I never got on board with that because it was just fear -mongering in my opinion in the other direction when you know kegels serve a purpose. Now given that, what kind of purpose do they serve and what is best fit work for pelvic floor strength? Because that’s really what kegels were about and are about is creating strength but do we always need more strength? 

That would be the simplest question. And I think that’s where some of the backlash came from. So let’s just kind of not fear monger here. This is a fear monger free zone. Let’s not get on some bandwagon of cool hashtags that get you attention because they’re controversial.

And say that, you know, Kegels are bad, never do them, or Kegels are all you should do, always do them. So let me just tease this out just a little bit for you. On the one hand, right now I still get the vast majority of patients who will come to me, sit down in the comfy chair in my office and go, well, I got a handout on Kegels and I’ve been doing them and it’s not helping. Or I’ve been doing them, they  didn’t seem to do anything or I did them and you know what? It just feels worse. So that’s the first story. 

That’s the first scenario that scenario A is you went somewhere and then someone told you to, whether it was a pelvic PT or a handout at a GYN’s office, someone told you to hold those kegels for 30 seconds and do them 10 times 10 a day or whatever. I hear 10 seconds, 30 seconds, 10, 100. I have heard everything.

And the bottom line is really none of that is necessarily helpful or true. And sometimes it can be harmful. So what I’m saying is if you’ve been to a provider and they just push a handout in front of you or tell you to do Kegels 30 seconds, 40 times a day, that’s highly suspect. To begin with, I never ask anyone to hold their pelvic floor for 30 seconds. So if someone has told you that, chances are, you should question it. 

Another scenario is they have been to pelvic PT. If they’ve been to a very aware OBGYN, the OBGYN should say, well, that’s not my wheelhouse. Go to the pelvic PT or OT. I think there’s a misconception, no matter where it comes from, that pelvic PTs or OTs are taking the place of GYN care, which is totally not true. There’s no competition, okay? 

So if you’re an OB -GYN listening, we’re not trying to compete with you. If you are a consumer of healthcare, you need an OB -GYN and you need a pelvic PT or OT. You need them because they do different things and you will need each of them across the lifespan for different things. Historically, I don’t know whether it is poorly written media or whatever it is that has pitted them against each other, which is not true. 

So in scenario B, you have been to someone and they either didn’t want to refer you to pelvic health because they thought that pelvic health would like steal them as a patient or something. And therefore you don’t really get referred properly or you’ve been to a pelvic and they are recommending something like I mentioned in scenario A. Which is kind of, I would call it outdated, but it’s kind of just flat out wrong. 

So a couple of different scenarios. You either don’t get the referral because of low health literacy, like somebody doesn’t know any better to refer you along the way, or they’re afraid they’re gonna lose you as a patient. Which is incorrect. Or you’ve been to someone and you’ve been to pelvic PT and it didn’t work or a pelvic OT and quote, it didn’t work or it made it worse. 

And I’ve had those scenarios too. So I’ve had scenario A and I’ve had situation B where you kind of have to re-educate because this happened the other day. I had someone and when I mean the other day, it could have been six months ago, it could have been two days ago, but I keep all these cases in my head. So I just pull them out when I need them. 

Someone had come in from a pelvic PT who had told them to just kind of kegel the crap out of things, holding it for 30 seconds.  Doing kegels here and there in different scenarios, and this person in no way was ready for that. Nor was it really the appropriate course of care. So just like there are, well, the cliche, there are bad apples in every bunch, that is true, that is true, that is true. 

For either not getting referred appropriately from your GYN or primary care provider or a Urogyne, urogynecologist, or you had a bad experience with pelvic health, unfortunately.  Because someone wasn’t reading the literature. Or maybe they were new and didn’t know enough. So let’s just get down to it. Whether it’s scenario A or B, it doesn’t matter. It’s the same end result, which is you’re not getting the care that you deserve or need. And you still don’t know whether to kegel or not to kegel.

