If you are reading this blog, chances are you are told to do more Kegel exercises but is the Kegel given more credit than it deserves? Is the Kegel exercise for all pelvic floor dysfunction cases? Is Kegel the best exercise for incontinence? How do you know if you are doing your Kegel exercise correctly? Get all your answers here!

What is a Kegel?

Kegel is the exercise to work the pelvic floor muscles. Women are typically instructed to imagine picking up marbles with their vagina and trying to hold gas in the anus; for men, it is to hold gas and urine at the same time. The purpose of bringing awareness to both the vagina/penis and anus is because the perineum, the distance between the two areas is being worked on.

Pelvic floor muscles are more than this area! They include the whole inner lining of the pelvis which does not get touched following the instructions above. So then, how do we truly address those muscles?

Nature’s Alternative to Kegel Exercise

If we had a normal lifestyle, we never would need to ‘pretend’ to pick up marbles with our vagina or exert our finger in the anus and try to hold urine at the same time!

In nature, walking and sexual intercourse with orgasm does the exercising of the pelvic floor. Ironically, in an industrialized nation, the two are barely happening and that is because the latter depends heavily on other factors that directly influence the desire to be sexually intimate. We won’t digress here but let’s say that our sexual behavior is far from healthy.

When you walk, all the muscles lining the pelvic inlet, the ‘bowl’ that holds your bladder, intestines, ovaries, uterus, and prostate, and the attachments to the pelvis (hips, lower back, and spine) all work and exercise.¬† Alteration in any of these listed structures will impact the pelvic floor and THAT is what is being ignored in properly treating the pelvic floor dysfunction!

Is Kegel Exercise the Same in all Genders?

Yes. Regardless of the type of external genitalia, vagina, or penis, the muscles surrounding those areas and the anus are the same in all genders. Accessing the inside of the pelvis, however, is different in that in males, it is only through the anus while in females, it is through both the vagina and anus.

pelvic floor

Are There Any Side Effects to Kegel Exercise?

With every muscle exercise, overdoing can exhaust the muscles and prevent them from doing their job. If when doing Kegel exercise, you engage muscles other than the pelvic floor muscles, you are not doing them correctly.

This typically involves activation of the lower back, the abdomen, the hips, and/or the glutes. Remember, you are working on the pelvic floor muscles and only those areas should be doing the work.

What is Kegel Exercise Good For?

Kegel exercises are to strengthen the pelvic floor muscles so they are good for all pelvic floor dysfunction symptoms. These include not only urinary incontinence and fecal incontinence, but organ prolapse, chronic lower back pain, chronic sacroiliac joint pain, postural decline with a sway back or a tucked under pelvis to name a few. Kegel exercise does not address all the muscles that influence these conditions, but a few. They are not the be-all, end-all exercises to the named conditions.

Kegels are not necessarily easy to do and should not only be done when urinating for example. The whole idea of holding the urine midstream is to give you an understanding of what that feels like. When done exclusively, you can potentially cause problems with the natural flow of the urine by interfering with the musculature involvement that you have developed as a result of long-lasting pee-pausing exercise.

Tips to Kegel Exercise

  1. Do them twice a day, first thing in the morning and before going to bed.
  2. Do them lying down for ease and a better understanding of how it feels.
  3. Make sure you are not using your glutes, the thighs, or arching your back.
  4. Start by doing a few seconds of hold and increase the number of seconds over time as you gain strength.
  5. Remember to breathe and don’t hold your breath.
  6. Remember to think of holding ‘gas’ in while pulling ‘marbles’ up the vagina or penis (ouch).
Pelvic Floor viewed from outside

Pelvic floor showing anus and external genital

Should I Buy Kegel Exercise Equipment?

The most effective non-surgical equipment I am aware of is BLT Emsella Chair. The Emsella chair is an FDA-approved chair for incontinence, providing 400 Kegel’s per minute with a hefty price tag; last time I checked, it was offered to patients by a few Urogynecologists, Gynecologists, medspa, and now our office. Patients describe it as feeling the whole inside of their pelvis uniformly contracting and lifting! Others feel more ‘vibration’ at one site of their seat than other sections at the beginning which goes away with consequent sessions. Some patients have claimed to have better sexual intercourse while others reported 100% resolution of their incontinence after only 1 session. Bottom line is that the results vary!

We use Emsella chair for all pelvic floor dysfunction patients with the exception of non-relaxing incontinence cases. Unlike all other offices that we know have this chair, at our clinic, the chair session is followed by biological breathing and neuro-kinesiology exercises to assure the postural integrity necessary to maintain the pelvic floor muscles is intact and in place.

You see, the pelvic floor muscles line the inside of the pelvis and play a huge role in holding the pelvis pieces (2 iliums’ and sacrum) together. That means the integrity of the pelvis plays a huge role in the strength of the pelvic floor as well.

Pelvis bones

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

When working on the pelvic floor muscles, all muscles surrounding and attached to all of the areas named in the pic above are addressed. The hips and the spine are the influencers of the pelvis as well and are almost always at least party dysfunctional in movement.

Will Emsella Chair Help My Weak Pelvic Muscles?

According to the Core Pelvic Floor Therapy website it applies ” a High-Intensity Focused Electromagnetic technology (HIFET) to deeply stimulate pelvic floor muscles and restore neuromuscular control. The focused electromagnetic energy and intense stimulation allow your body to create powerful muscular contractions. These muscle contractions work to repair the pelvic floor to enable patients to regain bladder control. One session can produce the equivalent of 11,200 Kegel exercise contractions. The procedure is administered using a patented chair device that allows patients to remain fully clothed and comfortably seated during treatment.” With the exception of the non-relaxing pelvic floor muscles, this machine may be used to strengthen the pelvic floor.

Is Kegel for Non-Relaxing Pelvic Floor Muscles?

Once the non-relaxing pelvic floor muscle relaxes, Kegel exercise and Emsella chair can be used with no problem. To relax the non-relaxing pelvic floor, however, internal work is necessary to release some of the trigger points and tension within the muscles that are reachable manually through the anus and or vagina/penis. Visceral manipulation assists in non-relaxing pelvic floor muscles as well and is performed by some pelvic floor therapists.

Who Do I See for My Pelvic Floor Dysfunction?

While most pelvic floor therapists are physical therapists; chiropractors (depending on each state), registered nurses, and medical doctors also perform pelvic floor therapy. As a chiropractor, I work on pelvic floor dysfunction and utilize postural neurology and neurokinesiology exercises to assist in strengthening of the posture while I may or may not do internal manual work. Pelvic floor muscles are a part of your musculo-skeletal system and as such within the scope of chiropractic.

Not all physical therapists and chiropractors choose to work with the pelvic floor muscle area because of the nature of the work. While many patients with weak pelvic floor muscles have a history of trauma, there are many sports injuries and postural presentations that result from our sedentary lifestyles that lead to weak pelvic floor muscles and seeking treatment by a pelvic floor therapist.

If you have weak pelvic floor muscles and are unsure what to do, if you have sought care elsewhere but your problem persists, please contact me and mention this blog.