If you’ve ever mentioned bladder leakage, pelvic discomfort, or changes after pregnancy in conversation, you’ve likely been told something like “just do Kegels.” It’s a common response. Kegel exercises have become almost synonymous with pelvic floor health and they’re highly effective in the right cases, but strengthening exercises aren’t the right solution for every pelvic floor problem.
In fact, depending on what’s causing your symptoms, doing more Kegels could be ineffective, or worse, could reinforce the muscle tension contributing to your discomfort.
The reason is simple: pelvic floors can have different problems. Some muscles are weak and need strengthening. Others are tight and need to relax. And sometimes, the issue isn’t strength or tightness at all, but coordination.
Before you start doing Kegels, let’s learn about the pelvic floor and how it functions.
What does your pelvic floor do?
The pelvic floor is a group of muscles at the bottom of your pelvis that supports the bladder, bowel, and reproductive organs. These muscles also support bladder and bowel control, sexual function, and core stability.
Like other muscles in the body, a healthy pelvic floor needs more than just strength. It needs flexibility, coordination, and the ability to contract and relax.
What is a hypotonic pelvic floor?
Hypotonic generally means that the muscles have reduced tone or are underactive. A hypotonic pelvic floor may not provide enough support or contraction when needed.
Depending on the individual and the underlying cause, symptoms of a hypotonic pelvic floor can include:
- Urinary or bowel leakage
- A feeling of heaviness or pressure in the pelvis
- Pelvic organ prolapse
- Difficulty maintaining control during activities that add pressure, like coughing, laughing, or exercising
For someone whose pelvic floor truly needs strengthening, pelvic floor muscle training (including Kegels) can be an important part of treatment. These kind of exercised can provide benefits for certain types of urinary incontinence and other conditions related to muscle weakness.
But weakness isn’t the only possible explanation for pelvic floor symptoms.
What is a hypertonic pelvic floor?
A hypertonic pelvic floor is one where the muscles are too tense or remain in a state of increased contraction. These muscles may have difficulty fully relaxing and coordinating with everyday functions.
Symptoms of a hypertonic pelvic floor can include:
- Pelvic pain or pressure
- Pain during or after sexual activity
- Difficulty starting or fully emptying the bladder
- Urinary urgency or frequency
- Constipation or difficulty having a bowel movement
- Pain with bowel movements
- Pain in the hips, low back, or surrounding areas
These symptoms can develop for many reasons, including chronic stress, pain conditions, injury, surgery, pregnancy or childbirth, and habits such as frequently holding urine or stool.
This is where the “just do Kegels” advice can become problematic. A muscle that is struggling to relax doesn’t necessary need more strengthening exercises which encourage contraction.
Instead, a pelvic floor with high muscle tone may need treatment focused on relaxation, mobility, coordination, and reducing muscle tension.
Hold off on the Kegels – try these 3 things instead
If you’re experiencing pelvic floor symptoms and aren’t sure whether your muscles are hypotonic or hypertonic, the most helpful first step may not be doing Kegels.
Instead, consider these three approaches:
1. Learn how to relax your pelvic floor
Many of us unconsciously hold tension in our bodies; clenching the jaw, raising the shoulders, or tightening the abdomen are common ones. The pelvic floor can do the same thing.
Slow diaphragmatic breathing is an easy way to begin noticing and releasing unnecessary tension in the body. As you breathe deeply and comfortably, focus on allowing your abdomen, rib cage, and pelvic area to move naturally rather than actively squeezing or holding.
As you breathe in deeply, pay attention to how your belly expands and your pelvic floor drops. You’re not trying to force your muscles to relax. Instead, you’re becoming aware of what relaxation feels like.
2. Stop guessing and look at your whole body
Pelvic floor dysfunction rarely happens on its own. Breathing patterns, posture, abdominal muscle activity, hip mobility, bathroom habits, stress, and pain can all influence how the pelvic floor functions.
For example, consistently straining during bowel movements or regularly holding tension in the body may contribute to pelvic floor dysfunction. Addressing these habits and issues can be important parts of the bigger picture.
Consider that bigger picture. Do you hold tension elsewhere in your body? Do you struggle with constipation? Is your breathing shallow? Identifying these may not address your pelvic concerns, but learning to manage them can help eliminate some of the pressure on your body.
3. See a pelvic floor physical therapist
You cannot reliably diagnose your own pelvic floor strength based on symptoms alone. Many of the symptoms of pelvic floor dysfunction can have more than one cause, and it’s possible to have both weakness and muscle tension.
A gynecologist or urologist may be able to diagnose your pelvic floor dysfunction, and a specially trained pelvic floor physical therapist can effectively treat the condition. By evaluating your muscle strength, relaxation, and coordination, they will develop a treatment plan that addresses your individual needs.
Pelvic floor health is about more than strength
Kegels aren’t bad; in fact, they can be an appropriate and useful exercise when well suited to the issue. But they aren’t a one-size-fits-all solution for pelvic floor complaints.
If you’re suffering with the symptoms of pelvic floor dysfunction, don’t follow misplaced advice and hope for the best. Take steps to get the support you need and the relief you deserve.
Body Restoration Physical Therapy is conveniently located in Roslyn Heights, New York. Dr. D’Antoni is experienced in assessing and treating all types of pelvic floor dysfunction. Ready to learn more? Contact us today.