Pelvic Floor Reality Check: When to Ditch Kegels and What to Do Instead
Many women are realizing kegels aren’t the answer to their pelvic floor issues….
I was one of them.
I started experiencing pelvic floor issues after my second baby. Well, I had been experiencing issues long before that but before then I thought that peeing your pants was the only pelvic floor issue one could experience.
Oh, how I was wrong about that.
It started with leaking, yes. Early postpartum I started leaking when I sneezed. I brushed it off as being early postpartum, even though as a trainer I’d been in the process of learning more about pregnancy, postpartum, and pelvic health for myself and my clients.
I vividly remember one day sitting on the floor changing my son. I sneezed and peed my whole pants. I muttered “Oh shit” and my husband asked if I peed myself. I said yes and we made a joke about it.
And I can’t say I was embarrassed about it then. I thought things would get better with time.
Then I started leaking during my workouts and while teaching my spin classes… that started to get my attention a bit more, so I started doing kegels and the few core and floor recovery exercises I’d learned.
Then one day I was teaching a core class- one of the choreographed ones. There was a plank-to-side plank exercise and as I moved from plank to side plank, I felt a pang of pain in my groin. It took my breath away, but I had to keep teaching.
Alexa cue Tay Tay- “Lights, camera, bitch, smile- even when you wanna die.”
From that point on I dealt with pelvic pain inside and outside of exercise. It happened when I was walking, during my workouts, and then that pain turned into prolapse symptoms.
I started to become apprehensive about every little movement I made. I spiraled into worrying that everything I was doing or had ever done was ruining my pelvic floor. As a coach who now helped moms learn more about their changing bodies and pelvic floors, I felt like a complete fraud.
The exercises I had been doing weren’t helping. They seemed to be making things worse.
So after putting my care off for far too long, partially from embarrassment and partially from… I don’t know, the expectation that these are just normal parts of motherhood paired with my history of vaginismus and being brushed off for pelvic pain for years that now I realized were probably related…
I finally made an appointment and had an evaluation with a pelvic floor physical therapist. Here’s what I learned…
I had a pelvic floor that was too tight and that was causing my pain, leaking, and pelvic floor discomfort. WHAT?!?!?!
I learned that many women have pelvic floors that are too tight and that can contribute to things like tailbone and pelvic pain, urge incontinence, and pressure feelings in your vagina- like you've got a tampon in that's falling out.
And that while kegels have their place in the pelvic floor rehab realm, they could potentially make tightness, and symptoms related to that tightness like pelvic pain, worse. Which was exactly what was happening to me.
Here’s why…
When your pelvic floor is tight, it’s already living in a contracted position. Your pelvic floor attaches to your pubic bone, tailbone, and both hips- so when it is in a constant state of tightness, it can pull on those areas causing pain.
Okay, so let’s tackle the first question on your mind- how do I know if my pelvic floor is too tight?
After 6 years as a women's health coach... these are the signs I can spot that tells me you have a tight pelvic floor:
-You have chronic lower back or tailbone pain
-You struggle with constipation or hemorrhoids
-You have a history of endometriosis, vaginismus, or vulvodynia.
-You have tight, achy hips
-You've dealt with pain during intercourse
-You have to pee all the time and when you go only drops come out or you're struggling to empty fully
These are all signs that your pelvic floor isn't operating optimally- more specifically that it may be too tight. The only way to truly determine if your pelvic floor is too tight is with a visit to a pelvic floor physical therapist.
But because you’re here, let’s go a step further…
If you suspect you're dealing with pelvic floor over tightness, kegels could make your symptoms worse… Here are a few reasons why:
1. Overactive pelvic floor muscles: In cases where pelvic pain is caused by hypertonic (overactive) pelvic floor muscles, Kegels can further tighten and exacerbate muscle tension if done too much or inefficiently, leading to increased pain and discomfort.
