Do I Need Kegels?

Let’s first define a “Kegel.” A Kegel is simply an isolated pelvic floor muscle strengthening exercise. It’s called a Kegel because Dr. Arnold Kegel was the first physician to describe the exercise (all the way back in the 1940s). 

Next, let’s talk about muscle function. All muscles – even our pelvic floor muscles – need three things to keep us functioning well and without pain:

1.     Strength to perform the tasks required of them.

2.     Flexibility to move through their full range of motion.

3.     Coordination to work how they’re supposed to when they’re supposed to. 

If your pelvic floor muscles lack strength, they can get overpowered and fail to support your pelvic organs. If your pelvic floor muscles lack flexibility, they can become too tense to be able to respond to demands. If your pelvic floor muscles lack coordination, they won’t respond appropriately to the signals from your brain. Dysfunction in one or more of these areas can lead to issues like urinary or fecal incontinence, pelvic pain and pain with intercourse, constipation, urinary urgency or frequency, and pelvic organ prolapse.  

You may be thinking at this point that the answer to the question, do I need Kegels, is yes because don’t all muscles need to be strong? Well, yes…but wait. Here’s an example: I stink at volleyball. I’m a pretty strong person and I can knock the snot out of the ball…if I can hit it. And I certainly have the shoulder mobility to play volleyball. What I lack is coordination, and no amount of strengthening or shoulder mobility training in isolation is going to make me better at volleyball. Similarly, your pelvic floor muscles may have the strength to support your bladder, but if they lack coordination, you might still leak when you sneeze. Or your pelvic floor muscles may have the flexibility for pain-free penetration, but if your brain can’t coordinate with your pelvic floor to relax, penetration will still be painful. 

Think of the last time you trained for an event or imagine an athlete training for sport. Rarely is any training done in isolation. Your pelvic floor also does not function in isolation. It’s part of a system that includes your diaphragm, abdominals, glutes, hip rotators, and muscles in your back. So, no matter what the primary driver of the dysfunction is, you need to train the system as a whole. 

Your pelvic floor may lack strength and Kegels may be a component to your rehab. However, isolated strengthening rarely generates the results you need. Additionally, when you hear, “just do Kegels,” most people will do 5-10 here and there throughout the day, which does not reach the level of time under tension required to truly strengthen a muscle. Imagine you want toned arms and you go around curling a 3-lb weight with your biceps whenever you think about it – not going to get those guns you want. 

One final word about Kegels: if strength is not your problem and instead tension is, doing Kegels may actually cause more harm than good. That’s why it’s best to have an evaluation by a pelvic floor therapist trained in internal assessment so that we can get to the true cause of the dysfunction.

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