Why Kegels Aren't Always the Solution: Balancing Flexibility and Strength

Pelvic floor health is an important topic that is gaining more attention (yay for us!!). We are learning how to take control of our symptoms, and that some of the generic advice we've been given isn't actually helpful for us. Let's start by breaking down some myths:

• Myth: All pelvic floor problems (incontinence, urgency, pain, etc) are caused by weak pelvic floor muscles.

• Truth: Pelvic floor weakness (lack of strength) and tightness (lack of flexibility) both cause pelvic floor problems.

• Myth: Kegel exercises fix all pelvic floor problems.

• Truth: While Kegels can help some women build pelvic floor muscle strength, it can make another woman's symptoms much worse!

Many women experience pelvic floor muscle tightness, which can be the underlying problem for conditions like incontinence, pelvic pain, and constipation. In this article, I will discuss the need for a balanced approach to pelvic floor health that includes both flexibility and strength and why we need to reconsider the "just do more Kegels" approach.

Understanding Pelvic Floor Issues

The pelvic floor consists of muscles that support the bladder, uterus, and rectum. When these muscles are healthy, they help control urination and bowel movements. However, many women suffer from pelvic floor dysfunction, which can show up in various ways. According to the National Health and Nutrition Examination Survery (NHANES), approximately 25% of women experience some form of pelvic floor disorder, making it a widespread concern.

Historically, we have assumed that weakness in these muscles causes most pelvic floor issues. This misconception has led to the prevalent recommendation of Kegel exercises, which has two large problems:

1. Kegels are difficult to instruct with just words and pictures, but most providers recommending Kegel exercises are not trained or appropriate to assess for correct pelvic floor muscle activation. A 2013 study found that 1 in 7 women were unable to perform a Kegel correctly without training.

2. While Kegel exercises can be helpful to build strength when the muscles are already flexible, they can worsen issues caused by pelvic floor muscle tightness.

You might be thinking "wait, I thought a tight pelvic floor was a strong pelvic floor?." This is a really common belief that I will explain next.

The Misconception of Tightness and Strength

Many people confuse tightness with strength, which can cloud our understanding of pelvic floor health. Think of strong and tight being in two separate categories - the opposite of strong with weak, and the opposite of flexible is tight. While strong muscles are good, tight muscles are not. When pelvic floor muscles are too tight, they can restrict movement and prevent proper activation.

Pelvic floor tightness isn't easily recognized since it tends to creep in over time. Just like in our neck, shoulders and other areas of our body, we tend to hold tightness in our pelvic area too. But unlike the neck and shoulders, we can't see signs that our pelvic floor muscles have tensed. The clues are more subtle than our shoulders rising up towards our ears.

Over time, muscle activation from guarding (your brains attempt to protect an area) and tension patterns (a stress response) can lead to shortened, tight muscles that irritate the nerves and joints around the pelvis. Eventually, the tension in our pelvic floor becomes too much for our body to handle. And when pain, bladder and bowel problems pop up out of seemingly nowhere, we tend to assume that it's from weakness because we didn't recognize the signs of tightness building.

Women holding hands for a group yoga stretch

The Importance of Flexibility

So what can we do to prevent or heal a tight pelvic floor? Incorporating flexibility exercises into your routine can combat tightness, relieve nerve and joint irritation, and improve muscle function. Techniques such as yoga, stretching, and breathwork can help release built-up tension. Some of my favorites for the pelvic floor are butterfly stretch, child's pose, cat/cow, figure 4 (piriformis) stretches, and pigeon pose.

Learning how to release your pelvic floor tension from habitual guarding and tension patterns is critical as well. While self-guided strategies like breathing and meditation can be helpful, many women benefit from the specialized support of pelvic physical therapy and/or counseling to address their unique physical and emotional barriers.

By prioritizing flexibility and muscle release, we can adopt a more balanced approach to pelvic floor health. This is critical for women at any stage, whether during pregnancy, postpartum recovery, or aiming to enhance overall well-being at any age.

Finding the Right Balance

Achieving optimal pelvic floor health requires balance between strength and flexibility. Like any good exercise program, stretching and strengthening exercises are both incorporated to help you achieve your fitness and wellness goals.

When women learn to release and lengthen their pelvic floor muscles, they usually find it easier to strengthen them afterward. Tight muscles can often hinder proper engagement, so addressing tightness first can lay the groundwork for effective strengthening.

In my practice, I've seen numerous women benefit from a well-rounded approach that incorporates both strengthening and flexibility exercises. This balanced method not only enhances pelvic floor function but also improves overall quality of life.

Practical Tips for Improving Pelvic Floor Health

1. Incorporate Stretching and Flexibility Exercises: Try adding yoga or gentle stretching into your daily routine. Focus on positions that encourage relaxation and lengthening of the pelvic floor muscles while sitting at your desk, playing with your children, or eating a meal.

   
   

2. Practice Breathwork: Deep breathing can be a game-changer for releasing tension in the pelvic floor. For example, inhale deeply through your nose, letting your lower belly expand fully, then exhale slowly through your mouth.

   
   

3. Consult a Pelvic Floor Specialist: If you're dealing with persistent pelvic floor issues, it may be beneficial to consult a pelvic floor physical therapist. We can offer personalized exercises and strategies tailored to your specific needs.

   
   

4. Listen to Your Body: Pay close attention to how your body responds during exercises and even stressful moments. Experiencing pain or discomfort may indicate that your muscles are too tight and require release.

   
   

5. Educate Yourself: Understanding your pelvic floor and its function is critical to improving your overall health. Consider exploring books or attending workshops focused on pelvic floor health.

   
   

Bringing It All Together

In summary, while Kegel exercises can be an effective component for some women, they are not the end-all solution for pelvic floor issues. It's essential to acknowledge that muscle tightness can play a significant role in pelvic floor dysfunction. By shifting our focus from solely strengthening to also embracing flexibility, we can cultivate a more balanced approach to pelvic floor health.

As women, we deserve to feel empowered in our bodies and understand the intricacies of our pelvic health. By integrating both strength and flexibility into our routines, we can enhance our overall well-being and tackle the root causes of pelvic floor problems. Remember, it’s not just about doing Kegels; it’s about finding the right balance for your individual body.

Citations:

• Nygaard, I., Barber, M. D., Burgio, K. L., et al. "Prevalence of Symptomatic Pelvic Floor Disorders in US Women," JAMA, 2008; 300(11):1311-1316.

• Wu, J. M., Matthews, C. A., Conover, M. M., et al. "Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women," Obstetrics & Gynecology, 2014; 123(1): 141-148.

• Bø K, et al. "Pelvic floor muscle function and strength in nulliparous women." Int Urogynecol J. 2003;14(25):25-31