Kegel mania started years ago. In fact most of the women I know have heard about Kegel exercises, even if they don’t really understand them or know how to do them very well. Often women will say, “I think I’m doing it right, but I’m really not sure.”
It hit such a craze for a while that now we have many women that have made their pelvic floor so tight that their muscles in their floor are spasmed and painful with intercourse, or their bladder or bowels don’t void or evacuate very well. And then other women seem to have no muscle tone in the floor at all, and are frustrated with their lack of understanding of how to control the floor.
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The History of the Kegel
Dr. Arnold Kegel was an American gynecologist who researched and studied the effects of the pelvic floor muscles on women’s’ health. He realized that many of these muscles were weakened after childbirth, and that it was important to restore their health as they are directly responsible for supporting the bladder, uterus and bowels.
He noted that when these muscles were strained, women would often experience urinary incontinence (leaking of the bladder), vaginal pain and dysfunction, or vaginal prolapse — where the bowel or bladder would fall into the vaginal cavity.
He published a study in 1942, after 18 years of research, that described a non-surgical approach to increasing the tone of these pelvic floor sphincters and their supporting structures. He espoused the idea that the pelvic floor muscles could be exercised like any other muscles in the body, and the Kegel exercise was therefore named after him.
Pelvic Floor Muscles Explained
The pelvic floor is made up of layers of superficial and deep muscles that go from the pubic bone to the “sitter”bones to the tailbone. They are a sophisticated set of muscles that control different activities in different layers and they then work in concert together to provide support to the organs above them.
The floor works rhythmically when we breathe with the diaphragm muscle, like a piston moving up and down all day long. It elongates when breathing in and shortens on exhalation. Dr Kegel stated in his research that these muscles were “the most versatile in the human body and could still be strengthened after years of disuse.”
The most common use of the Kegel exercise was used with urinary incontinence. Urinary Incontinence can come in different forms, and is often related to pelvic floor weakness or poor motor and sensory patterns of control. There can be urge incontinence, stress incontinence or a mixture of the two.
The Pelvic Floor & Incontinence
Urge incontinence, sometimes called overactive bladder, occurs when you suddenly have an intense urge to void, and before you have time to get up to go, you void. Stress incontinence occurs when you exert a pressure on the bladder, like when you sneeze, cough, laugh, lift something heavy or jump on the trampoline with your kids.
Physical therapy is prescribed for both of these types of incontinence and good restoration of the pelvic floor muscles can occur in 1-3 months with the use of specific exercises, neuromuscular stimulation and biofeedback training for the floor.
Kegels Don’t Solve All Pelvic Floor Problems
The interesting thing is that the Kegel exercise, which encouraged the patient to contract the floor muscles by stopping the flow of urine and holding the contraction, actually only targets a particular layer of the muscles that directly involve the bladder activity.
However, this exercise does not include the other necessary muscle cues to stimulate the entire floor to know how to contract, so all the layers of muscles know how to work together for the best floor health.
The muscles that attach to the pubic bones and the muscles of the deep layer are not being stimulated with this exercise, so there are exercises that are “Beyond the Kegel” that need to be done. Your women’s health physical therapist knows what these exercises are and how to cue you in learning these muscle contractions so the whole floor can have full restoration of function for good bladder, bowel and sexual health. It’s never too late to have a healthy pelvic floor, you just have to choose it.
Sheree DiBiase, PT is the co-founder of Pelvic Floor Pro and leading expert on pelvic floor physical therapy. She has 35+ years as a physical therapist where she’s owned clinics in California, Washington and Idaho. She’s now focussed on providing access to pelvic floor physical therapy nationally.