Surprised?

You might be shocked to hear me suggest that kegels may NOT be necessary since I consistently preach the value of kegel exercises in my classes, on my videos, and on my blog. But hear me out. Just like most things in life, there are two sides to the kegel story. (Don’t know what the heck a kegel is? Click here to learn more.)

Here’s the deal:

If we lived in an ideal society, moving in the ways — and in the quantities — that humans were designed to move, then our pelvic floor muscles would NATURALLY be kept supple, vital, and strong. Here are some examples of this ideal “utopian” society (as far as movement is concerned). We would be…

  • Moving regularly throughout the day. Changing positions often — bending, squatting, standing, sitting, walking, etc.
  • Maintaining good posture and strong, supple hip and spinal joints. We would NOT have a “forward head” and slumped shoulders from being on devices all day!
  • Performing manual labor and ACTIVE activities of daily living — working in the garden, hunting or gathering food, cleaning and maintaining the home without the use of modern technology.
  • Squatting when using the restroom.
  • Lifting, pushing, and pulling objects of all sizes — heavy, and lightweight.
  • Walking, running, actively playing with our children… Simply MOVING (!!!) without being tethered to modern technology that tends to keep us motionless and fixated on an artificially lit screen.
  • Giving birth naturally, when our bodies are ready, without modern medical intervention such as episiotomy and/or synthetic oxytocin (Pitocin). NOTE: I realize that in some cases artificial induction via synthetic oxytocin is necessary and even life-saving, but the frequency of its use may not be justified as described in this article by Chris Kresser. Furthermore, it has been suggested that medically induced labor subjects the muscles and nerves in the pelvis to greater force than does natural labor. Regarding episiotomy, click here and here for abstracts of articles that describe the risks associated with episiotomy when it comes to pelvic floor muscle health and postpartum outcomes.
  • Living life unencumbered by excess body weight or obesity, which contributes to pressure and strain on the muscles of the core and pelvic floor.

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If we lived and moved in these ways, most women would retain well-functioning pelvic floor muscles (not to mention the rest of the body) into old age. We would be less likely to develop pelvic organ prolapse. We would be in control of our bladders! We would retain the natural reflexes that cause the pelvic floor muscles to assist the urethral and anal sphincters by reflexively contracting before a cough or a sneeze to help keep us dry and leak-free.

Our pelvic floors would not be overly weak, nor would they be overly tight/tense.

We would NOT need to do kegels!

Unfortunately, for most modern women — due to a largely sedentary lifestyle (leading to muscular disuse) and/or trauma during childbirth — we lose these natural pelvic floor reflexes over time. We also lose vitality in the muscles of the core and the pelvic floor.

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Reality Check:

As time marches on and people become more and more connected to machines and technology that make life more “convenient” (i.e. less physically active), I can only *hope* that my messages of “moving more” and “falling in love with movement” take hold.

I do think that a shift in consciousness happening. The majority of people today acknowledge and understand the importance of exercise and MOVEMENT in terms of health benefits, and more and more people are interested in adopting a healthy, active lifestyle.

But is the message taking hold? Is it being implemented? Are people really doing it?

Not enough. Nope, we’re still not there.

Thus, for many modern women, kegels can be helpful.

What this means for you:

Since we have not yet returned to the ideal “utopian” society described above, you should know how to do kegel exercises. You don’t need to do hundreds a day (as some people recommend) or even hundreds a week, you simply need to know how to quickly find and activate the pelvic floor muscles with conscious awareness so that they can provide an extra “boost” of control when you really need them, such as when you have a full bladder and there’s no restroom in sight, or when you’re preparing to cough or sneeze, or when you’re jumping on the trampoline with your kids.

You also need to know how to do kegels CORRECTLY. Don’t do them while you’re peeing. Fully relax after each contraction. Make sure a strong, supple pelvic floor is balanced by strong, supple glutes (buttocks) and other core muscles (hips, deep abdominals, and back muscles). And finally, make sure your posture is in-check (believe it or not, proper alignment is essential for pelvic floor and bladder health).

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An important note:

Kegels are not for everyone. Some women hold chronic tension in the pelvic floor muscles and their muscles are short and tight most of the day. This often results in pain with intercourse, difficulty initiating urination, urinary urgency or frequency, a feeling of tension or pain in the pelvic area, and/or the feeling that “no matter how many kegels I do I still don’t see results!” If this describes you, discontinue any attempts at kegels. Please read this article, see if you can do the “reverse kegel,” practice deep breathing and meditation for relaxation, and consult a women’s health physical therapist. She can help.

In summary:

MOVEMENT is necessary.

In a perfect world (in terms of movement/activity), kegels would NOT be necessary… But we don’t live in a perfect world. Thus, for many of us, as we work toward “moving more,” kegels are a nice back-up strategy.

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Real-world application:

  • If you live like our ancestors did and are physically active throughout the day, if you change positions often, if you squat to relieve yourself and walk everywhere you go… If you don’t sit passively in a chair for hours at a time… And if you don’t have any pelvic floor dysfunction, then you probably don’t need to do kegels. It’s nice to know how to do a kegel in order to identify with that region of your body, but you probably don’t need to practice them on a regular basis.
  • If you live a fairly active lifestyle (but not quite as “cave-woman-ish” as described above) and if you don’t have any pelvic floor dysfunction, then make sure you know how to do kegels (you can click here for a tutorial). I encourage you to do 5-10 kegels approximately 3 times per week to keep the muscles supple and vital, and to maintain a good mind-body connection between the brain and the pelvic floor. Your primary focus should be on keeping your activity level high, walking as often as you can, and keeping your ENTIRE core strong.
  • If you live a sedentary lifestyle and DO NOT currently have pelvic floor dysfunction, then make sure you know how to do kegels (you can click here for a tutorial) and consider doing 5-10 kegels approximately 5 times per week to isolate the muscles on a regular basis. Here’s why: if you lead a sedentary lifestyle, then YOU ARE AT RISK for pelvic floor weakness (which can lead to bladder control issues and pelvic organ prolapse). Work on strengthening the muscles NOW, before problems develop. Hopefully you can prevent them. In addition, I encourage you to increase your activity level (daily walking is a great start) and begin a total core strengthening program (my YouTube videos are a great place to start).
  • If you live a sedentary lifestyle and you DO have pelvic floor dysfunction, then you should be doing kegels under the supervision of a trained women’s health physical therapist. Keep in mind that kegels are only part of the story when it comes to treating pelvic floor disorders such as incontinence and prolapse. You must also focus on finding and maintaining proper posture, using good body mechanics when lifting/pushing/pulling etc., increasing your activity level as a whole, and keeping the rest of your hip and core muscles strong.

Remember:

When done correctly, kegels can help your pelvic floor muscles retain health, vitality, and the ability to quickly and effectively activate when needed. This will help YOU maintain control of your bodily functions, ultimately increasing confidence and quality of life. Ultimately, isn’t that what we all want?

Pelvic Health Self-Help

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~Dr. Bri, PT, DPT

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