So to clear that up, I just want to say kegels can actually be helpful. But. And there’s always a but, isn’t there? It depends. That’s another common phrase because you can almost say that in every case because I like to look at each of my patients and people that come to me and trust me with their care as what we would say in the research arena, an N of one.

If I have seen one person with pelvic pain, I have seen one person with pelvic pain and I treat them each individually. And they don’t necessarily have to come with pelvic pain. It could be pain free, but maybe they have leakage. Pain free, but maybe there’s some sexual dysfunction, right? Or they’re just not quite getting where they want to be.

So if you look at each case as one case and we’re not trying to make blanket assumptions about everyone, that’s where the phrase it depends comes from. It depends, but Kegels are rarely helpful in isolation. Now I’m going to bust that myth just a little bit in a minute because there are some exceptions to Kegels in isolation. They can be helpful, but most of the time, not as much in isolation. Which means doing straight up pelvic floor contractions on their own just for the sake of doing them. Well, somewhat helpful. It depends on what your condition is. And I’m gonna explain that as we go. 

So the one thing that I really want to emphasize that is pretty much true all the time is that kegels are really never helpful if you’re doing them without seeing a pelvic specialist first. Because you haven’t been evaluated. The muscles haven’t been evaluated. Organs and where they’re located haven’t been evaluated. So we don’t know if doing Kegels will make things worse or not until you’re evaluated. 

So that’s pretty much the rule that stands true all the time. You could pick up Kegels like a handbag that you like and do them if you want to. Nobody’s gonna demonize you for that. It’s very proactive, but I would recommend getting a pelvic evaluation from a therapist that specializes PT and OT that’s different from GYN. 

They’re not going to do the same evaluation. Okay. So if you go and you say, well, I had a pelvic exam for my GYN, it is not the same as what you’re going to get from a PT or an OT at all. And depending on level of specialty and technology that’s available. For example, in my clinic, I use ultrasound imaging that is kind of upleveling the care that you’re going to get and the evaluation that you’re going to get.

So ask your questions, be an informed consumer. You want to see a pelvic PT or OT that specializes and that has had postdoctoral education in pelvic therapy. And preferably, if you can access it, it would also be fantastic to get ultrasound imaging from your pelvic PT or OT. Highly recommended. It is going to save you time and money. You’re gonna get better faster, because they’re not guessing. 

All right, so moving on from that little piece. Always get an evaluation first, and if imaging is available, please get that as well. That is not the same ultrasound imaging as you’re going to get with your GYN. They are looking for different things. They’re not looking at musculoskeletal structures like we are. 

Okay, so the next thing, and this is very clear in the literature, handouts, magazine articles,

Quick advice from an OBGYN who says, hey, just do some kegels, it’ll be fine. They are not substitutes for seeing an actual pelvic PT or OT, period. And the literature, the research well supports that. Handouts, don’t fly. Maybe as a paper airplane. But otherwise, they’re not going to cut it. You need to have that one -on -one.

I’m not saying this is some pitch to bring people into the practice. That’s not the point because I want you to be done with me ASAP as soon as possible. If I do my job well, you will not need me again until the next problem, you know, arises because my job is to teach you how to not need me. 

Okay, moving on. So there are some exceptions to the isolation rule. The first exception is leakage. Yes, Kegels can be helpful if you don’t have a significant or remarkable pelvic organ prolapse. Kegels can sometimes help and sometimes people get like vaginal weights, for example, pop them in, do some Kegels. Hey, no more leakage. Fabulous. That was a very simple case, right? But human beings are not simple, especially if you’ve had one, two, three, you know, plus kids, it’s not that simple. 

So if it is that simple and you go that route and it works, congratulations, you’re very proactive and you didn’t have any kind of organ position issue like a prolapse and that’s wonderful, that’s great. But it may not be the best way to do it. Again, not saying you can’t, you can do anything you want to and if it helps, wonderful. So the first rule is that when you have leakage, usually bladder, but it could be bowel leakage too. Sometimes Kegels in isolation could help. But not always, it depends. 

