Pelvic Organ Prolapse, Endometriosis, and Kegel Exercises
Before I dove into the world of core and pelvic health, I was familiar with Kegels. I mean, isn’t every lady out there? We’re told that Kegels are the go-to exercise for strengthening the pelvic floor. If we’re facing pelvic issues, it’s tempting to think that doing more Kegels will solve the problem and get those muscles in shape.
Here’s the catch: Kegels might not be the best approach, especially if you’re dealing with pelvic floor dysfunction, pelvic pain, prolapse, incontinence, or conditions like endometriosis.
The problem is that when most people think of the “pelvic floor,” Kegels are probably the first thing that comes to mind. Doctors often recommend them to treat pelvic floor dysfunction or aid postpartum recovery. The standard advice is to “pretend you’re stopping the flow of urine” to engage the pelvic floor muscles. (Just a heads-up: practicing this while urinating can lead to bladder infections, so avoid doing that!)
Unfortunately, the standard treatment in Western medicine for pelvic floor dysfunction hasn’t evolved much beyond this isolated approach. Kegels often fail to deliver the results we hope for and can sometimes make things worse! Actually, it’s a lot like endometriosis (as I explain in my book): Here we have a multi-factorial problem (this time involving the pelvic floor), something caused by many factors and requiring many factors to heal it … yet we’re told to clench our vajajays to fix it. Hmm, something seems off about this approach…
Excitingly, though, there is a lot that can be done about this issue! So don’t lose hope; simply change your understanding of a better treatment plan.
Curious about why clenching your pelvic muscles might not be the best solution and what you should do instead? Keep reading! My colleague and pelvic floor expert, Dr. Angie Mueller, will break it down for you. Also, if you’re interested in her program (which I swear by! And no, I’m not affiliated), you can use my promo code to get 10% off: HEALENDO10
Rethinking Kegals for Endometriosis —By Dr. Angie Mueller
When I first graduated from PT school and started treating clients with pelvic health issues, I taught all of my patients Kegels. I used biofeedback or manual feedback and trained them to do all sorts of crazy Kegel exercises while they laid on their back, or sat in a chair, or stood. As a new PT, I was discouraged becuase my patients were not resolving their pelvic floor dysfunction with this Kegel protocol I was teaching them. It took me a few years to really accept this reality and start to explore why this was not working, because I was thinking, “How could my expensive doctorate level education possibly have taught me an intervention that didn’t work!?” Well, this is medicine. Medicine evolves, and is not an exact science. We are always learning new and better ways to elicit that healing power in our patients. After my realization about Kegels, I was blessed with some incredible mentors and teachers, and I learned new ways to treat pelvic floor dysfunction that really work!
Unfortunately, Kegels are still implemented as one of the primary treatments for pelvic floor dysfunction.
Here are the six key reasons why Kegels are NOT the answer to resolve pelvic floor issues.
1) Your Pelvic Floor is probably already stuck in a kegal
Did you know that 99% of pelvic floor dysfunction is related to pelvic floor muscle spasm? Yup, the most common problem that occurs in the pelvic floor muscles during pelvic floor dysfunction is muscle spasm, which means they are stuck in a contraction (a kegel) and can’t relax. Think about that again: They are already STUCK in a kegel! This is why contracting a muscle more (one that already can’t relax) can often make matters worse. Kegels actually exacerbate pelvic floor muscle tension, and can increase the symptoms of pelvic floor dysfunction. Most of the time, when someone has pelvic floor dysfunction, the first course of treatment is to “un-kegel” their pelvic floor, by teaching them how to relax it.
2) 80% of the pelvic floor muscle fibers are involuntary, meaning you can only “clench” 20% of them
Only 20% of the pelvic floor muscle fibers are voluntary, meaning you can activate them with thought. So when you do a kegels, you only target 20% of the pelvic floor muscle fibers!
