To Kegel or Not to Kegel, That is the question!

March 15, 2013 in Bladder issues, Exercise, Pelvic Floor, Post Partum, Prolapse

If you were to ask any woman what is the number one exercise to do for a healthy pelvis and the answer would be “a kegel,” or pelvic floor contraction.   Healthcare Practitioners all tell you to do a Kegel if you are peeing in your pants when you laugh, cough, jump or sneeze or if your bladder is falling out.  It’s the number one “go to” exercise that women are told to do with any problem in the pelvis.   Contrary to popular belief the Kegel may not be all that it’s cracked up to be and is not always what I recommend.

The Problem with Kegel Exercises

We are well aware of the state of the muscles we see on the outside of our body.  You can look at your biceps, your “Popeye” arm muscle that helps bend your arm, and see if it’s got good tone in it or not.  A muscle used through normal daily activity stays rather healthy and strong.  If you were to immobilize a joint the muscles influencing that joint quickly fade away to mush.

The problem with our pelvic floor muscles is we can’t see them and probably have no idea what state they are in.   Are they truly weak or do they have too much tone in them?    Just like the knots in your shoulders cause your shoulders to raise up to our ears, the pelvic floor muscles can have too much tone in them causing them to contract and not be able to relax.  So many women are walking around with TOO MUCH tone in their pelvic floor muscles and yet the number one suggestions practitioners make with any problem in the pelvic floor area is “DO KEGELS!”   If the muscles don’t know how to relax and have too much tone in them, doing Kegels is only going to make the problem worse.

Think of the pelvic floor muscles as an elevator.  Normal resting tension is at the ground floor.  A full contraction starts at ground floor and reaches 5th floor, maximum contraction ability.  If you are holding tension in your pelvic floor muscles and they hang out at 3rd or 4th floor all the time there is not much contractile ability  for the muscles to get you to 5th floor.  The contraction feels very weak and doesn’t move very far.  It’s not that the muscle is weak per se, it’s that it’s already contracted and can’t find the ground floor.    It’s really relaxation ability that is needed for these muscles.  They need to find ground floor again.  Doing more kegels is like banging your head against the wall!  You are not going to get very far.

The other problem with Kegel’s is not many women know how to do them correctly.   They just don’t know how to engage the muscles to get them to contract.   To read more about the correct way to kegel click here.  In my practice it’s very common for women to NOT be able to fully contract their pelvic floor muscles.   We carry so much tension in our pelvic floor muscles that they can’t fully relax all the way to be able to contract fully.

What about after childbirth?

The pelvic floor muscles get stretched to their max, are lengthened after having a baby and need help finding the ground floor again.   So you think that strengthening for most moms after childbirth is critical.  Well it is in most, but not all moms.

It is interesting to note that in some women, just months after having a baby when you’d expect to find lengthened weakness in their pelvic floor that they are actually hanging out at 4th floor.  This may be due to trauma in the muscles or an unconscious holding pattern.  If you tear during childbirth then scar tissue can cause increased tone in the muscles and help hold the muscles at 3rd or 4th floor.  Getting those muscles to relax is key.

So how do you know what state your pelvic floor is in?

You’ve got to check yourself!  Yes that means inserting your finger inside your vagina and feeling your muscles engage and relax.  How do you do this?

Checking for Pelvic Floor Strength:

  • Sit semi-reclined so back is nice and supported
  • Bend knees up and separated slightly
  • Insert your index finger or thumb into your vaginal opening
  • Think of the opening as a clock and check your muscle contraction ability in 4 quadrants:  at 1:00, 5:00, 7:00 and 11:00.
  • See if the left side contracts the same at the right side:  1:00 and 11:00 should be the same as is 5 and 7:00.
  • Checking out the relaxation ability of the muscles is just as important as the contraction ability.

Addressing tone in the pelvic floor muscles

  • Gentle massage of the tissues may help it respond more and be able to contract more fully.  If you are postpartum your pelvic bones may be out of place and may need some adjustments to get back to normal positioning after childbirth.
  • Also learning how to relax the pelvic floor muscles is key.  Feel the tension in your muscles when you check internally.  Both sides should be able to bounce and move up and down with pressure.  If one side moves and the other doesn’t then you need to work on the side that doesn’t move.  Adding gentle pressure and encouraging the tissues to relax is key. Focusing in on that muscle and breathing into it can help it relax.
  •  See a Women’s Health Physical Therapist if you need help in discerning what your pelvic floor muscles are doing or need help in getting them to relax.