The other scenario in which isolation helps isolated Kegels, meaning just doing pelvic floor contractions or Kegels alone with nothing else involved is for sexual enhancement. Now that is more of a case where it could work over the leakage issue because you’re going to be working on increased body awareness, proprioception, where things are in space, increased sensitivity.

And one of the ways that’s sometimes done is through clitoral stimulation. So stimulating the clitoris. Because that should, and most of the time, if you have a functioning pelvic floor, stimulating that will actually help with recruiting the pelvic floor. You’ll get a quick kind of flicker of pelvic floor activity. That’s a plus. That’s great. Sometimes actually stimulating the clitoris in that way is going to teach people where their pelvic floor is. That could be a positive too, but it’s definitely going to work in the realm of sexual enhancement. 

So that’s another way that, again, it depends. It depends because if you have back pain or painful intercourse or whatever, that may be a time where that isolated kegels won’t work.

So again, it depends, but those are two scenarios where you could probably get away with isolated kegels and it not be, you know, it not be too bad. It might actually work out well for you. 

So the best way, the best way to recruit the pelvic floor that we know of right now, according to the literature and according to what I have seen again and again and again in practice using ultrasound imaging, because you can see it. We don’t have to guess. I do not have to guess. Is a combination or a pairing, okay, recruitment. 

You can also think of it as a coordinated effort between the core and your pelvic floor. Now, I’m also the voice physio, the voice to pelvic floor physio, which means I teach voice to pelvic floor or three diaphragm connection. So if you have voice issues and sexual issues or voice issues and pelvic pain or voice issues and back pain, or jaw issues and sacroiliac joint pain, which means think of those three diaphragms, right? The voice, the respiratory diaphragm, and your pelvic diaphragm. 

If you have pain or dysfunction along the lines of any of those diaphragms, they very well could be connected. And that’s what I mean by a kind of a paired recruitment. So if you were to come in and see me, I would be looking at clearing your voice and also making sure you’ve got really good vocal quality and that as you speak, which does pressurize your pelvic floor, that you’re doing it in a way that’s sustainable for pelvic health, sexual health.

That means using the respiratory diaphragm correctly, right? So oftentimes the treatment comes down to something really simple. It’s complex and layered, but the answer is simple, breathing. Changing breathing patterns. I have seen amazing things happen by changing breathing patterns for people, particularly women, but also men too. They need the same healthy breathing patterns for pelvic and sexual function. 

So what does that look like? If I’m changing someone’s breathing to impact three diaphragms and I’m not, you know, kegeling alone, I’m doing it paired up or doing a combo recruitment or a combo coordination with my core and my pelvic floor, what do we do? What does it look like? Well, first of all, I want to say that I’m going to put in the show notes, finding a pelvic therapist is probably A1 most important. 

Now, I can only see a limited number of people. It’s why I’m doing this podcast, because I want to help you find the people that you need to get to for support and help. If you’re specifically having a problem that I specialize in, then I’m happy to see you if I can get you on my schedule. I do first consults free, because that’s how much this stuff means to me. You may not see me at all after that first consult, which means you get my time for free.

But for a limited number of people, I can see you via telehealth, I can see you via group, or I can see you actually in North Carolina if you choose to do that. Because I do have people that come in from out of town, out of state, and out of country for those specialized issues. But finding a pelvic therapist, I’m going to put three websites in the show notes. Go down there and find that. Look it up and see if there’s a pelvic therapist in your area in your region. 

Keep in mind that therapists in your state can see you anywhere in the state and there is a lot that can be done over telehealth. So don’t worry if you’re in a far, you know, rural area and you can’t reach your pelvic therapist. That’s okay. We can do a lot virtually. Now we’ve talked about how isolated Kegels could help, but we haven’t talked about how they harm.