As for the other 80%? They rely on involuntary training. To put this another way, you need to train your pelvic floor muscles to work correctly when your NOT thinking about them… like when you orgasm, sneeze, poop, pee, assist in breathing, or jump on a trampoline. Or simply to hold your organs up correctly in the case of prolapse.
This is why a 100% kegal approach misses the majority of the muscle! Instead, pelvic floor muscle rehabilitation needs to target the INVOLUNTARY muscle fibers of the pelvic floor, not the voluntary ones. Don’t worry, I will explain exactly how to do this :) In fact, it’s my job to train involuntary muscles of the pelvic floor, and help hundreds of women every month achieve this goal.
3) The pelvic floor is only 30% muscle, anyways.
Pop quiz: if the pelvic floor is only 30% muscle, what is the other 70%? Fascia!
And we don’t rehab fascia the same way as muscles, so a kegal won’t help here either.
Even worse, when fascia is chronically loaded without proper muscular support (a weak, atrophied, and spasmodic muscle, for example), it will stretch and weaken. To rehabilitate weakened fascia, it must be unloaded and progressively exposed to gentle eccentric forces to strengthen it.
How does one “un-load” the pelvic floor? For starters, we have to remove the 11 pounds of pressure our organs may be adding to it by lifting the organs back into the correct position. This is done through training of the diaphragm and posture (again, I will explain how soon). Kegels fail to address the pelvic fascia, are concentric in nature, and do not unload the pelvic floor.
4) Your diaphragm is actually the key to Resolving pelvic floor dysfunction for good
Believe it or not, the diaphragm is the secret to pelvic floor rehab. That’s because both the respiratory diaphragm and the pelvic diaphragm (i.e. the pelvic floor.. yes, it’s diaphragm of its own!) are intimately connected. They mirror each other. Whatever the diaphragm does, the pelvic floor will follow.
When the diaphragm is has optimal mobility and function, that will be mirrored in the pelvic floor. If your diaphragm is acting incorrectly, so too will your pelvic floor.
Ultimately, true pelvic floor muscle rehab creates an environment in your body where the pelvic floor muscle can be reflexively triggered through your posture and breathing, without your conscious thought.
Here is an image that Katie made for a blog on breathing and pelvic floor health that really captures what I’m trying to say. You HAVE to fix the breathing to release your poor stuck-in-a-kegel pelvic floor.
5) Pelvic floor dysfunction involves so much more than just the pelvic floor muscle.
Pelvic floor dysfunction is more complex than just an isolated muscular problem. It involves dietary and behavioral factors; inflammation levels (why pelvic inflammation from endometriosis, for example, can contribute to prolapse); it has everything to do with how you breathe; it is impacted by your exercise choices and your common daily postures; it is related to the management of pressure in your abdomen and the position of your organs. Pelvic floor dysfunction is impacted by spinal and pelvic alignment, hip strength and mobility, abdominal muscle function, and glute strength. Any impediments of blood, lymph, or nerve flow to the pelvis will negatively impact pelvic floor function.
To truly rehabilitate the pelvic floor, all of these factors need to be considered and addressed. Isolating the pelvic floor muscle with kegels will not fix pelvic floor dysfunction.
6) The answer lies in the involuntary nervous system.
You can’t fix a problem in the involuntary nervous system (i.e. pelvic floor dysfunction) with voluntary muscle isolation training (i.e. Kegels). Just like I write about in another blog (this series), when training your pelvic floor, it is important to understand that we don’t have voluntary control over most of it. So to train and strengthen 100% of the pelvic floor, we must involve reflexes that activate those involuntary muscle fibers of the pelvic floor.
And that’s precisely what I teach my clients in The Core Recovery Method®. If you’ve read Katie’s book Heal Endo, her blogs on core dysfunction, and seen her Instagram posts on how she retrained her own core, this is the same program.
If nothing else, please remember that rehabbing your pelvic floor is so much more than kegels!!!
kegal for endometriosis