While it is important to have good contraction ability of your pelvic floor I believe there is a much better way to keep your pelvis healthy and strong that doesn’t involve Kegelling!   Stay tuned as I’ll share with you what that is all about.  Until then check out your pelvic floor muscles and see what shape yours are in.

 

Check out other great blog posts:

Sarah Cody at birth play love gives a run down of the importance of eating organics:

http://birthplaylove.com/organic-food

Sarah Bauer at Press Pause Photography works up a list of birth and baby services in Northern Colorado:

http://wp.me/p2HgfA-9B

How to do Kegel Exercises Correctly

March 4, 2013 in Exercise, Pelvic Floor, Pelvis

Doing Kegel’s Correctly

Do you know how to do a Kegel correctly?  Most women don’t!  Yet kegel exercises are all the rage.  They are the most popular piece of advice given to women for any condition in the pelvic region.  Yet many women don’t know how to engage their pelvic floor muscles correctly.    Let me explain the correct way to contract these muscles.

pelvic floor musclesTo figure out what needs to be contracted let’s find the boney landmarks that house the pelvic floor muscles.  Sit on a hard chair and roll your pelvis forward so you become aware of your pubic bone coming into contact with the chair.  Then roll your pelvis backwards so your tailbone feels the contact of the chair.  Then move your weight over to one side so you feel your sit bone in contact with the chair and then repeat to the other side.  You have just contacted all four boney landmarks to where your pelvic floor muscles attach.  To contract your pelvic floor muscles think about pulling your pelvic floor muscles up and inside your pelvis while bringing all four of those boney landmarks together.   Imagine a purse string being pulled tight to gather all the material to close the purse.

If you are doing a kegel correctly you should not have any muscles on the outside of your body visibly contracting.  Nobody should know you are doing a kegel.  If your pelvic floor muscles are weak or you don’t know how to activate them correctly, your butt, leg and abdominal muscles kick in to try and help out.

In order to make sure you are doing the exercise correctly there are two positions you can get into that guarantee you are contracting only your pelvic floor muscles.  One position is sitting in a chair with your knees spread wide open and leaning forward with your trunk. Your arms can rest on your legs.  As you contract your pelvic floor muscles your legs should remain still.

An even better position is child’s pose.  In this position you are kneeling on the floor, sitting back so that your butt is resting on your heels and your body is draped over your thighs with you arms either out in front of you or by your sides.  There is no way you can contract anything but the pelvic floor muscles in this position.  If you don’t feel anything happening between your sit bones then your pelvic floor muscles are either too weak or just not contracting.

Another way to figure out if you are contracting your pelvic floor muscles correctly is to try and stop the flow of urine.  If you can stop the flow or are able to deflect it a bit then those are your pelvic floor muscles you are using to make that happen.  As you try this pay attention to what is happening in those muscles to get a feel for that contraction.

Warning!  It is important that you do not test your muscles by stopping the flow of urine all the time.  Testing your contraction ability about once a month is preferred.  If you stop the flow of urine too often your bladder gets confused and doesn’t know if it should start or stop the flow.  The nervous system that controls the bladder is very sensitive and you don’t want to be messing it up by testing your muscles too frequently.   Remember testing about once a month should be tops!

NORMAL STRENGTH OF THE PELVIC FLOOR

A strong pelvic floor muscle should be able to hold a contraction for 10 seconds.   See how long you can hold your contraction before the muscles fade away from weakness.  You can work on trying to hold the contraction for 10 seconds by just reengaging the muscle for the duration of those 10 seconds and then relaxing.  Just do 3 sets of these 10-second holds and then you could be done, for the hour.  Doing that every hour will hopefully improve your strength.  If it doesn’t get stronger or you have difficulty even engaging the muscles, stay tuned for my next post on the problems with kegel’s.

 

 

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