By Jenna Jarvis
Over the last decade, the term “Kegels” has become the standard recommendation and almost promoted as a “cure all” for women dealing with pelvic pain or dysfunction; the assumption being that the pelvic muscles are weak and need to be strengthened. We know that miracle cures rarely exist and as a Women’s Health Specialist, I often cringe when I hear patients tell me they were told to do Kegel exercises by a friend, website, or even a medical provider, without first undergoing an individualized examination to determine whether pelvic floor weakness is the true underlying problem. To be clear, Kegels can be helpful for pelvic floor dysfunctions related to weakness; however, Kegels are not a one-size-fits-all exercise for all women with pelvic floor dysfunction.
Similar to any other muscle in the body, the pelvic floor can and often has too much tone and recommending generic Kegel exercises for someone who already has too much tone will be like adding fuel to a fire, the symptoms will often worsen! You ready for the tricky part?
Even for women with too much tone, they often STILL have weak pelvic floors, which can lead to signs such as urinary or fecal incontinence, often confusing the patient as to what is the cause. To reiterate, patients can have too much tone in a muscle that is still weak. All muscles have an ideal length-tension relationship. To produce optimal strength and function, they need to maintain a proper length-tension relationship.
So if Kegel exercises are not always the right solution, what is?
Pelvic floor physical therapists have the understanding and training to interpret symptoms, and then examine the pelvic floor, lumbar spine, pelvis, and hips to determine what treatment is appropriate for the patient. If the pelvic floor has too much tone, we must first address this issue via combination of deep breathing exercises, down-training of the pelvic floor, manual therapy of the pelvic floor, biofeedback exercises, etc. If pelvic floor weakness is also an issue, we will prescribe specific pelvic floor exercises based on the patient’s weakness and symptoms. Ultimately, a thorough assessment of the pelvic floor is necessary to target the underlying cause of the patients and create a detailed, individualized treatment plan.