What is a Kegel?
Kegel exercises are named after the first physician to describe this contraction. A Kegel is a contraction of your pelvic floor muscles (often referred to in the media as the PC, or pubococcygeus muscle) and is more accurately called a “pelvic muscle contraction” or a “pelvic muscle exercise.”
It is actually performed by a group of several muscles that encircle the urethra (bladder tube), vagina, and rectum. When the contraction is performed correctly, these “openings” of the body should close. No outward sign of effort should be visible with a pelvic floor muscle contraction. For example, you can perform these contractions while standing in line at the grocery store and nobody would know you are doing them! There should be no closing the legs together, no squeezing the bottom, and no pressing your stomach outward. All you should feel is a lifting of those pelvic floor muscles and a slight tensing or drawing in of the lower abdominal muscles.
Sounds easy enough, but they are actually much harder to perform than you would think. A study published in the early 1990s in the American Journal of Obstetricians and Gynecologists (Bump, et al) looked at the performance of women doing Kegels after brief verbal instruction. They were then re-tested, and only 49 percent of these women performed the contraction correctly. Worse yet, 25 percent of the women were performing them in such a way that would actually PROMOTE incontinence. It was their conclusion that simple written or verbal instruction is inadequate when prescribing a Kegel exercise program.
How does a Kegel work?
Women frequently say, “I’ve tried Kegels and they don’t work.” Based on the study above, it seems likely that these women were not doing the contraction correctly and potentially making their incontinence worse. If you don’t exercise a muscle properly, it’s not going to get stronger. Women also tend to perform pelvic muscle contractions at an inadequate amount or frequency based on their current level of strength. For example, holding the contraction for 10 seconds–that’s like running a marathon for women with incontinence or prolapse, as it over-exercises the muscle and tends to create muscle soreness without gains in strength. Worse yet, over-exercising can lead to a decrease in muscle performance, which means incontinence may worsen. Some women, however, tend to under-exercise, which isn’t going to get them stronger either.
Learning to perform pelvic muscle contractions correctly can be frustrating, especially if you are trying to eliminate or reduce incontinence or prolapse. If you feel you are unsuccessful, ask your physician, nurse practitioner, or midwife for a referral to a Pelvic Health Physical Therapist (PT). Pelvic or women’s Health PTs are trained in identifying the appropriate type and amount of pelvic muscle contractions you should be performing to be successful. They may also identify other areas of weakness that would need to be addressed and provide you with valuable education in order to maximize your outcomes.
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