Not all pelvic floor issues are created equal. In fact, some exercises that benefit certain patients could potentially be counterproductive for other patients. Unfortunately, many patients learn this the hard way.
“I’ve been experiencing pelvic pain for several months/years, and I did some research and discovered the concept of Kegels. I tried, them, but they made my symptoms worse!” I have heard this one too many times from new patients at their initial evaluation. That is why I have decided to blog about this very important topic and to hopefully clarify a widely held yet incorrect misconception. Namely, Kegels, or pelvic floor muscle strengthening exercises, are not appropriate for all patients.
The conditions that impact the pelvic floor can be broadly subdivided into UNDERACTIVE and OVERACTIVE pelvic floor dysfunction. Underactive dysfunction includes: pregnancy, postpartum, aging related changes and muscle weakness. These often manifest as bladder incontinence, fecal incontinence, and pelvic organ prolapse (descent). Overactive dysfunction is associated with tightness of the pelvic floor muscles, which often manifests as urinary urgency, urinary frequency, constipation, pain with prolonged sitting, coccydynia (tail bone pain), chronic pelvic pain, and sexual dysfunction.
Underactivity of the pelvic floor muscles requires an uptraining (or strengthening) program. Overactivity requires a downtraining (or stretching) program.
Kegels, or pelvic floor muscle strengthening exercises, are inappropriate for individuals experiencing overactivity of the pelvic floor muscles. Attempting to contract a muscle that is already in spasm will only make the problem worse. It can further tighten the muscles and result in additional pain. In other words, muscles that are constantly “on” don’t want to do any more work.
If a person is experiencing both weakness and tightness, it is crucial that they address the tightness before they attempt to strengthen the muscles. Muscles that are at a normal resting tone respond better to exercise than muscles that are in a contracted and shortened position. Once the muscles are stretched and have achieved an improved resting tone, it may be appropriate to initiate a strengthening program.
Therefore, if you or someone you know is experiencing pelvic floor muscle issues and are unsure whether to perform Kegels, please speak to a pelvic floor therapist. As musculoskeletal experts, we can assess whether the problems are due to muscle tightness, muscle weakness, or a combination of the two.
At Revitalize Physical Therapy, we will diagnose the type of pelvic floor muscle issue at hand and treat it accordingly, including a customized home exercise program tailored to your specific needs. We look forward to the opportunity to help you!