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The Key to Kegels

What are Kegels? Put simply, Kegels are to the pelvic floor what yoga is to the body, mind and spirit. They are an accessible form of low-impact exercise that has the potential to dramatically improve your life.

To get even more granular, “Kegel pelvic floor exercises are used to strengthen the muscles that support your uterus, bladder, bowel, and rectum,” according to WebMD. Kegels have enjoyed some publicity as of late, being touted as a way to treat erectile dysfunction and achieve pelvic floors of steel.

So how do you do them?

Many of us are not aware of where our pelvic floor muscles even are, so engaging them can be a challenge.

There are several ways, per Healthline. One is to simply replicate the experience of holding in gas. If you attempt that and then feel it in your vagina or back end, you’re doing it right! You can also locate these muscles by stopping urine while on the seat or putting a finger inside yourself while doing the exercise to feel the pull. Although please do not get in the habit of doing this routinely, as it sends mixed messages to your pelvic floor! You get one shot at it, for educational purposes only!

If you are of a certain age, think back to those claw arcade machines you played with as a child. The Cleveland Clinic compares the motion of a Kegel to the claw opening and closing around a prize.

You then will tighten your muscles for a count of five, and relax for the same count. For optimal help, perform these endurance contractions 20x, three times per week. You can also perform Quick Flicks, or “fast exhale squeeze, fast inhale release” 50x, three times per week.

Your physical therapy appointment is another great time to check your Kegel form. You shouldn’t be embarrassed or feel like you are bothering your therapist. That’s what they are there for!

Now, let’s take a closer look at what they’re for.

Pelvic Organ Prolapse

As I explain in my book The Inside Story, “POP is associated with the excessive descent of one or more of the pelvic organs or the vaginal wall.” It can happen after childbirth, and there are several different types of prolapse. These include uterine or cervix prolapse, cystocele/anterior prolapse, rectocele/posterior prolapse, and rectal prolapse. I also talk about prolapse in this blog post – well worth the read! Pelvic organ prolapse has a number of treatments, ranging from a pessary to surgery, but Kegels can make pelvic floor muscles stronger and those are the muscles that keep those organs stable.

Incontinence

Pelvic floor muscles affect how much control we have over our urination and defecation, which is why it may be recommended to strengthen them to treat urinary, urge and fecal incontinence.

Better Sex

Now I’ve got your attention! Yes, Kegels can even help in this department. According to WebMD, there is scientific evidence that Kegels can “enhance female sexual arousal by relaxing the vagina, improving lubrication and allowing more blood flow to the genitals.” In men, they may heighten the pleasure of orgasm and provide “greater control over ejaculation.” (Pelvic floor muscles really are the center to so much that goes on in our bodies!)

Who Shouldn’t Do Kegels

Kegels can be a problem for people with a hypertonic pelvic floor. This means the pelvic floor muscles are unable to fully relax. Nebraska Medicine states, “While these exercises may benefit both men and women, performing too many ─ or performing them incorrectly ─ may increase muscle tension and pain, or worsen your symptoms.” One journalist received a hypertonic pelvic floor diagnosis simply from doing Kegels alone, so you have to be careful. They also provide very limited benefit for overflow incontinence.

As usual, it is best to speak with a healthcare provider.

Also, have patience: Don’t expect overnight success as they can take up to a few months to work. Try adding Kegels to your Google calendar or doing them first thing in the morning. You can even pair them with your favorite podcast to help make the habit automatic. And the result is not only a stronger pelvic floor but stronger relationships, less embarrassment, less pain, more pleasure – overall, a pretty big impact for such a really tiny movement!

Here’s how to handle a real pain in the butt! When I say “pelvic floor,” what do you envision? Most people think of a vagina, but the pelvic floor isn’t the vagina. Rather, it’s “a group of muscles and tissues that support important organs like the bladder, urethra, anus—and in women—the uterus, cervix and vagina,” according to the FDA.

