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Why Aren't My Kegel's Working?

I don’t know about you, but more and more I am reading and hearing about fitness coaches encouraging folks to contract their pelvic floor muscles during exercise activities. This is great news! I am glad that the pelvic muscles are finally gaining the public spotlight.

However, if you have given Kegels (aka pelvic muscle exercises) a try and are still leaking during activities, know that a pelvic therapist can still help you improve your function. I often see women and men who doubt that pelvic physical therapy will benefit them, in part because they have already tried to do Kegels.

Here are some reasons why Kegels don’t often do the trick with verbal instruction alone.

More than one well-constructed study has shown that with only verbal instruction, there is a 40-60% error rate when trying to perform Kegels. In one study, a group of women were given only verbal instruction for performing pelvic muscle contractions. Another group also underwent internal assessment by trained practitioners who gave verbal instructions while monitoring pelvic muscle activity. In the group that included internal pelvic muscle assessment, success rates for performing pelvic muscle contractions went up dramatically. For example, some pelvic muscles (yes, there are several pelvic muscles) might be working just fine, but others may be “on vacation.” For example, in a well-intentioned effort to avoid leaking urine, many of us are squeezing around the anus, when what we really need to focus on is coordinating the smaller, more delicate muscles around the urethra.

It is also helpful to learn how to coordinate your breathing when you are training your pelvic muscles. Breath training will ensure that your diaphragm and pelvic muscles function well together. A common pattern observed when learning to activate the pelvic floor (or when learning any new activity) is that many of us take a big breath in before attempting a pelvic floor contraction. This overexertion can put excessive downward force on the bladder or rectum, further challenging a weak or overactive pelvic floor to function effectively.

There may also be painful or tight tissues and muscles in the pelvis that are preventing the pelvic floor muscles from contracting effectively. A gentle, systematic, detailed exam of your hips, back and pelvis could reveal additional issues that need to be addressed to make the entire pelvis stronger and more efficient.

I have lots more I could share, but for now I will leave you with one more reason that Kegels are sometimes ineffective. Some of us need to instead focus on relaxing our pelvic muscles. Pelvic muscles can end up being chronically fatigued from always being on alert – this is especially common when people are experiencing incontinence and are trying to keep from leaking. It is difficult to know if pelvic floor muscles are overactive without a detailed skilled assessment.

There are many additional elements to consider in pelvic rehabilitation, and I am interested in hearing from you – what would you like me to address in my next blog post?


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