Pelvic Floor Mythbusters: Is kegeling the one true way to a healthy pelvic floor?

Pelvis Drawing

Fiona McMahon PT, DPT.

Is kegeling the one true way to a healthy pelvic floor? Not always. We can end the blog here. Just kidding, of course there is nuance to be considered here. But as pelvic floor physical therapists, nothing is more cringe inducing than hearing the phrase “just do your kegels” thrown around for myriads of ailments from low libido, to pain, incontinence, and erectile dysfunction. While it is true the pelvic floor muscles can be involved in all of these conditions and in some cases kegels may help, there are many cases where kegels are the EXACT opposite of how you should be treating these muscles.

Physiology

To understand kegels we must first understand the pelvic floor. To understand the pelvic floor we must also explain the muscles at a very basic level. Bare with me readers, this will help us as we bust through this myth. Muscles, all muscles do what they do, by contracting and getting shorter to produce force. This is easy to see on a bodybuilder doing a bicep curl. As she curls her hand up you can see these muscles shortening into a little ball. Not only is this a great way to show off your gains in the gym, the shortening of these muscles are providing the strength to perform this task. We call this shortening a concentric contraction. Kegels are concentric contractions too! A good kegel will cause the pelvic floor to shorten and provide strength. Let’s go back to our body builder for a second. She has done her lift now she needs to lower her dumbbell back to the floor. In order to lower that dumbbell back to the floor in a controlled way, she needs what’s called an eccentric contraction, which is the controlled lengthening of the muscle. If she did not have a good eccentric contraction she may not be able to lower that weight effectively after she curled it. What if she couldn’t lower her bicep at all or just very slowly after her bicep curl? Maybe her weightlifting wouldn’t be as effective, she’d tire more easily, or she could develop pain. Would you tell this woman that more bicep curls would help? Or might you suggest a program of stretching first? Telling someone to do kegels, when you don’t know the status of their pelvic floor and how well it can relax is similar to telling the bodybuilder with the non relaxing bicep to just do more bicep curls. At best it certainly won’t help the situation and at worst it could cause more pain and dysfunction.

“But Fiona, I have incontinence, so that definitely means I have weaknesses, so it’s good for me to do kegels, right?”. Maybe… but in my experience, probably not. Let’s agree on one thing, it’s completely intuitive that people would think that kegels would help incontinence. The muscles of the pelvic floor are responsible for continence… so they must be weak if one is experiencing incontinence. You are right! When we think weak with muscles, we often think weak and loose, which is one form of weakness, but we rarely think weak and tight. Let’s go back to our body builder lady. She deserves a name at this point. Let’s call her Kendra. If Kendra has a tough time moving her lifting her arm from fully straight to a full bicep curl, we could guess she is weak and loose. But if Kendra could not fully straighten her arm out she would be considered weak and tight. Both of these versions of Kendra would have trouble curling heavy weight. One Kendra due to frank weakness another Kendra because she simply does not have enough room or range of motion to generate enough force to curl that dumbell.

Tight and weak pelvic floors are a lot like second Kendra with the poor ability to lengthen her arm. Tight pelvic floors have less range of motion to generate force. You need a good amount of force from the pelvic floor to counteract the pressure of activities like lifting, coughing, laughing and sneezing and stay continent. Over loose and over tight pelvic floors can’t really do that.

If you have pain in your pelvis not from a medical condition, (although tight pelvic floors present with many medical conditions), your pelvic floor is probably tight. A tight pelvic floor may also have trigger points which can send pain to various locations in your genitals, back, legs, and abdomen. Continuing to tighten can cause this pain to get worse.

Treatments

So how do you know what to do? This is where a skilled pelvic floor physical therapist can come in handy. They can assess the muscles by touching them either externally or internally to determine what course of action is right for you. If you are loose and weak, HAPPY DAYS! Strengthening can help them get better. If you have tight and weak muscles, HAPPY DAYS again! Gentle lengthening, stretching and down training of the muscles can help them get better. Did you know, because a tight pelvic floor can cause weakness itself, returning the proper length to the muscles can restore strength, without actually needing to kegel?! Wild! Regardless of the situation happy days can be ahead.

Skilled PT

Really knowing the pelvic floor is a skill and requires advanced expertise.  Kegels should not be initiated, unless the physical therapist has carefully examined your pelvic floor. Not all therapists are trained to do that technique so it is important to inquire about their background before starting pelvic floor PT. There are a lot of different ways to treat the pelvic floor, to read more What is Pelvic Floor Physical Therapy . If you are interested in learning more give us a call at 212- 354-2622 for a free consult if you live in the greater NY/NJ/CT area.

PH101: Ladies Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a ladies’ session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 30th . Please register at pelvichealth101.eventbrite.com

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

On October 23rd at 7pm we will be hosting our  “Men’s Only Seminar”. Join us as we discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!

For more reading on male pelvic health topics, check out:

All About Testicles

Navigating Life with Chronic Pain: Part 1

Navigating Life with Chronic Pain: Part II

Prostatitis What it is and What to do About it

Location:

110 East 42nd Street

Suite 1504

NY NY

10017

Pelvic Health 101 Flyer-jpeg

 

PH101: Pain and Sexuality: is it all in my head?

 

By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.

On October 16th at 7pm, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

 

Pelvic Health 101 Flyer-jpeg

 

 

PH101: Does My Diet Really Matter?

Fiona McMahon, DPT

Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can  provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 9th at 7pm, “Does my diet really matter”.

jessica-drummond-headshot-197x300This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar was a hit last year and is a great starting point for those considering adding nutrition as part of their healing journey.

Register at pelvichealth-101.eventbrite.com  today.

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

Mama’s 101: Recovering After Birth

On September 26th at 1 pm scoop up your baby and join us for our FREE educational seminar hosted by Dr. Joanna Hess as she provides the inside scoop on how to get back to leak free, bulge free movement.

Address:

Beyond Basics Physical Therapy – Downtown

156 William Street

Suite 800

New York, NY 10038

Date:

September 26th at 1 pm

Mamas 101 Flyer_Jpeg

Pelvic Health 101 is back! Come to Our First Class on September 18th

 

On September 18th, at 7pm we will be kicking off our fall semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Flyer-jpeg