Could Kegels Actually Hurt Me?

Could Kegels Actually Hurt Me?

You’ve seen the claims. A stronger pelvic floor! Fewer Leaks! Better Sex! The kegel craze is hot right now and for good reason. Kegels can do all of these things and we’re a big proponent of doing them for maintaining good bladder health and a healthy pelvic floor. But before you jump on the kegel bandwagon, read this post. Because while kegels can be super effective for all the reasons listed above, they can sometimes cause problems in women who have certain conditions.

Many women suffer from a weakened pelvic floor, the series of muscles and tissues that form a hammock at the bottom of your pelvis, and are responsible for holding many of your organs (including your bladder) in place. A weakened pelvic floor can be caused by many factors, but pregnancy, childbirth, and aging are all high on the list.  This laxity in the pelvic floor can lead to things like incontinence, or even pelvic organ prolapse if not treated properly.  And a great way to treat it (most of the time) is with kegels.   

But not everyone has a weak pelvic floor – some women experience pelvic floor tension, which prevents the pelvic floor muscles from contracting or relaxing at a normal rate, again making them weak, but in a different way.  This can lead to things like constipation, painful intercourse, or the inability to empty your bladder completely.  

People with pelvic floor tension are advised NOT to do kegels, and if you think about it, it makes sense. Trying to tighten something that is already too tight can make your problems worse.

So, how do you know if you should be doing kegels or not?  Our best advice is to see a physical therapist specialized in women’s health.  A trained PT can give you a thorough evaluation and can determine if you have a pelvic floor that’s too tight or too loose.

An added bonus is that if your PT finds you’re a good candidate for kegels, they’ll be able to show you exactly how to do one – something that is actually somewhat difficult for many women.  And, if you’re advised NOT to do a kegel, they’ll be able to help you learn how to relax your pelvic floor and will show you exercises to help with that as well.

It’s also worth noting that while kegels are great for many people, they also aren’t the end all be all move for your pelvic floor. Your muscles are all connected, after all, so concentrating just on kegels won’t be as effective as if you worked your entire core, glutes and thighs. 

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Ask The Expert: Should Men Do Kegels?

Should Men Do Kegels?

Question: I hear about kegels for women all the time, but what about men? Can kegels benefit men too?

Expert Answer: Absolutely!  Kegels are an important part of a woman’s workout routine to prevent or manage bladder leaks, but they are just as important for men. In men, kegels can help with fecal incontinence, overactive bladder, urinary retention, erectile functioning and even orgasms.  Interested in seeing the benefits for yourself? Here’s how to do them:

How To Do Kegels For Men

There are two types of kegel exercises that you can do to strengthen and tone your pelvic floor muscles.

Long Contractions.  

Long Contractions work on the supportive strength of the muscles. To perform a long kegel contraction, tighten your pelvic muscles and hold for 5 seconds. This may be difficult at first – don’t worry if you can’t hold the contraction for the full five seconds. With practice you’ll be able to work up to this.

Overtime, work your way up to 10 seconds per contraction. Be sure to rest for 10 seconds in between each contraction – knowing how to relax your muscle is as important as the contraction.

Short Contractions.  

Short contractions work the fast twitch muscles that work quickly to stop the flow of urine and prevent leaks. To perform a short contraction, tighten your muscles quickly, then release, and repeat.

When Should I Perform Them?

Like any muscle, you don’t want to do too much too soon. Aim for 5 reps of both short and long contractions, 3x per day on your first day. As you gain more confidence and strength, work your way up to 10 reps, 3x per day of each.

Continue practicing kegels and you should see improvements in 3-6 months. And, if you find that you need some help with kegels, talk to your doctor or physical therapist. They will be able to provide you with more personal instruction, which may include biofeedback therapy.

Good luck!

Postpartum Isn’t Easier When You’re a PT

Postpartum and Physical Therapy

….But it helps

Pregnancy can be a wonderful time of growth, change and anticipation.  As the baby grows, the mother’s body goes through normal musculoskeletal changes.  Muscles in the abdominal and pelvic region stretch, ligaments soften and joints loosen.  Some women handle these changes with ease but others may need the help of a physical therapist to manage pain and incontinence

After the birth of the baby, there are still changes. The postpartum (or post-birth) period can be a beautiful yet challenging time for the mom too. We call this time period the fourth trimester. 

As a PT and mom, I can attest to the challenges I listed above. I can also say that postpartum doesn’t get any easier or feel any better because you’re a PT and you intellectually understand the physiological changes in your body after having a baby. I’m a PT and I know what I need to do for myself and my recovery but knowing what to do and experiencing the discomfort and managing it are different.

Hormones greatly affect the mom emotionally and physically and the pelvic floor muscles are overstretched and weak.  The new mom likely has an incision to care for and may be experiencing some urinary leakage. Ligaments and joints gradually tighten as hormones begin return to pre-pregnancy levels.  However, muscles like the lazy.  If a muscle isn’t exercised it will remain loose and weak.

My prescription for healing after having a baby? Kegels, Tummy Time and Walks.