2. Muscle imbalance: Pelvic floor issues- pain especially- can sometimes result from an imbalance in the muscles surrounding the pelvis and hips. While Kegels target the pelvic floor muscles, if you don't work on fixing the imbalances in other muscle groups with breathing exercises, stretching, and strengthening exercises, it can keep causing dysfunction and pain.
3. Incorrect technique: Performing Kegels with incorrect technique or excessive intensity can strain the pelvic floor muscles and surrounding tissues, leading to discomfort or even injury. Mainly- your pelvic floor needs to learn to relax before addressing strength issues. It’s like trying to strengthen your bicep when you’re not fully extending your arm- you can’t build full strength in the muscle without contraction AND relaxation for a full range of motion.
4. Psychological factors: There are a lot of factors behind pelvic floor dysfunction and pain. Psychological factors like trauma, stress, and anxiety can contribute to issues. Pelvic pain can be made worse by feelings like stress, anxiety, or fear of pain. Doing exercises like Kegels might make the pain and stress worse for some people.
If you experience pelvic pain that worsens with Kegels or other pelvic floor exercises, it's essential to consult with a provider specializing in pelvic health. They can conduct an evaluation to determine the underlying cause of your pain which is essential for figuring out a personalized plan.
If you’re noticing kegels aren’t helping or are even exacerbating your symptoms the first step is being evaluated then with that information we can develop a plan based on your needs to get you the quickest results.
Here are alternative, and highly effective, options for kegels:
1. Manual therapy: Techniques such as myofascial release, trigger point therapy, and pelvic floor physical therapy can help release tension and restore mobility in the pelvic floor muscles. Important note: if your pelvic floor physical therapist is only recommending kegels or recommends discontinuing exercise due to your pain or pelvic floor dysfunction, I highly recommend getting another opinion.
2. Relaxation techniques: Practices such as diaphragmatic breathing, mindfulness meditation, and gentle yoga can help reduce muscle tension, alleviate stress, and promote relaxation in the pelvic region. These are super important when dealing with symptoms of pelvic floor over-tightness and prolapse.
3. Habit adjustments: Your movement and lifestyle habits impact your pelvic floor. Things like posture, movement mechanics, breathing, and tension habits can have an impact on the function and coordination of your pelvic floor and other muscles in your body- which can contribute to the muscle imbalances we talked about. It’s all connected. In addition, your lifestyle habits- nutrition, hydration, sleep, stress management, and overall movement impact your pelvic floor in different ways. I could write a whole novel on that so I’ll save these for a deeper explanation in another blog.
4. Exercise: When it comes to pain and pelvic floor dysfunction, exercise is the solution more often than not. You go to physical therapy and what do they give you? Exercises. However, it’s important to address more than just the pelvic floor and core in your exercise routine. Especially if your issues are being exacerbated by your workouts- like running after your kids or dog, jumping on a trampoline, or during any workout or exercise you enjoy doing. It’s important to address hip mobility, and glute strength, with prioritizing strength training to better support your pelvic floor. A good exercise program should incorporate rehab essentials, breathwork, mobility, and strength work. Shameless plug- working with a women’s health coach can help make this process WAY easier. If you want to learn more and see if working together might be a good fit, fill out this application right here.
TL/DR:
While Kegels can help with pelvic floor rehab for some, they might not be right if you're dealing with pelvic pain or certain pelvic floor issues like urge incontinence. It's important to be careful with pelvic health treatments and talk to a qualified pro who can give you personalized advice and a plan. By learning more about what causes pelvic pain and trying different ways to rehab your pelvic floor, you can work on reclaiming your strength and confidence
Okay, I know that was quite a bit to take in there. How are you doing? Feeling overwhelmed?
If you’re feeling like “What do I even do now?!?!?!?!!”
I’ve got your back. Your next step is this guide right here. Inside I’ll teach you how to relax your pelvic floor and some beginner exercises and tips to begin addressing pelvic floor tightness.