Let’s have a conversation, maybe even change the narrative about how we look at our pelvic floor (PF). On social media, I see so many great, eye-catching posts with similar messages. “I like my pelvic floor, how I like my coffee. Strong AF.”
I’m sure that these posts inspire many women to try to strengthen and strengthen their PF by doing a million kegels. And therein lies the problem. Kegels are not the holy grail of pelvic floor exercises. Let me explain.
A recent study of women with lower back pain, showed that 95.3% of these women had pelvic floor dysfunction, 82.4% of those women had tenderness and a high resting tone of their PF. What does this mean? For many it meant they were unable to fully relax and lengthen their PF. For these women the aim of having a strong AF pelvic floor, and training their PF with this in mind, frankly wasn’t going to help. In fact it may have even exacerbated their symptoms. Learning correct breathing mechanics, which encourage the PF to lengthen, and in turn go through it’s full range of motion, should be a vital part of their rehabilitation training.
What no kegels? Yes, you read that right! No kegels for those who have trouble relaxing and lengthening their PF.
During another study looking at continent women (the dry ones) vs incontinent women (the pant wetters), electrodes were placed on the women’s PF. The electrodes measured the involvement of these areas during specific activities. The pant wetters produced a stronger contraction of their PF. This contraction despite being strong was also considered inappropriately strong for that activity, where the external oblique muscle was also found to be over engaging. This study showed us that it is not just about strength, it’s about the appropriate strength of the PF for the appropriate activity.
I do get it, “I like my pelvic floor how I like my coffee, strong, long and with a well timed, appropriate contraction” doesn’t quite roll off the tongue; but I believe as health and fitness professionals we need to start to change the way we look at the pelvic floor, how we educate ourselves and our patients about the pelvic floor and what holistic functional pelvic floor exercise programs should now look like.
If I had a dollar for every time I heard “but aren’t I better off having a tight pelvic floor than a weak one?”. The short answer is no. For the long answer keep reading…
A recent study of women with lower back pain, showed that 95.3% of these women had pelvic floor dysfunction, 82.4% of those women had tenderness and a high resting tone of their pelvic floor muscles. What does this mean? For many it meant they were unable to fully relax and lengthen their pelvic floor. In this state the pelvic floor gets tired and fatigued; there is a reduction in blood flow and a buildup of lactic acid. And with all of this, it can also be weak. Yes you can also suffer with light bladder leakage with a tight pelvic floor.
For these women training their pelvic floor by doing kegels, frankly will never help. In fact it may have even exacerbated their symptoms.
So I hear you asking. How do I know if I have a tight pelvic floor? Ideally if you are concerned you should make yourself an appointment with an osteopath (or physiotherapist) trained in the area of pelvic floor internal assessment. But some common symptoms associated with pelvic floor overactivity include:
- Vulvar burning, throbbing and aching.
- Lower back, hip pain and coccyx pain.
- Dyspareunia – pain with intercourse.
- Vaginismus – involuntary engagement of the pelvic floor associated with vaginal penetration.
- Bladder symptoms – tension in the pelvic floor muscles surrounding the bladder and urethra can trigger the feeling of needing to urinate often and for some incomplete emptying.
- Bowel symptoms – difficulty having and/or pain with a bowel movement with or without anal fissures (small tears) can be associated with a tight pelvic floor. Overactive tight pelvic floor can also be a cause of functional outlet constipation.
- Jaw pain – as many who clench and tighten their pelvic floor also tense their jaw.
Treatment for a tight pelvic floor, is all about the why? Why is it tight? What factors are influencing the tension? What other musculoskeletal areas are impacting the tension? Why does it keep coming back?
Will there be internal pelvic floor myofascial release? Maybe.. If you are comfortable with internal work and it is indicated, I would recommend having a full assessment of the pelvic floor and the fascia found within the layers of the pelvic floor.
Posture, alignment, foot and pelvic mechanics and the jaw all impact the function of the pelvic floor, such that these areas are commonly assessed alongside the pelvic floor during a consult. Then comes education, on stress management techniques, correct breathing mechanics and movement practices to encourage the pelvic floor to lengthen, and in turn go through it’s full range of motion. This is a holistic pelvic floor rehabilitation program. Not kegels, i’m not saying you’ll never do kegels again, but for now. STOP.