It's the first thing most of my patients will say after listing off a laundry list of symptoms, "My friend says I need to be better about doing my Kegels." In fact, Kegels have become a knee-jerk solution among girlfriends, mothers, sisters, daughters, and physicians who want to offer a quick fix. Can’t play soccer with your kids without leaking. Kegel! Can’t eek out a sneeze without crossing your legs. Kegel! Can’t insert a tampon without causing pain. Kegel? Not so fast.
Kegels are strengthening exercises for the pelvic floor invented as a companion to the perineometer by Dr. Arnold Kegel in 1948. As an gynecologist and professor, he developed both as part of his research “A Non-surgical Method of Increasing the Tone of the Sphincters and Their Supporting Structures” in an attempt to help women strengthen their pelvic floors, particularly after birth. [Kegel, Arnold H.: The Nonsurgical Treatment of Genital Relaxation, West, Med & Surg. 31: 213-216, May, 1948]
Non-surgical? What can be the harm? The truth is, there are many different conditions and combinations of conditions that cause pelvic floor dysfunction. Some truly are caused by muscle weakness. But others are caused by the opposite of muscle weakness; muscles that are too tense, overworked and in spasm. In fact, muscles in this condition can mimic weakness in that they do not have the freedom to perform the job they are meant to do. They're like a little wind up toys that's hit a wall, always going but not getting anywhere until one day it the batteries wear out. In this situation, doing Kegels can actually make symptoms worse including worsening incontinence, chronic constipation, bladder retention, pain with sex or inserting tampons, pain with vaginal exams, feeling like you have constant bladder infection, menstrual-like cramping, back pain ... makes me think Kegels should actually come with a WARNING label.
In fact, women who are found to have this condition, a hypertonic and/or short pelvic floor, should be asked to do exactly the opposite ... the anti-kegel or pelvic floor drops. They should be taught to relax and stretch their pelvic floors so that the muscles are rested and free to perform their function when it comes time.
So how can you tell which, if either, is right for you? A pelvic therapist will ask you to provide a detailed history, including bladder, vaginal, rectal and abdominal symptoms, in order to identify any red flags. You will also have a manual internal exam to determine the state of the musculature and pelvic structures. Lastly, a EMG assessment can help put in place the last pieces of the puzzle in order to make the appropriate treatment diagnosis and, subsequently,create a program that will relieve your symptoms, not make them worse. Without these three elements, you are merely experimenting. Sometimes the results can be fabulous and other times you blow up the chemistry lab.
So, the next time your well-meaning girlfriend says, "Just do your Kegels! It worked for me," put out your yellow CAUTION sign and say "I think I'd better consult a pelvic specialist."