Moving on from finding a therapist, because I say this, it’s so important, you will need a pelvic health therapist before you leave this planet. Everybody needs one, just like a primary care physician, whoever that is for you, nurse practitioner, PA, MD, DO, whatever. You also need a pelvic therapist. And it’s gonna exponentially make your life better. And if you care about your back, your pelvis, your.sex life, any of that, you will find one. Okay, so that’s it. I’m gonna leave you with that. 

Moving on, let’s talk about help versus harm. We’ve talked about the help, let’s talk about the harm. When do Kegels harm? I have had, I’m gonna speak in terms of cases, I like to do that sometimes. I had someone come in who had been told incorrectly and it just, it angers me but it also breaks my heart. Because these people are losing quality of life, not days or weeks, like months and years of quality of life. This person who was male had been told that they just needed to work their pelvic floor. And this individual had pelvic floor tone that was so high that he couldn’t actually urinate. He had to catheterize himself to empty his bladder.

That also means there’s probably bowel problems too, like emptying the bowel. So that’s a whole other story. But what I want to say about that is no one without physically examining you internally, externally, and with ultrasound imaging should just throw a recommendation at you to contract your pelvic floor because they’ve never seen it. They don’t know what it’s doing. So whether it’s in your Pilates class or your yoga class and they’re telling you to mula banda the crap out of it.

No. That’s a no. 

Because you don’t know what your pelvic floor is doing. Plus, how are you supposed to know you’re even doing it right? My practice is biased, right? Because everyone that walks through the door already has a problem. But I have screened hundreds of other people, therapists actually. And in screening all of those therapists, very few of them could actually recruit their pelvic floor properly.

So what does that mean if therapists who are trained can’t do it correctly? It means that the average person off the street has no clue about what their pelvic floor is doing, if it’s up and down, sideways, whatever. And so that’s our job, is to teach you that and empower you with that information. So the first thing I would say is, if someone just throws out, hey, try some Kegels, I’d be like, hey, no, I’m not gonna do that. I’m gonna see my therapist first. So that’s one. 

Two. If you have pelvic organ prolapse, how would you know if you have it? Well, you usually have a dragging heavy sensation in the perineum, kind of in the saddle, in the crotch area. It could get worse with a cycle because the cervix tends to drop down. And that is in females, obviously. Just the anatomy and the way we’re structured means that things can actually fall down and out. And that’s what pelvic organ prolapse is.

So if you have that heavy dragging sensation or an aching deep in the pelvis, or you literally feel like something’s falling out, or you’ve actually had to push something back up inside you when you’re trying to empty the bladder or something. That’s indicative of a pelvic organ prolapse. And the best person to see for that is you could go to a urogynecologist, you could go to a gynecologist, however, their focus really is on other things. They’re trained surgeons, right?

In a way, I want to encourage you not to waste their time on that because we do that. The pelvic PTs and OTs here in the United States, I can only speak for the US, fitting pessaries and evaluating for prolapse is within our scope. It does not mean every pelvic PT or OT that you see has had the specialty training. So ask. 

In my practice, I have gone through that training, which is above and beyond just being a pelvic PT. Which is already a specialty in itself. So please ask and find the therapist who can evaluate your prolapse. It will change your life. You might be able to completely eliminate your symptoms and not have it anymore. And the reason I say that is because, well, it will change your life, but two, that’s where Kegels really may not help. And it may actually make the prolapse worse, especially if you don’t know what you’re doing with the pelvic floor.

So that’s a way that kegels could harm. The other way that kegels can harm is, and this is not a hard and fast rule, I just wanna make sure that you know that. This is definitely not a fear -mongering episode. You could have higher resting tone. So think of if you went around all the time with your jaw clenched, right? If you’d clench your jaw all the time and then you finally try to relax it, what happens? You kind of have this resting high tone all the time. That can happen in your pelvic floor. 