The secret sauce to making sure that prescription works? Repetition

Understand the purpose of kegeling

The pelvic floor muscles create a natural bowl or basket supporting our pelvic and abdominal organs.  The pelvic floor is vital in controlling our bowel and bladder, is part of our core muscles, assists in our sexual response and must stretch to allow for the baby to slide through the birth canal.

A kegel is the contraction of the pelvic floor muscles. You can learn more about how to kegel, here.

Mimic your baby + get on your tummy

Use that tummy time to kegel from a new position and just take in the moments you have with your new little one.

Try to walk at least once a day

You need socialization and your baby needs it too.  Lucky for you, walking is a great pelvic floor exercise.

At the end of the day, variety and repetition are key. As both a PT and a mom, I’ve found that strengthening the pelvic floor by challenging those muscles in a variety of ways will allow the muscles to become strong enough to maintain dryness. Eventually, your pelvic floor wall will become strong enough for a return to pre-pregnancy activities.

Although we all have to deal with this postpartum changes, being a PT certainly helped me have perspective. I hope this article can help you too!

P.S.  Remember that whatever you do in the name of healing your body is a way to take care of yourself. If you don’t take care of yourself, how could anyone expect you to take care of your little one? Take a deep breath and give these suggestions a try. If you need an extra boost to get you going, read this blog post for inspiration!

 
About the Author, Michelle Herbst:    I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

 

Gender Neutral Pelvic Floor Tips

Gender Neutral Pelvic Floor Tips

Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women.  The pelvic floor helps keep us dry.  More than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.  

Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.  

Here are my best pelvic floor tips.

Start a Bladder or Bowel Diary

For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking. Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks. Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.But, please consider what you can do with the information. Are there any trends you are seeing? Do you have more problems in the morning, afternoon or evening? Do you need to space out your fluid intake?  ou may be able to cue into changes that may positively impact your bladder control and confidence.  

Drink more water and consider cutting down on alcohol and caffeine

Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass. Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse.  Hydration with plain, old water is one of the keys to improved bladder function.  And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern.  Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?  

Kegels

Yes – we need to talk about this.  Men can do Kegels and should do Kegels to improve bladder control.  Kegels are not just meant for women.  Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance.  Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry.  Here are some cues that may help you or your loved one perform a Kegel.   

 Return to the idea that pelvic floor is a muscular sling.  It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.

  • Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly. When you do this – you may feel a gentle tightening of the muscles underneath your navel. Your tailbone may gently rises up and in. Continue your normal breath. Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.

  • Continue breathing and hold the Kegel for a few seconds. Then gradually relax. Repeat until you’re fatigued or have completed your goal.

That concludes my list of my best pelvic floor tips. What are your best practices?

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Incorporating pelvic floor exercises into your general workout routine - 3 best moves to add now.

3 Pelvic Floor Exercises to add To your workout routine now.

A guest blog written by Michelle Herbst, PT

Pelvic Floor Exercises, or Kegels, is the contraction of the muscles between the pubic bone and tailbone. When a pelvic floor exercise is performed, the person should feel a gentle tightening and lifting sensation in the lower abdomen and perineum. The pelvic floor muscle contraction is complete when the muscles relax and let go of the contraction.

Please keep in mind these tips when performing a pelvic floor exercise to protect yourself from undue harm. One, you must be able to maintain your breath and therefore be able to inhale and exhale while performing a Kegel and avoid breath holding or bearing down. Two, your muscular effort should be around 75 to 80 percent. If you are exerting 100 percent effort, you are likely using the pelvic floor muscles and many other muscle groups as well.

There are many variations and progressions of a Kegel exercise.

Here are 3 ways to incorporate pelvic floor exercises into your daily routines.

Exercise One: Kegel Progression

The pelvic floor muscles are made of two muscle fiber types – fast and slow. Therefore, Kegels can be progressed by varying the hold time and intensity of the muscle contraction. One of my favorite progressions is simply lengthening the hold time followed by a few quick pelvic floor contractions. For example, a Kegel can be held for 5 seconds followed by 5 quick contractions. This Kegel Combo can be done in any position – seated, standing or lying down. It can be done to the beat of music while seated at a stop light or at the end of a cardio or lifting session when you are your mat working the abdominal exercises.

Exercise Two: Kegel with Breath Work

Yoga is the all the rage and you my find your zen when performing a Kegal with breath work. While your yoga instructor is cueing you in inhale and exhale think about what your pelvic floor. Typically, during focused breathing such as in a Yoga Class, there is always slight tension on the pelvic floor. However, you further engage the pelvic floor muscles when you forcibly exhale. During this type of exhalation, the pelvic floor muscles tighten further along with our deep abdominal muscles to push the air up and out of our lungs. Try it. It may transform your yoga practice.

Exercise Three: Kegel with Plank

Plank. It is a much loved and hated exercise. It is a great way to fully engage our core. And, to reap the benefits of the plank - you must focus on the pelvic floor. If your wrists and feet can tolerate a full plank – go for it! If you need to modify, do a half-plank on your knees. Or, try a wall plank by standing with your feet an arms-length away from the wall and placing your hands on the wall.

