clients are able to feel what they need to feel in this position, but if you’re having trouble you could try elevating your feet or breathing in a side-lying position. I often like to challenge this breath by moving to positions where there’s more load placed on the pelvic floor, like sitting or standing.
I’m by no means saying the Kegel is a terrible exercise, but I am saying there are way better strategies that can more effectively address pelvic floor weakness/tightness. This breathing technique is one of those strategies, which is why it is a big part of programs I put together for my clients both in-person an online. Want more info on how to work with me? Click here.
Have you tried the core and floor connection breath? How does it feel to you? Let me know in the comments!