These are the original articles I read to understand how to fix my ‘issues’. Oh, and for you Aussies who don’t know Kegals are the same as pelvic floor exercises.
WHY KEGELS DON’T WORK
by Christine Kent on April 8, 2009
The concept that prolapse and incontinence can be improved by doing ‘reps’ of classic pelvic floor contractions is anatomically false.
Arnold Kegel, a gynecologist practicing in the middle of the 20th century, was the first to place women on their backs and instruct them to contract their pubococcygeus muscles around his fingers. Kegel also developed the perineometer to measure the strength of pelvic floor contractions.
Today there is a virtual army of physical therapists who specialize in women’s pelvic floor ‘strength training’. The basis of this therapy is placing women on their backs and inserting fingers into their vagina to measure pubococcygeous muscle strength, a measurement often quantified by a modern version of Kegel’s perineometer.
Many PTs have added “core strengthening” exercises to their regimen, all of which have been borrowed from yoga and Pilates. These exercise systems compliment each other, because contracting the abdominal muscles leads to a coinciding contraction of the pelvic floor. Women on their backs pulling navel to spine while maximizing pelvic floor contractions constitute the core of most physical therapy programs.
One would think that the massive population of women who are onto their third or fourth or fifth surgeries for prolapse might get a little edgy when told by their doctor or PT to just “Do your Kegels” to avoid further problems. Sadly, they don’t get angry, but ever more resigned to the fact that they must be defective and pelvic floor dysfunction hard-wired into their genes. If Kegels worked to prevent or reverse even a small percentage of prolapse we would know about it after all these decades of women Kegeling themselves silly. The reality is they don’t work at all.
The reason Kegels are useless is because the concept of strengthening a “hole” at the bottom of a “floor” is anatomically inaccurate. There is no hole and there is no floor. There is only a flattened tube at the back of the body that is slowly turned inside out over time because of postural and lifestyle factors that compromise the natural pelvic organ support system.
“Kegeling” pulls the tailbone under and disrupts the natural pelvic organ support and urinary continence systems. “Kegel” is a concept that was based on an erroneous model of female anatomy, which viewed the pelvis as a “bowl” with a “floor” that must be “strengthened”. Not only is the entire anatomical concept wrong, but what has flowed from such profound error in judgment has cost women immeasurably in terms of time, expense, and suffering.
Each time we breathe in, the muscular diaphragm underneath our lungs pushes all our abdominal and pelvic organs down and forward. This means that the bladder and uterus are pushed into the rounded lower belly where they are pinned into position by the forces of intraabdominal pressure. The bladder, uterus, and sigmoid colon, which is contiguous with the rectum, are positioned right behind the lower abdominal wall and at right angles to the pelvic outlet at the back of the body. In this way they are protected from the forces of internal pressure.
The only role the thin, sinewy pelvic diaphragm plays in keeping the organs well-positioned is by stabilizing intraabdominal pressure. The pelvic “floor” functions like a trampoline or drum skin to rebound pressure. Therefore, tautness of the muscles is a much more appropriate concept than “strength”.
That tautness is obtained by stretching the pelvic diaphragm to its greatest dimensions, which is accomplished when the body is held in natural, upright, weight-bearing posture – whether seated or standing. If the abdominal wall is not pulled in, the breath can work to push the organs into the hollow of the lower belly where they are safe from the forces of intraabdominal pressure. When the pelvic diaphragm is elongated is this way, the urinary continence system is also supported. Sitting with the lumbar curve fully in place and then contracting the pelvic diaphragm strengthens the tiny musculature surrounding the urethra. However, there is plenty of “tonic” action happening in those structures even without consciously tightening them. I would argue that working and living in natural female postures supplies the urinary tract with enough muscular activity that the concept of “Kegeling” is made obsolete.
Strengthening the vaginal sphincter muscles does enhance sexual intercourse and orgasm. Therefore, this is one logical reason for engaging is this exercise. How better to “practice” than during actual sexual activity?
Sadly, the commonly held misconception of female anatomy has given rise to an entire industry of vaginal weights and exercisers, which women continue to buy. It has also resulted in a ubiquitous medical practice that amounts to little more than a waste of time for women. A realignment of posture and strengthening the true female core returns women to their natural pelvic organ support system and helps them avoid dangerous and debilitating surgery. It is time the concept of “Kegel” becomes known for what it truly is: exercise to enhance human sexuality.
KEGELS THE RIGHT WAY
by Christine Kent on June 16, 2008
Throughout the life of WW I’ve striven as much as possible to make this information “self evident” to women. There has been enough gobblety-gook from textbooks, MDs, PTs and so forth. Women have to know these techniques work because they can sense it for themselves.
That said, I’d like to describe the way I believe pelvic floor contractions should be done.
First of all we need to ask the question, what are we trying to accomplish with kegels? Here is the true anatomy of the situation:
• The pelvic diaphragm is attached from the lowest point at the back of the pubic bones to the highest point at the sacrum/tailbone.
• There are three sphincters along the way enclosing the urethra, vagina, and anus.
• In bipedal posture the pelvic diaphragm is adapted to close the sphincters with decreasing intensity – from lowest to highest.
• It therefore follows that the effect of this closure is most pronounced upon the urethra, then the vagina, then the anus.
• The pelvic diaphragm muscles are a vital part of the urinary continence system. They must contract and relax properly to maintain urinary continence.
• These muscles also play a role in vaginal/sexual health by maintaining the sphincter muscles of the vagina.
• Pelvic diaphragm muscle closure at the level of the anus is less important because the human anus itself has adapted a set of two (internal and external) highly functional sphincters that operate over and above the closure accomplished by the pelvic wall.
• At the level of the anus, the pelvic wall muscles are much more useful in helping things go out than keeping them in.
• Under extreme circumstances the pelvic wall can assist to maintain fecal continence – picture running to the bathroom with extreme diarrhea. The tailbone is tucked under and a hand probably pressed on top.
• It is only when the tailbone is tucked under that the pelvic wall has enough slack to reinforce the anal sphincter.
• This is why when doing kegels on your back you feel it most in the anal area.
• Yet, anatomically, tightening the top of the pelvic wall is of no practical value.
• Additionally, when this area is too tight symptoms such as tailbone pain, sexual discomfort and constipation arise.
• Tightening the bottom of the pelvic wall happens naturally with bipedal posture and therefore should be the goal of all kegel exercise.
So here I offer the maximum wholewoman kegel:
Sit comfortably on the floor. This can be done in a chair as well, but sitting crosslegged on the floor is far more beneficial. When the hips are externally rotated, the belly and pelvis (and therefore pelvic organs) can rotate into their most forward positions.
Now…keeping the upper body posture (shoulders down!), raise your arms into a graceful full moon circle above your head. Your hands should be above your forehead rather than above the crown.
Take a deep breath IN through your nose and hold it while moving forward over the tops of your thighs and maximally contracting your pelvic diaphragm. Hold.
Release as you breathe out, all the while keeping your spine straight from tailbone to top of head. Repeat as many times as you wish.
The arms do not move and the spine remains in one line from top of head to tailbone. There may be a little pelvic movement back and forth, but it should be very minimal (we maximize pelvic rocking in other exercises.) It is your belly that is expanding over the very tops of your thighs.
It will be self-evident that your muscles are contracting hard around your urethra while bladder and urethra are being pulled forcefully toward their proper positions.
• Alternate with your legs stretched out in front for a great hamstring stretch.