Let’s bust some Kegel myths - my top 5!

As a postnatal woman you will likely have some experience of pelvic floor exercises, either because you’ve been told to do them lots and lots or because nobody has mentioned them and given any physical issues you may have now, you’re wondering why. After both of my kids I don’t remember anybody mentioning them to me, maybe they gave me a leaflet but I certainly never read that in my confused state! I had 2 vaginal deliveries with ventouse assistance and a small tear with my first, and a very speedy delivery with my 2nd causing a large, almost 3rd degree tear. Both deliveries clearly affected my pelvic floor, in both cases I required some stitching but no midwife, health visitor or Dr mentioned PF exercises - or I possibly got the “you’re doing your PF exercises aren’t you” question which doesn’t exactly guide me in the best way possible for recovery.

Kegels, or pelvic floor muscle exercises, were invented by Dr Arnold Kegel in America in 1948 as a way of strengthening the pelvic floor in order to prevent or reduce stress urinary incontinence and prolapse in women. The effectiveness of these exercises has been well proven in systematic reviews and remains the first stage in treatment throughout the world.

However, we also know that there are some limitations of these exercises so let’s look at those now:

1) Am I doing them right?

So we know that kegels are effective, but we also know they are only effective if you know what you’re doing, what you’re supposed to be feeling, when you might not be doing things correctly/effectively or if there’s an issue that needs to be addressed.

Did you know:

• 60% of women don’t know where their PF muscles are

• 80% of women don’t do their PF exercises correctly without supervision

• when women do them with supervision, they are not only effective but do exactly what we want them to - prevent and reduce incontinence and prolapse symptoms

Answer: get to know what’s going on “down there” and what your specific needs are to feel and be effective.

2) Are Kegels enough?

Many women I speak to say they’ve been doing a million PF exercises and it’s made no difference, they squeeze and squeeze and still have the same issues as before. So what’s going on here, why aren’t these magic exercises working?

For some women, what they do when they Kegel doesn’t translate to their real life movement pattern. So every time you pick up your child from their cot, or lift something heavy on one side, or walk downhill you are unable to cope with the added stress on your pelvic floor because the gentle, stationary exercises you’ve been doing don’t give you enough strength for your life.

This is my biggest focus and mindset I need to help shift - we have physically demanding lives. Whether you workout, run marathons or just run around after your kids, all that bending, lifting, twisting and carrying is hard on your pelvic floor and so if you’re experiencing leaking issues with daily movements, you need to strengthen in a way that more directly relates to how you move.

3) Are Kegels the only thing that will help?

As we found out above, doing Kegels correctly is the most important aspect of using them for recovery so having that personal knowledge is important.

Alongside this is understanding your specific habits around breathing and alignment - we all have postural traits that we repetitively fall into, like standing on one leg and dropping the other hip, or swaying hips forward and squeezing your glutes, or breathing mainly using your shoulders. When we understand what we do that’s not as effective as possible for our bodies, then we can change it.

You will not be able to get a stronger pelvic floor by Kegels alone if you also have a dysfunctional breathing pattern or stand and move with significant imbalances, so addressing this with support is key.

Transferring PF exercises into daily movements is the next step - and this will include how you breathe and align - in order to make those good squeezes really relevant to the way you move and function. This means you need to learn to work your PF with your whole body which will take some good coaching and support to connect with.

4) I am doing my Kegels but feel my symptoms are getting worse! What’s happening?

For around 30% of women, incontinence and prolapse symptoms can be caused by their pelvic floor being overactive (sometimes called hypertonic although this is an incorrect description), which is when they have a hard time releasing and relaxing their muscles between contractions. This means their PF stays slightly contracted all the time resulting in muscles that can’t fully contract and also can’t fully relax and so they don’t have the control that’s required.

Again this is where having a personalised understanding of what’s going on is required in order to make effective change and individualised support for happy movements in the future.

5) I only need to do Kegels after I’ve had a baby don’t I - then I’m done?

Well yes, and no!

So my preferred way of working with a client through pregnancy, delivery and up to around 2 years after delivery is to ensure she has a good understanding of what’s going on with her PF and how it’ll help during delivery, also addressing any pregnancy related issues she may have. Then in the immediate postnatal stage we work on finding connection again, throughout the body with the PF the centre of that focus. And then as she gets more connected and we know there aren’t any residual issues, she will need to do less focussed on her pelvic floor and more about the whole body building PF connection into all movements. At this point we know we can probably remove Kegels from a programme. However, peri-menopause symptoms and fluctuations in hormones like to throw a spanner in the works at about the age most women seem to be recovering from their pregnancies and early postnatal stage. This may require reassessing the PF strength and connection, meaning you need to take a couple of steps back and be more flexible with how your body is responding on a week by week basis.

It’s a fantastic time to really learn and listen to your body!

So there you go, keeping that conversation open that Kegels are not the only answer to all your pelvic floor problems, it’s more complicated than that - which you might have realised already!

Any questions, get in touch or comment below, I’d love to hear from you.

Kathryn x