Pelvic floor conditions are rarely discussed openly in our society, which can leave many patients who suffer from pelvic floor dysfunction feeling alone dealing with their symptoms.  Searching the internet will often lead people to do the Kegel exercise, with little consideration for other factors.  And after giving birth many women are simply told, “do your Kegels and you’ll be fine,”  but given no education about the pelvic floor.  Kegel exercises are helpful for many pelvic floor conditions, but sometimes they are not the appropriate choice.  In addition, even if the patient is a good candidate for Kegels, research shows that only about 50% of females do a kegel correctly (Bump et al., 1991, p. 324).  

So what happens when Kegels don’t seem to be working for you, or if they seem to make the problem worse? Or if you’re a male and no one has ever taught you anything about Kegels? Treatment with a pelvic floor physical therapist can make a huge difference in your recovery. 

Before we talk about treatment, let’s review normal pelvic floor function.  When the pelvic floor muscles activate, they gently lift upwards to support the organs above them and squeeze together to maintain bowel and bladder continence.  The pelvic floor muscles also have to be able to relax, in order to urinate or pass a bowel movement.  To do this they gently move downward and release pressure around the urethra and anus. Essentially, the pelvic floor muscles should have the ability throughout your day to adjust to the demands placed on them during times of activity to provide appropriate support and maintain continence, as well as being able to relax during times of rest and bathroom use. Pelvic floor dysfunction often arises from the muscles inability to perform these actions in some manner and can be helped by specific retraining of the muscles. 

In patients with pelvic pain the muscles of the pelvic floor are often overactive and aggravated, so trying to squeeze those muscles as hard as you can may make the problem worse. The pelvic floor muscles are a place in the body where many people hold tension without realizing it- similar to the jaw, shoulders or low back. When someone holds tension through the pelvic floor those muscles live in a state of squeezing and lifting. This constant tightness helps explain why people with pelvic pain may also experience difficulty urinating or constipation symptoms. 

If this is the case, often the place to start with these symptoms is for the person to learn how to relax the pelvic floor. It is the exact opposite of a Kegel, and is sometimes called a reverse Kegel. Relaxing the pelvic floor is harder than one might think. A cue that is often given for women to do a Kegel correctly is to imagine picking up a marble with the vagina. For men (or  women too), Kegel exercises are often cued by saying draw “the anus up and in”. The relaxation exercise of the pelvic floor works in reverse. 

So imagine trying to set down a marble with the vagina and allowing the anus to lower. These exercises help release tension through the pelvic floor and are best done paired with a deep, slow inhale because of the relationship between the pelvic floor and the diaphragm. 

Even for patients who don’t have pelvic pain, pelvic floor relaxation can be beneficial. Think of it as a stretch for the pelvic floor muscles just as you should stretch after a run or other type of workout, the pelvic floor benefits from stretching after it works too. 

A comprehensive pelvic health physical therapy program will likely include a bit of both pelvic floor muscle activation (Kegels) and pelvic floor muscle relaxation. Your physical therapist will help guide you to find what works best for you and your body. 

If you are dealing with pelvic floor dysfunction you aren’t alone. Our pelvic physical therapists at Andersonville Physical Therapy are here to help you rehabilitate your pelvic floor and achieve your goals for health and wellness. 

In the meantime, to learn more about your pelvic floor, we recently shared some video discussing Kegels and the pelvic floor muscles and function. 

Schedule an evaluation with a Pelvic Floor Physical Therapist today!

Bump, R. C., Glenn Hurt, W., Andrew Fantl, J., & Wyman, J. F. (1991). Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology, 165(2), 322–329. https://doi.org/10.1016/0002-9378(91)90085-6