It’s not as simple as just doing Kegels.
We all have a lot more time than usual on our hands—or some of us do, at least. And while you might be filling that time by writing the Great American Novel, or organizing your cabinets, or baking sourdough, or watching every TV show known to woman, quick question: Have you considered strengthening your pelvic floor? No?
Well, a bit of good news for you: You could technically strengthen your pelvic floor while you’re doing all of those activities, if you so desire. And if you’re asking yourself what the point of pelvic floor strength even is, and whether you personally need to worry about it, we’re here to say there is definitely a point and, yes, you probably do.
This is an issue that’s close to my heart, so I reached out to Janaki Amin, PT, DPT, CFMT, who has been working in pelvic health since 2015. Full disclosure: She’s my very own personal pelvic floor physical therapist.
I found her a couple of years ago, after laparoscopic surgery to remove a cyst from my ovary led to some pelvic floor problems, and she was a true godsend. When I booked my first appointment, I discovered something that I found striking: There are tons of pelvic floor PTs in New York City, and all of them are booked weeks or sometimes months in advance.
In other words, pelvic floor physical therapy is something that many, many women need—and very few women talk about. I’m starting the conversation.
Ahead, Amin tells us everything we need to know about obtaining—and maintaining—a strong and healthy pelvic floor.
Should I be working out my pelvic floor from home?
Any time is a good time to start taking care of our bodies. Our body functions as a whole, or a sum of many parts. In order to work on the pelvic floor from home, one needs to understand the function of the pelvic floor and its connectivity.
Pelvic floor musculature is responsible for continence—bladder and bowel—as well as the ability to have pain-free intercourse and orgasms. They also play a major role in maintaining our posture and pressure systems.
There are a lot of myths about the pelvic floor. For example: “Leakage is normal after childbirth.” It is considered normal just after childbirth—not months and years after childbirth.
Another one: “Painful sex is normal post-childbirth, or ever.” Sex doesn’t need to be painful. There is help out there for such issues.
Another: “Just do Kegels and you’ll be fine.” It’s important to get a physical exam performed [first] to determine if your pelvic floor muscles are tight or loose. If they’re on either end of the spectrum, they can cause incontinence and pain symptoms.
An exam will reveal whether you need to do Kegels for strengthening, or relaxation exercises for lengthening followed by strengthening. There’s no one-size-fits-all.
Someone could be tight, others could be lax, and some could have a mix of both. Imagine the tightness of your upper back after a stressful week at work. When you foam-roll your back to release tension, you can feel the knots in those muscles. Pelvic floor muscles are muscles and [react] similarly to stress.
One more myth about the pelvic floor: “Go home and have some wine. You need to relax.” This is the worst! Ask questions [when you go to see a pelvic floor specialist], and if this is the answer you get from your provider, find yourself another provider.
We hear about working out our pelvic floors and doing Kegels, but there’s a right and wrong way to do that, right?
A proper Kegel includes a contraction of muscles, a relaxation to baseline, and then the ability to elongate the muscles. Each muscle should be able to tighten, return to baseline, and be able to elongate beyond baseline.
When the awareness of these contractions is lacking, people often compensate by squeezing their buttocks or leg muscles to contract the pelvic floor. When asked to bear down, people often compensate by pushing down their abs primarily.
The pelvic floor muscles, just like any other muscle of our body, should be able to work in coordination with other body parts, while being able to dissociate from other musculature.
Any reason it’s not a good idea to work out our pelvic floors from home?
[There is] nothing wrong with working out your pelvic floor at home—but every person has different challenges, and if possible, an in-person exam would be invaluable to design a personalized program [to start out].
Given the current challenges, pelvic health specialists can also provide telehealth guidance to personalize programs for each person.
There are physical devices women can use to “train” their pelvic floors, including the Elvie Trainer and the Lelo Smart Bead. What do you think about these? Recommend, or no?
It’s tough to recommend any one trainer. Each person has their own challenges. There’s nothing better than personal feedback using your fingers. If that’s challenging, then depend on trainers, or dilators, or wands.
But again, first and foremost, you need to find out what is the nature of your pelvic floor at rest: tight, lax, or a mix. For example, is it lacking coordination with your diaphragm—breath coordination—or is it unable to dissociate from your gluteals? Exercises and tools are also dependent on what your primary complaint is.
Anything else we can work on from home?
Learning a bit more about how to sit would make a world of difference while we’re forced to work from home right now. Here’s a video that has great suggestions on how to make your home environment a good work environment for your body.
Our posture, whether we are sitting or standing, should be balanced over our pelvic floors.
Pelvic floor training is generally associated with either better orgasms or incontinence issues. Can pelvic floor training really help with these things?
Absolutely! Pelvic floor treatment should be focused on why the incontinence issues are present. Is it a muscle imbalance, or a pressure system issue? For example, are you suffering incontinence when you jump, sneeze, or run?
Or do you have it when your bladder is full and you hear water trickling, or open the door to the bathroom or your home? One is caused by stress, and the other is due to urge. If you have both, then it’s mixed incontinence.
Once again, the treatment and exercises depend on which one you have. The answer is usually never as simple as “Do your Kegels.”
Analyzing the driver of your issues is important. Women who have children or don’t have children can have any or all of the above. Same for women who had a vaginal childbirth versus a C-section.
If the muscles are tight, we work on relaxation of the muscles in order to get them to a better length, so we can retrain them and strengthen them. If the muscles are too lax, then proper Kegels will work for you.
If your left side is tight and the right is lax, how do you train that? Some pointers from your pelvic health specialist would be the way to go. And we haven’t even talked about posture! How one is positioned makes a huge difference.
What’s the best way to find a good provider?
If you’re looking for a pelvic floor specialist, Amin suggested checking out the International Pelvic Pain Society, the Academy of Pelvic Health Physical Therapy, and Herman & Wallace Pelvic Rehabilitation Institute for more resources.
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