So yes, the pelvic floor involves your back door. And while you may not want to bring up back door pain, bleeding or discomfort to your pelvic floor therapist (because you think of her as the vagina expert), she might just be the key to solving it, or at least understanding it better!

And what exactly can cause this? Let’s explore.

Levator Ani Syndrome

Let’s start with levator ani syndrome. Levator ani syndrome is caused by muscle spasms and is a type of pelvic floor dysfunction. Getting its name from the levator ani itself, it’s a group of muscles located around your butt and vagina. They can range from mild pelvic or rectal pain to something way more intense than “pain in the butt”. It can even cause you to awaken from a dead sleep! It can also feel like pressure that mimics “sitting on a ball,” according to the Cleveland Clinic.

What causes it? There are theories: Everyday activities can be likely culprits, from prolonged sitting while working or traveling, to sex, to life stress, to painful bowel movements. But a definitive cause hasn’t been found.

Pelvic floor physical therapy can treat this condition, along with muscle relaxers, warm baths and rectal dilation (ideally taught to you by your awesome pelvic floor PT!).

Hemorrhoids

You’re probably pretty familiar with hemorroids already, maybe a little too familiar! What you may not know is that there are three types – internal, external and thrombosed, as the Mayo Clinic explains.

Hemorrhoids are just another way of saying your veins are swollen. Internal and external are exactly like they sound, either in the rectum (internal), which is the last stoop for stool on its way from the large intestine to the toilet, or external, typically viewable from the outside, where the anus is. Both can involve bleeding and pain. Thrombosed hemorrhoids may be located externally or internally, according to the Cleveland Clinic. The pain can be much worse and you develop a clot.

The same causes of pelvic floor dysfunction can also cause hemorrhoids – aging, pregnancy and/or constipation. Do your best to avoid constipation, whether that means more water, more fiber or exercising. Never strain to have a bowel movement.

There are many hemorrhoid prevention exercises, like Child’s Pose and pelvic floor contractions that your physical therapist may be able to help you master. The Mayo Clinic recommends over-the-counter cream, Tylenol and warm baths to treat.

Fissure

A fissure is a tear in tissue around the anus. And again, constipation is often the culprit. Bowel movements may not be the simple process they were before you had the fissure, as now you’ll experience pain and bleeding. You may also experience spasms near the anal sphincters. The good news? It doesn’t take much to treat this condition – a warm bath and avoiding constipation can do the trick.

Anal Fistula

An anal fistula is a connection that has sprung up between your anus and the external skin, according to the Cleveland Clinic. This leads to pain, swelling and possibly pus. Most often, the cause is a perianal abscess which typically happens when an anal gland is infected. Surgery is the main way to treat anal fistulas. An MRI that shows the pelvic floor may be needed in the diagnosis stage. There is also a rectovaginal fistula, which, according to the Mayo Clinic, is an unnatural connection bonding the rectum or anus and vagina. Stool or gas is then able to emerge from the vagina once this happens. Childbirth, Chron’s disease, surgery and radiation are a few causes.

Rectal Prolapse

In a rectal prolapse, a person’s rectum leaves their anus and is actually visible. It is part of a larger category known as POP or pelvic organ prolapse. In more severe cases, you may even see pink tissue emerging from the anus. Fecal incontinence, constipation, bleeding and incomplete emptying of the rectum are all symptoms, says the Mayo Clinic. As with hemorrhoids and pelvic floor dysfunction, advanced age (over 50) and constipation could be to blame. Treatment might be as simple as a laxative or as complex as surgery.

While many of us don’t want to think about anything related to the anus, as the symptoms tend to be uncomfortable and private, it is important to listen to our bodies when they speak to us. Colon and anal cancer are real risks. Screening is important if your doctor recommends it. Take care of that pain in the butt now before it becomes a bigger one later. And that’s … the bottom line.

Tag: pelvic floor dysfunction

What are Kegels?