Suffice to say, if you have orofacial tension, so if you’re watching YouTube, you’ll see me like pointing at my face and my neck and the muscles around the neck. Tension there almost always equals tension in the pelvic floor. So if you have jaw issues, you’re probably going to have some pelvic floor issues. Hopefully not bad and hopefully that can be completely resolved.

But if you do have that high pelvic floor tone, high orofacial tone, okay, face and neck tone, neck pain, vocal problems, or painful intercourse or attempted intercourse, that’s called dyspareunia that hasn’t been evaluated. Those are all conditions where I would say, let’s hold off on the Kegels. Let’s maybe not Kegel right now. Go and get an evaluation first and they’ll tell you the exact parameters for which you can and how it will help. And they may say no Kegels at all. 

Other conditions where Kegels are not really helpful, endometriosis and painful bladder syndrome or interstitial cystitis. Those are conditions where may not be helpful. Again, it requires an evaluation for that. So moving on, moving on. We’ve talked about harm, we’ve talked about help. We have talked about when they help in isolation versus when they don’t help in isolation.

So what else is there to talk about? 

Universally helpful practices. You might want me to leave you with that because I always like to, in this summer of self-care, I want to leave you with something to do and to practice. So here’s a universally, mostly universally helpful practice. I want you to get into a comfortable space, even if you’re driving and listening to this, pull off for just a second, it’s not gonna take long. 

Get comfortable and get to know yourself. Now, optimally, you know, if you’re driving, pulling off on the side of the road, you can’t really get to know yourself that much because you could be considered illegal, right? So funny, ha ha. Preferably, you’ll do this practice at home. It doesn’t really require you to disrobe if you don’t want to, but you could. But getting to know yourself is essential. 

First of all, I want you to think of all of the skin and muscles between your sitting bones. Just imagine them. It’s not a lot of space, so you don’t have to imagine really hard. I want you to imagine that it’s a rubber band and that when you inhale all of that skin and muscles between the sit bones, which is all soft, right? It’s stretching and lengthening, inhaling and lengthening all of that tissue. Like a rubber band. 

And I use the rubber band analogy all the time because why is it important? The more stretch you get out of the pelvic floor, it’s like a rubber band. It will shoot further. Like if I was going to shoot that rubber band, like we call them bean shooters in the South. Little slingshots. If you pull that rubber band back, the further you pull it back, right? The further that little bean or rock is going to fly when you let it go. 

Or if you just pop a rubber band, right, and pull it back, let it go, the further it’s going to fly. That’s your pelvic floor. It’s meant to be a little trampoline. Now, it’s not that simple, but let’s make it that simple for right now because if you envision that skin and muscle and everything between the sitting bones, stretching down on your inhale. 

The belly expands, the rib cage expands out to the side, like bucket handles lifting. Everything stretches down and out. Give your pelvic floor a big rubber band stretch. Now, if you have the opportunity to disrobe from the waist down and get a mirror and look at that area, you’re going to see a literal stretch, which is fabulous. That’s what you want.

You don’t, the skin there, the perineum, what we call it, shouldn’t just sit there. It is mobile, it is responsive, it should be.

So all you have to do is really kind of focus on an inhale for six counts, but don’t just blow your exhale out quickly because you want to stretch the pelvic floor slowly, slowly let it rebound back. So we’ll inhale, two, three, four, stretch the pelvic floor down and then let it go just to slowly exhale, two, maybe make it noisy, three, four, five, six, very slowly.

Do that at least two or three minutes. And really only two or three minutes. It doesn’t take a lot to change pelvic floor tone. You will get more power out of the pelvic floor. You will get that decreased tone, kind of a return to steady state of where the pelvic floor is just kind of at ease and relaxed. And it’s also a really good stress reliever, stress manager. So anytime you need to access that, go and do that. Self-evaluate, visualize the pelvic floor stretching.

And enjoy the ride and relaxation that it gives you. All right, until next time, that’s your practice, that’s your homework, and I will see you soon.