Move it or Lose it
Kegels (aka pelvic floor exercises) are healthy, simple, and effective. We all know all that, right?
But … are they essential? Let’s find out.
The Kegel, was first recommended by obstetrician Dr. Arnold Kegel around 1950.
For those of you who don’t know, it is the most commonly practiced non surgical intervention for a weak Pelvic Floor. There is a mass of evidence to support their success and many people both men and women report them to be beneficial.
They’re powerhouses for increasing pelvic floor strength. But there is one problem……..women hate doing them and many tend to forget (we need consistency to make changes in the body)!
So is there another way??
Let’s find out.
Anatomy of the Pelvis
The pelvic floor is made up of the:
Coccygeus muscle (formally our tail wag muscle)
Iliococcygeus muscle
Pubococcygeus Muscle
Puborectalis and Pubovaginalis muscles. The ones most closely involved with with bladder and bowel control
Two buttock muscles intimately connected with and who profoundly influence pelvic floor:
Piriformis
Obturator Internus
In very simple terms, the pelvic floor attaches to the Tail Bone, the Pubic Bone and the Sit Bones. Move them and you move the Pelvic Floor. So what dies that mean? If you want to beef up your pelvic floor you need to move the bones thereby causing contraction and relaxation of the pelvic floor.
How can I make these bones move?
Every time you squat the sit bones widen and the pelvic floor is stretched UNDER LOAD. A good Squat is an example of a phenomenal good pelvic floor workout.
When do you move the tail bone? Every time you do a Cat/Cow exercise or a Pelvic Tilt, for example
When is the time when you most move the pelvis? During walking. With each and every step your pelvis gently and subtly moves (unless it is super tight and that is another story).
The pelvic floor is very closely connected to Obturator Internus via mutually integrated connective tissue. Obturator Internus, like Piriformis, attaches to the thigh bone. Move the thigh bones (well and properly) and you will tension, load and work your pelvic floor.
All movement done well, and done properly is good for the pelvic floor. Conversely inactivity is its enemy. On a very fundamental level if we want to help our pelvic floors when we need to get up from our collective chairs.
Any other way?
When you move and walk
When you squat, or Sit/Stand from a chair, or hinge back from an all fours position
When you do Glute Bridges
I could go on: pelvic clock, pelvic tilt, Cat/Cow, even the good old Clam, side leg raises, lying on your back and doing leg circles.
This leads us back to pilates and strengthening-based classes. Here you treat your body and pelvic floor to a variety of healthy movement patterns which will indirectly contract and relax the pelvic floor. Hurray!!
So Kegels alone may not be the answer??
There is a tendency to focus on the contraction/lift of the Kegel, and to forget or even omit the lowering phase.
A lot of people think “I want my pelvic floor to be strong and tight” so more squeezing, more pull, more effort” More must be preferable. Higher must be better. Longer must be good
No not really. You want it to be dynamic, supple and responsive. We want to get the muscle to respond to the demand of life. Pilates and strengthening are great ways of training the body and pelvic floor to respond load.
But isn’t it just the difficult childbirth I experienced?
We tend to assume that Pelvic Floor weakness is caused by child birth and it is, for sure. However, men get Pelvic Floor dysfunction, older women who have never had children get pelvic Floor dysfunction, younger women who haven’t had children develop issues. It is a growing problem. It seems that the risk factors have changed. Also though, people are more prepared to talk about it and not suffer in silence so maybe we are more aware of the problem than we used to be
What is this new risk factor? Inactivity.
The pelvic floor needs you to move and not to sit down any more than is strictly necessary. That is a lot of load bearing down on the pelvic floor with no respite, no altered blood flow, and often with the tail bone “trapped” underneath you.
SO A FUNDAMENTAL WAY TO ADDRESS DYSFUNCTION IS TO Move MORE
Activity in general as a start, although with the massive proviso that if you have PF dysfunction it may prevent you from walking or taking exercise. This is when a careful focussed programme of exercises may be vital, alongside learning all the tips and ideas for addressing things like Urge incontinence: the sudden and frequent need to rush to the toilet.
There is another risk factor too: when breathing patterns are off-kilter. This can be due to a variety of factors like: tending to breathe in the upper chest: associated with anxiety and in extremis, hyperventilating. A tendency to belly suck constantly, wear clothes restricting the abdominals, or have super tight “ripped” abdominals. All of these things prevent the big breathing muscle, the diaphragm from working properly and that DIRECTLY disrupts the PF which works in tandem with the diaphragm. When the latter contracts, the PF relaxes, and vice versa.
Disrupt normal breathing and you disrupt PF function. Conversely, restore good breathing and you will really help your PF. This is rarely discussed sufficiently when people learn to do their Kegels.
But where to go from here:
If you really want to do Kegels, be careful, focussed, and trust your teaching source. Make sure you always relax as well as contract. Try and get referred for specialist help with a pelvic health physiotherapist.
Add the other stuff into your daily life. Are you breathing properly? Reserve the slimming pants for special occasions. Keep active.
In addition, I run a 6 week course of online sessions designed to Restore Your Pelvic Floor. The Pelvic Floor Revival is designed to give your pelvic and pelvic floor all the movements that will help your muscle work well again.