To Kegel or Not to Kegel?

When treating conditions related to the pelvic floor, I’ve come across many patients that have heard about kegels, but many are unclear why they are performing them and or how to correctly perform them. The following statements are very common:

“I heard about kegels online and I tried them, but it didn’t help my pain” or “I started doing kegels, but I don’t feel like I am doing them right.”

The common misconception is that doing kegels or “tightening” your pelvic floor muscles will decrease your pain, but this is not always the case. Pelvic floor muscle dysfunction can be broken down into two categories; overactive or underactive. Studies show that pelvic floor overactivity can cause pelvic pain and refer pain to other parts of the body.1 In this case, performing kegels would not be an appropriate treatment as the muscles are already in a contracted state. With overactive pelvic floor muscles, the focus is often down training and relaxation in order to decrease the tone of the muscles. This is important because the pelvic floor muscles (similar to all of the muscles throughout the body) need to be in an appropriate resting position to function efficiently. This happens to be midway between a contracted and relaxed state.

In the case of pelvic muscle underactivity, symptoms of incontinence and decreased support of the abdominal organs may be experienced.1 Performing kegels is likely appropriate with underactivity in order to improve the strength of the muscles, therefore improving support and function. While these are two classifications of muscle dysfunction, it is best to have a physical therapist specializing in pelvic health complete an internal assessment of the pelvic floor musculature before performing kegels.

1. Bradley MH, Rawlins A, Brinker CA. Physical Therapy treatment of pelvic pain. Physical Medicine Rehabilitation Clinical N Am 2017; 28: 589-601.

Kim Micheletti, DPT