Truthfully- Kegels Are Still Awesome

Picture of the pelvic floor.   http://en.wikipedia.org/wiki/File:Gray404.png (Free to use.)

There has been a lot of talk lately about Kegels.  The exercise pioneered by Dr Arnold Kegel years ago and long used to strengthen the pelvic floor, improve sexual function and prevent incontinence has come under fire, particularly in the natural birth community.  It seems like everywhere I go people are saying that you shouldn't Kegel any more.

Frankly, I have been a little disappointed in the natural birth community as I have watched this go down.  There has been very widespread acceptance of the anti-Kegel movement yet nobody seems to be able to offer ONE SINGLE SHRED of evidence that Kegels are actually harmful.  There are no research articles to support this trend, just the word of a few people, none of whom are physical therapists or doctors or in any way able to legally diagnose and/or treat pelvic floor dysfunction. 

I have taught Kegels in my childbirth classes and so I have been paying attention and reading the anti-Kegel articles.  Most talk about replacing Kegeling with squats or other lifestyle changes.  So- are they right?  Do we need to shun Kegels and embrace this "revolutionary" new change in female pelvic floor health?  (For the record, squats aren't revolutionary.  They have been around a very long time.  I  have taught BOTH squatting and Kegels as part of a complete preparation for pregnancy, birth and lifetime health.)

The more I read the more I think that the answer is a resounding NO.  I am willing to embrace something new if it will really help women and improve lifestyle and if it is backed by evidence.  But I am unwilling to throw my arms around something just because it sounds fun and different. 

I had the privilege recently of listening to an experienced and well known physical therapist who has specialized in female pelvic floor dysfunction for the last 40 years speak on this very subject.

Pamela Jones' knowledge was astounding and her explanation of the subject and the current controversy was illuminating.  I wanted to take a few minutes here and share with you some highlights of what she said.

1.  Kegels have a long track record and dozens and dozens of studies supporting their benefits to women.

Here is one such study.

2.  You can measure the strength of the pelvic floor using biofeedback and other technology and determine if the muscles are getting stronger or if they are hyper or hypotonic.

For more info on this, click here.

3.  You cannot "move" the tailbone or coccyx by doing excessive Kegels (causing "mom butt" as some have claimed.  Though moderation in all things is a good idea.)  The pelvic floor is simply not that powerful of a muscle.  It exerts a small amount of force. 

4.  Squats are helpful to the pelvic floor and it's function but many people (especially as they get older and the pelvic floor coincidentally often gets weaker) are unable to squat because of problems with their knees.  For this reason Kegeling and learning to do it young is important.  While squats do strengthen the pelvic floor, they are not an option for many people.

5.  There are some women who have a pelvic floor with too much "tone".  Pamela Jones said that these women have usually had trauma, often caused by sexual abuse, which has caused this excessively toned pelvic floor.  In essence they are tightening up almost constantly.  She said these women are frequently aware that they do this- it is a kind of defense mechanism.  These women are often referred by a therapist to work on the physical damage that abuse has caused after they have been working on the physiological damage.

Some have claimed that women with this excessive tone or tightness should just be squatting and that Kegeling will only make things worse.  Sadly, I don't see how squatting will fix past abuse and magically release the pelvic floor for a woman who has other issues causing the problem.

This CAN be helped with a physical therapist, biofeedback, and learning to relax and release the area.  There IS help available but it probably won't come from a generalized video or from a blog post, rather from an experienced and sensitive care provider.

Pamela Jones also mentioned that this condition (hypertonicity) has affected less than 1% of her clients in 40 years of work.  Frankly, telling all birthing women NOT to Kegel is akin to telling ALL VBAC women that they shouldn't even bother.  I am saddened that we have accepted this.

6.   There are other activities that strengthen the pelvic floor- squatting is one of them as is walking.

7.  There are lifestyle factors that can weaken the pelvic floor.  Inactivity, excessive coughing (like that caused by smoking), obesity (increases pressure on the pelvic floor) and other things that are fairly common among sedentary people like ourselves. 

8.  Women are more prone to pelvic floor dysfunction and they are far more likely to wait a very long time to actually seek help.  Men have one less "hole" that their pelvic floor must accommodate and they often seek help right away rather than suffer in silence for years.  (This made me laugh.)  While women often assume that urine leakage is just part of growing older- it doesn't have to be.  Pamela has seen total incontinence reversed with a great Kegel program.  She has also seen organ prolapse fixed with Kegel exercise.  This is a fabulous tool for lifetime pelvic floor health.  

9.  In 40 years of practice, Pamela Jones, PT has seen only ONE woman who actually made things worse by doing Kegels- and she was doing them incorrectly.  (She was pushing rather than tensing the pelvic floor.)

10.  There is not clinical evidence that a strong (or weak) pelvic floor can improve the birth experience and encourage proper positioning (chin to chest rather than a military presentation).  The baby is much higher than the pelvic floor when labor begins,  The pelvic floor is what the baby travels through as it is exiting the birth canal.  Pamela did say that bio-mechanically it did make sense that a strong pelvic floor could hold up all the organs better and help apply the pressure needed to encourage a chin to chest presentation for the baby.  (I mention this because I have always taught that Kegeling can encourage proper positioning.  I wish there was research evidence for this claim, but there isn't documented double blind studies done on this subject.)  She also felt that Kegeling was important during pregnancy and especially after birth.

~~~

In essence, Kegels are an important part of pelvic floor health, preventing or reversing urinary incontinence and correcting organ prolapse.  Personally I wish that we would be more careful and more thoughtful before we abandon practices backed by years of research in favor of something that sounds new and fun.  (Like how we have all but abandoned natural birth in favor of invasive alternatives that are only proven later to be harmful.)

We owe women more than that.

I wrote a detailed article on Kegels a short time ago.  I spoke with another physical therapist also specializing in pelvic floor dysfunction and a Chiropractor to compile as accurate of information as possible.  You can read it on the Birth Boot Camp website.  It contains multiple links to some of the vast research supporting the benefits of Kegels. Any mistakes here or in my previously published article are mine and mine alone.  I am not a health care provider and lack the in-depth knowledge of anatomy and the human body needed to truly explore this subject.  I have done my best but am grateful to those who know more and from whom I have learned so much.  

I also want to point out that Pamela Jones did this presentation for free.  She is dedicated to helping women improve their lifestyle through Kegeling and other activities that strengthen the pelvic floor.  She also allowed Birth Boot Camp to use her fabulous exercise plan in our workbook, free of charge.  She truly seeks to help women.  You can find her here.