Here are a few head to toe cues to get you planking.

When in plank, the hands are stacked under the elbows and shoulders. The chin is slightly tucked lengthening the back of the neck. Your shoulder blades are pulled down and back towards the spine. The chest opens and the pelvis is slightly lifted. Your legs are hip width apart. In full plank, your ankles are 90 degrees as you weight bear through the toes. Now, draw your focus to your pelvic floor muscles.  When you tighten the Kegel muscles, you may feel like your tailbone lift up and in. Hold your plank and breathe. Smile too – you just may enjoy how strong you feel.

 
Michelle Herbst, PT

Michelle Herbst, PT

 

It's All About The Base: Learning How To Work Out Your Pelvic Floor

It's All About The Base

We all have health goals. They are often about being more health conscious and physically active.  I’ve heard varying goals from “I want to lose 15 pounds” to “I want to be able to run my first marathon,” but rarely do I hear “I want a stronger pelvic floor” or “I want to be able to jump or exercise without leaking urine every time.” In fact, most people don’t even know about these muscles and how essential a strong pelvic floor is for everyday function.  

The pelvic floor is an amazing set of muscles that span inside your pelvis, from your pubic bones to your tailbone, that act as the base of your core.  They work to control your bladder and bowel and maintain continence, allow for pain-free and enjoyable intercourse, hold up the pelvic organs and help stabilize the pelvic girdle and spine…that’s a lot of responsibility for muscles that are often neglected in the daily workout plan.

As a pelvic floor specialist, I am often asked “How do I work out my pelvic floor?”  The fact is, most people don’t know how to turn on their muscles the RIGHT way.  They are often trying so hard to squeeze as tight as possible that they are engaging everything but their pelvic floor! They will hold their breath, clench their butt, squeeze their inner thighs, tighten up their abdominals and totally miss the boat. 

A pelvic floor contraction, or Kegel, is a very subtle feeling.  It includes a compression and lifting of the muscles deep inside the pelvis, like you are trying to suck a marble up with your vagina or lift your testicles in fear of walking into ice cold water!  Too frank? Well then imagine that you are stopping the flow of urine, which is actually a good test to see if you are engaging the RIGHT muscles.  You can always tighten your pelvic floor mid-stream and see if you can stop, or at least slow down the flow, but this should just be a test, and never a means to actually exercise these muscles.

Although the pelvic floor is the star of this article, you have to also understand that these muscles don’t work in isolation.  Remember that the pelvic floor is the BASE of the core, but also works with other muscles as an integrated system.  The major supporter of the pelvic floor is the diaphragm, which is the dome-shaped muscle at the bottom of the rib cage that is essential for breathing. 

When you take a deep breath in through your nose, your rib cage expands and the diaphragm moves downwards, changing the pressure system in your abdomen so your pelvic floor muscles RELAX.  As you exhale through your mouth, the diaphragm moves upwards, and again, the intra-abdominal pressure is changed, and the pelvic floor returns to its resting position.  Wow! Who knew that just practicing breathing could also be working the pelvic floor!

If you want to get fancy, you can coordinate the two muscle groups together:  

Start lying on your back with your knees bent.  Place each hand on the side of your rib cage. Inhale deeply through your nose, imagining your rib cage is expanding in all directions into your hands, and keep your pelvic floor relaxed.  As you exhale through your mouth, let your rib cage return to resting position and gently tighten your pelvic floor muscles and hold for up to five seconds, then release.  Repeat this sequence for a good 5-10 minutes each day…it’s more about the quality of the breathing and pelvic floor contractions, not just the quantity.  (If you are a numbers kind of person, then try to shoot for 30-50 contractions a day.)

It is essential that you allow for the relaxing aspect of this exercise.  Like any other muscle in the body, we need to make sure the pelvic floor is able to go through its entire range of motion, which means it should be able to tighten, and then release or relax, so it can be able to contract again.  Remember that these muscles are working 100% of the time, and in order to maintain a strong pelvic floor, you need to let these muscles RELAX in between each contraction

 As you feel more comfortable with this exercise, try it sitting or standing, so you can start working out your pelvic floor throughout the day. The beauty of exercising your base is that no one even knows you are doing it!  You can be standing in line at the grocery store or sitting in your car, waiting for the light to turn green, and BAM!  You are working your base out!  Even better, think about integrating your pelvic floor and diaphragm into your gym routine, especially lifting weights or doing other core work.

I dare you to start thinking about exercising all aspects of your core, especially your pelvic floor.  Remember, it’s all about the base!

Victoria Yeisley, DPT, has been specializing in pelvic floor physical therapy since 2008.  She completed her Doctor of Physical Therapy at Boston University and currently works with Northwestern Medical Group in Chicago, IL, where she is integrated as a part of the OB-GYN team.  Victoria’s passion lies in empowering her patients to not only be educated about their pelvic floor, but to gain control over their symptoms.  She feels extremely lucky to be able to practice her passion every day and hopes to be able to continue to promote pelvic floor muscle awareness for all!