To Kegel or Not To Kegel…That Is The Question…

When something is going on, “down there” and you go to your gynecologist, what do they say? Especially if you have had kids? They tell you to do your kegels, right? Keep doing them and it will get better soon. You aren’t doing enough. You aren’t holding them long enough. You don’t know how to do them. Then you look up online what to do and you get hundreds of different kegel programs. However, the unfortunate part is, most (yes the MAJORITY) of women (even men) do not know how to do the kegel exercise properly. How do you react when I say,


Whatttt?!? Did I just say that? Yes, I did. I 100% stand behind it too.
First of all, what exactly is a Kegel? Don’t worry if you don’t know, join the club. It was once thought to be a common word but unfortunately not so much. A kegel is an exercise where you “squeeze” the muscles around your vagina and your rectum to “close the holes.” We use these contractions to improve strength, endurance, coordination, or control of urgency/frequency, etc. But remember, not everyone needs to be doing them!
I’m going to give you a few reasons why the kegel exercise would NOT BE A GOOD THING TO DO:

  • You feel tightness in your stomach (lower region) or irritability, meaning those muscles are tense.

    • Don’t do a kegel because:

      • If you do, you are actually increasing the pressure of your lower abdomen/core region which will not help loosen things up OR make them function better. You would then just

  • The muscles on your inner thighs (adductors) into the groin are really tight.

    • Don’t do a kegel because:

      • You are already tense around the pelvic region and increasing tension by contracting the pelvic floor will not make a positive change. The best option to do FIRST is to stretch out the inner thighs and relieve the tension.

  • If you have pain in your vagina or pelvic region constantly or daily

    • Don’t do a kegel because:

      • This can indicate something else going on internally with the musculature. If you have tension or a problem going on internally already, then doing a kegel will only make things worse.

  • If you have pain inserting a tampon, having intercourse, or getting a papsmear done

    • Don’t do a kegel because:

      • You potentially have tightness in the musculature internally (pelvic floor region) which is contributing to the pain. Or you may be having sensitization impairments or problems (cannot feel what you should be feeling).

  • If you have difficulty performing a deep breathe with proper diaphragm movement

    • I posted about this before, but have put another video here for you. (Subscribe to my youtube channel for more!)

      • If you are unable to breathe properly you have no ability to control your internal pressure. You will have too much pressure in your abdomen already and with a kegel this will only increase.

Hopefully this clarifies some of your questions about whether or not Kegels are right for you. This, of course, is not to be utilized as medical information and if you are having pelvic floor dysfunction. Please let me know if you have any questions!

How I grew to Love my Pelvis

Half the time, I notice my patients come in and sit down without having any idea why they are here. Most of the time, they ask, “How in the world could a physical therapist help me?” Typically they are anxious, afraid, fearful of the unknowing. I can just see it in their eyes that they have never in a million years heard of going to a physical therapist for a pelvic floor issue. They understand to go a gynecologist, or their primary care, but they do not know why they might come to me.
Well, neither did I. No, I’m just being honest. I did not know that the profession I paid so much to be a part of, the schooling I went through that was exhausting and caused so much anxiety, had any part in …. well our parts. There was one class I sat through, a total of 4 hours, that explained the anatomy of the pelvic floor and described it was an option. I remember sitting there thinking:
             I WILL NEVER, EVER, EVER GO THERE IN MY CAREER. THAT’S NOT WHAT WE                                                                                       DO. 
The professor was speaking of “internal” examinations, touching “deep muscles,” bowel and bladder habits….yuck! I couldn’t help but instantly feel uncomfortable. We DON’T talk about that! I left the class and completely ignored everything she had said. I ignored how rewarding she said her job was, how much she has learned since going into it, how she is now loving every second. Nope, just sounded gross so I ignored it all. 
Until I got out of school. I took my first job and started on my career path. I was treating all of the exciting stuff that you never got to SEE in school. The complex cases, the impairments that have been there for years…all of it. I LOVED it. One day the clinic director asked me, “Are you by any chance interested in pelvic health? We are trying to fill a spot here.” I instantly got fearful from remembering my past 4 hour course and said, “I don’t think so.” However, I couldn’t help but continue to think about it. I started to look up blogs, articles, webpages, about people who have had pelvic health treatments or those who have treated them. From patients’ I was getting things like:







I got to thinking. This is something. There has to be more to it. So, I went back to my director and said, “I’m willing to give it a shot. Hope I like it.” We sent me all the way to Seattle to take the first Pelvic Health Level of training. I walked into class, had not looked at any of the materials because I was still ignoring everything. Sat down and there it was. A very large, hairy vagina on the projector screen.
I looked into what patients had said about treatments. I NEVER looked into what the training entailed. So we started with anatomy (I will blog about this), then got into dysfunctions, treatments, etc. Then we partnered up and she said we are preparing for the internal examination….
I did not come here for THAT! I did not even shower twice or “prepare” or look to see if it’s okay down there. I did not even mentally get ready but you want me to take my pants and underwear off and jump on a table and let someone I just met examine me?!
The answer was yes.
This turns out to be the EXACT mindset of most patients when they come in to see me. They become fearful. They have no idea what to expect.
So, my examiner started to ask me some questions. Some deep questions. This was before we did the internal examination. She was asking if I leaked urine or feces, if I had constipation or bowel problems, pain with sex.
Instant embarrassment. Do I have to ADMIT to my problems that are private? They are normal, right? I fought with myself for a minute. Then with tears forming and with pain in my chest I spoke up. I said,
“I leak urine if I cough, jump, or run. Which I do a lot of the above. I had a … traumatic event at one point in my life… so internal examinations make me really anxious and emotional. I am unable to have sex with my partner because it hurts. If we do, I just suffer and cry later. But I have friends who deal with these things too so it’s nothing abnormal.”
I’m a freaking physical therapist and that was my response. You have got to be kidding me, right? I look back at all of this now and I truly wish I knew then what I know now. Long story short, they did the internal, I cried, I had no coordination or ability to contract/relax my pelvic floor appropriately and I had “trigger points” in my vagina.
Next day was treatment. It was dreadful. It hurt, I cried more. I treated someone else and cannot say I particularly enjoyed it. Class was over and my husband and I went out to explore Seattle. I ran and….no leakage because I had been doing what the examiner told me to do. Wait…no leakage? None whatsoever? Wow. Okay, well now I’m curious. Let’s see if….sex still hurts? We tried and…….
Literally 2 treatments. I was sold. I went back to the course and stood up in front of them all and said, “I’m cured. You all cured me. I’m sold. Let me learn.”
They all smiled like this happens all the time….later I find out it does.
My back story? I’d been leaking with jumping, running, or exercise for about 8 years. I was a ballet dancer all of my life and was one of the “excessively flexible” ones. I had never been told to control my pelvic floor, or even what it was. So, I never paid attention. I also had bouts of IBS loose stool or constipation. I had terrible habits. Once I learned about it all and changed what I needed to,
After that one course I’ve been HUNGRY for more information. I started seeing patients, learning about conditions, and BOOM. I’m GOOD at this. I’m good at connecting with and forming relationships. I’m good at helping women feel comfortable. I’m good at education. I still sometimes do not know what to do for a particular case but I love finding out. The reward I had with my simple treatment that helped get rid of 8 years of problems is all I needed to start me on this journey.
My pelvis is a part of me. It is something I need to care for and pay attention to. So should you.
Continue following, bring your friends, to get more information on what pelvic health is, dysfunctions, education, etc. I’m so excited for this!