Dr. Kegel was a surgeon who performed thyroidectomies and when he became unable to perform surgeries, became more interested in the contractibility of the pelvic floor muscles in the mid-1920s. In 1951 he reported that “in more than 30% of women, however, no contractions, or only weak or delayed contractions, can be elicited in spite of diligent efforts.” This early research is fairly consistent with what we know today. Dr. Kegel also found that his patients would “invariably try to substitute contractions of extraneous muscles, especially those of the abdominal wall and gluteal region.” He invented a biofeedback device to help women see when they were contracting the proper muscles and found much greater success.
Fast forward to today, and more sophisticated biofeedback machines are only one tool in the toolbox of pelvic health physical therapists to conservatively treat urinary incontinence and more. But among the general public, there is still a lot of misunderstanding about what to do with these muscles. Because of all this misunderstanding, I actually hate using the term "Kegels" when educating my patients or other therapists.
Here I will discuss a few of the most common myths:
- MYTH #1. The best way to do Kegels is to stop the flow of urine while on the toilet.
- Fact: Doing pelvic floor contractions on the toilet is NOT a good idea – it can cause urine to flow back up the ureters toward the kidneys and can lead to urinary tract infections (which are a major precipitating factor for urinary urgency, frequency and incontinence)
- Fact: A full excursion of the pelvic floor muscles involves more than just the urinary sphincter in coordination with your breath and other trunk muscles
- MYTH #2. Squeezing as if around a tampon is the best way to do Kegels
- Fact: Again, a full excursion of the pelvic floor muscles involves more (see the next post: One way to access your pelvic floor muscles)
- The way Kegels are typically described, it is akin to holding your elbow at a 90 degree angle and flexing your bicep all day long - not very useful for being able to pick up a box or even bring your fork to your mouth!
- MYTH #3. You should do Kegel exercises as often as possible (every time you’re stopped at a red light, waiting at doctor’s office, bank, etc)
- Fact: Many men and women with pelvic floor dysfunction (including incontinence) actually have a hard time relaxing their pelvic floor muscles. For these folks, this would be bad advice. The pelvic floor muscles are already too short and/or too fatigued from being “on” all day long to do their job when they’re needed.
- MYTH #4. Holding the pelvic floor tight all the time (or mula bandha for yogis) will make me strong and invincible
- Fact: It is true that having a strong pelvic floor is crucial for overall core functioning and can help yogis do really neat things like floating in sun salutations and arm balances, but for the same reason as in myth #3, holding the muscles all day everyday is a bad idea.
- Fact: holding the pelvic floor contracted all the time can disturb your breathing patterns. The pelvic floor is designed to descend (relax) when your diaphragm descends (on the inhale). Keeping the pelvic floor constantly braced can restrict the excursion of your diaphragm, limiting oxygenation, creating a “stress” feedback loop, and changing the way your abdominal muscles function.
- MYTH #5. If I just focus on my “core” my pelvic floor will automatically get stronger
- Fact: Having abdominals that are much stronger, more active, or shorter than the pelvic floor muscles can create problems in both the pelvic floor and breathing patterns. Rather than reinvent the wheel on this subject, I will refer you to an excellent post by Julie Wiebe, PT.
- Fact: Pelvic floor problems are essentially an issue of mind-body disconnect. Any suggestion that just focusing on something else will fix the problem is misguided. On the contrary, we need to make friends again with this shamed and forgotten area of the body. (see this post by Sarah Haag, PT)
- Food for thought: If what we were doing for our "core" in fitness, yoga, and pilates was working, wouldn't you think the incidence of urinary incontinence among instructors would be much lower than the general population? This isn't the case. Research shows that the incidence of urinary incontinence in instructors is the same as the general population.