Kegels: Why We Should Stop Straining

Hey everyone! We’re pleased to introduce Rachel Gelman, our pal and licensed pelvic floor therapist based in San Francisco, who's talking about kegel exercises this week. With so much information out there about kegels as a sexual "game-changer," Rachel talks about what people aren't discussing when it comes to exercising our pelvic floor muscles. - Betsy

At least once a day I get asked about kegels.

“Should I be doing them?”

“Am I doing them right?”

“If I do them, will my orgasms get better?”

As a pelvic floor physical therapist who primarily treats patients (men and women) with pelvic pain, I usually advise them to NOT do kegels. This often surprises people because every magazine, blog or talk show recommends kegels to strengthen the pelvic floor and make their sex life better. The problem I tend to see is that people do kegels all the time, and are so focused on tightening that they forget to relax. You wouldn’t walk around all day flexing your biceps without letting your arm rest at your side. If you did eventually your arm would probably start to hurt, and you might have a hard time carrying objects or typing at your computer. The same thing can happen with the pelvic floor. If you only focus on tightening it, you can develop pelvic floor dysfunction which can present as pain with intercourse, urinary urgency, constipation or even urinary incontinence!

Another problem I see is that people do their kegels while urinating. If you are among this group of people: PLEASE STOP! When you continually stop and start your flow of urine, you start to disrupt the pathways between your bladder and your brain. This can lead to urinary hesitancy, retention or incontinence.

But what about sexual function?!

I get it. I too see countless articles that tell readers kegels produce better orgasms. If only it were that simple! Sexual function relies on so many factors: psychology, physiology, and spirituality to name a few. So, doing pelvic floor exercises alone is not the end all be all of sexual pleasure. If anything, I recommend gentle cardiovascular exercise over kegels, as increasing overall blood flow can improve energy levels and mood which can lead to better a better sexual experience. Sex is a much bigger experience than just the vagina, so why direct all your efforts on one area of the body?

So when is doing Kegels ok?

Kegels are useful if one has a weak pelvic floor that needs to be strengthened. Some examples of people who might fit this criteria are post-partum women or post-menopausal women. Basically, something has happened that has overstretched the pelvic floor muscles and made them weak. It would probably also help to know that your pelvic floor muscles are always working. They support the pelvic organs, contribute to posture and stability and keep us continent. So they are not a muscle group that needs intensive strengthening.

FIND THE RIGHT TIME AND PLACE.

There is a time and a place for kegels. If you are having symptoms that lead you to believe that you should be doing pelvic floor exercises I recommend you contact a pelvic floor physical therapist first to determine if kegels are the right treatment for you. You might be surprised, and may find that relaxing instead of contracting is best!

If you want more information on this topic and more check out our blog: http://www.pelvicpainrehab.com/blog/

All my best,

Rachel Gelman, DPT, PT

Rachel is a Bay Area native who has received bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. Rachel practices at the Pelvic Health and Rehabilitation Center in San Francisco. She specializes in the physical therapy management of numerous pelvic pain disorders. As a practice, we believe in a multi-disciplinary, collaborative approach to diagnose and treat all components of pelvic pain.