What is the pelvic floor?
The pelvic floor is a complex network of muscles, ligaments, and connective tissues that provide support for the pelvic organs, including the bladder, uterus, and rectum. These muscles form a sling-like structure that stretches from the pubic bone to the tailbone and from one sitting bone to the other.
The pelvic floor muscles play a crucial role in maintaining continence, supporting the pelvic organs, and facilitating sexual function. They help control the release of urine and feces by tightening and relaxing in response to nerve signals from the brain. Additionally, they help stabilize the pelvis during movement and provide support for the uterus during pregnancy.
Weakness or dysfunction of the pelvic floor muscles can lead to a variety of issues, including urinary and fecal incontinence, pelvic organ prolapse, and sexual dysfunction. These problems are more common in women, especially during and after pregnancy, but can affect people of all genders and ages.
Exercises to strengthen the pelvic floor, such as Kegels, can help prevent and alleviate pelvic floor problems. In some cases, pelvic floor physical therapy or surgery may be necessary to treat more severe cases of pelvic floor dysfunction.
Could you explain how to do Kegels. What is the most basic guide you can give me?
I like to explain the pelvic floor as the bottom of the core muscles. The diaphragm would be the top, the abdominals would be the front, and the lumbar multifidus would be the back of the core. The pelvic floor is a sling of muscles under the pelvis, and the goal is to lift the sling. Kegels can be performed sitting, standing, lying down, and with dynamic movements, but should be practiced sitting and lying on your back first. Once your awareness of the pelvic floor's strength improves, you can think about doing it in all of your daily positions.
Do I need any special gear to do Kegels? For example, a yoga mat or special shoes?
No equipment is needed to perform a Kegel, but there are a few things that can help provide feedback to know if it is working or not. One of the things that I work on with my patients to improve pelvic floor strength and awareness is to have them sit on a blood pressure cuff, which we are going to call the Joey cuff.
- Sit on a firm chair with the Joey cuff under the pelvis between the sits bones, or ischial tuberosities.
- Give the bulb on the end of the cord a few pumps until you feel the Joey cuff lift into your pelvic floor sling.
- Check the reading on the little glass piece and rock back and forth; notice the needle on the gauge swinging in a large direction up and down.
- Sit still, find a good, tall sitting position, and raise your pelvic floor.
- As you lift the pelvic floor, you should see the needle on the instrument pop up about 2-4 millimeters of mercury, a small movement on the gauge.
Because of pelvic floor weakness, many people will have very little movement of the needle. This visual feedback is very helpful with learning the pelvic floor exercise known as a Kegel.
My brother is an OBGYN, and he, as well as a pelvic floor physical therapist, use internal electric stimulators to help give feedback and an extra boost with pelvic floor re-education.
If i'm doing Kegels for the first time, should I see my doctor first? Why or why not?
It is not necessary to see any doctor to get started with pelvic floor strengthening, but it is really difficult to know if you are performing a Kegel correctly without cues from a professional. A baseline can be established with a doctor of physical therapy or your OBGYN. Progress can be monitored and made with professional supervision, but you can also do pelvic floor strengthening in the car at a red light once you know how to do it properly.
Are Kegels just for women, or can men benefit too?
Kegels are for both men and women; we all have a pelvic floor sling, but our other anatomy varies. Men need to strengthen their pelvic floor as well, and if they do, they will see a dramatic improvement in back pain.
Is stopping the flow of urine a Kegel?
I want to talk about what many of my clients have been instructed to do over the years: stop the flow of urine. If you have been instructed to stop the flow of urine to perform a kegel, then that is incorrect, and here is why. The pelvic floor is composed of two muscles, the elevator ani and the coccygeus. These muscles form the flat, broad muscle of the pelvic floor, also known as the sling of the pelvic floor.
There are also the sphincter muscles that control when we need to go to the bathroom. If you stop the flow of urine, you are actually taking a sphincter muscle and doing something that you should not do. A sphincter muscle is always tight, and when it's time to go to the bathroom, we get it to relax, and it opens, and that’s when we void. It is neurologically incorrect to try to get a sphincter muscle to close, as we only have the ability to open it.
The sling should be lifting, not the sphincter tightening or closing. It's an intervaginal contraction with a lift of the pelvic floor, not at the sphincter. For men, we cue them to lift the boys. This gives them an advantage with visual feedback in a mirror that women do not have.
Learn more about Kegels from the Cleveland Clinic by clicking here.
Check out this interview with a board-certified urogynecologist to learn more about pelvic health.
Call 512-215-4227 to get started with our physical therapy team to strengthen your pelvic floor.