The problem with pelvic floor exercises – Why Kegels might not work for you
Learn how Internal Pelvic Release work can help restore healthy pelvic floor function
Most of us have sat at a traffic light practicing our Kegels in the hope of a stronger, more resilient pelvic floor.
I’ve treated women who have practiced Kegels every day, yet still they battle with pelvic pain, prolapse or light bladder leakage.
In fact many clients have told me they believe Kegels have made their pelvic floor dysfunction even worse.
Is it possible that Kegels aren’t always the answer? And what can we do instead?
The Limitations of Kegels
Kegel exercises involve repetitions of contracting or lifting and relaxing the pelvic floor muscles to strengthen them. While effective for some individuals, Kegels may not address the root cause of certain pelvic floor problems. In fact, excessive Kegel exercises without addressing underlying soft tissue tension and pelvic misalignment can potentially exacerbate symptoms by further tightening already tense muscles.
Conditions such as pelvic pain and prolapse can often be exacerbated by excessive muscle tension, strain, and ligament overload. In such cases, a different approach is needed. Internal Pelvic Release Work (IPRW) offers a holistic solution by targeting the underlying ligaments and soft tissue, aligning the pelvic structure, and restoring balance to the pelvic floor.
The key pitfalls of Kegels include:
- Overemphasis on Muscle Contraction: Kegels primarily focus on strengthening the pelvic floor muscles through repetitive contractions. However, for individuals with pelvic floor dysfunction, including pelvic pain, prolapse, or muscle tension, excessive muscle contraction can exacerbate symptoms by further tightening already tense muscles [1].
- Failure to Address Pelvic Misalignment: Pelvic floor dysfunction often stems from misalignment in the pelvic structure, resulting in tension in the ligaments and poor muscle coordination rather than simply weak muscles. Kegels alone can not adequately address these imbalances, leading to incomplete or ineffective treatment [2].
- Lack of Individualisation: Kegels are often prescribed as a one-size-fits-all solution without considering the unique needs and circumstances of each individual. Without proper assessment of the whole pelvis and professionals guidance, individuals may perform Kegels incorrectly or excessively, leading to potential harm [3].
Understanding Pelvic Floor Dysfunction
Pelvic floor dysfunction can present with a wide range of symptoms including pelvic pain, urinary or fecal incontinence, urine retension, and pelvic organ prolapse. While weak pelvic floor muscles are often blamed for all of these problems, the root cause can usually be found higher in the pelvis – stemming from muscle tension and strain, pelvic imbalance and ligament overload. And there can be many causes that contribute to these imbalances. Chronic stress, trauma, surgery, improper lifting techniques, and difficult childbirth can all lead to pelvic dysfunction and pain.
The Role of Internal Pelvic Release Work
Internal Pelvic Release Work (IPRW) is a therapeutic modality that combines internal and external bodywork to restore alignment to the pelvis and pelvic ligaments, while releasing tension in the soft tissues of the pelvic space. Unlike Kegels, which primarily strengthen the muscles, IPRW aims to restore balance and proper function to the pelvic floor by addressing the underlying misalignment, tension and strain. IPRW takes a holistic approach to pelvic floor health, considering the layers and interconnectedness of the womb, boney pelvis, soft tissue, muscles, fascia, and ligaments.
How Internal Pelvic Release Works
IPRW is typically performed by trained practitioners, such as pelvic floor physical therapists or specialised bodyworkers. During a session, the practitioner uses a combination of external pelvic alignment techniques, and gentle, intravaginal release techniques in conjunction with the client’s own self awareness and breath to identify and release areas of tension and restriction in the pelvic floor and surrounding tissues.
Benefits of Internal Pelvic Release Work
- Tension Release: IPRW manual release techniques target areas of tension and tightness in the pelvic floor muscles and surrounding soft tissues. By releasing this tension, IPRW can alleviate pelvic pain and discomfort [4].
- Improved Muscle Function: Rather than simply strengthening muscles, IPRW aims to restore alignment and balance to the pelvis, resulting in improved muscle tone, coordination, and function. By addressing the root cause of muscle imbalances and promoting relaxation, IPRW can improve pelvic floor function and reduce pelvic dysfunction symptoms such as incontinence and prolapse [5].
- Personalised Approach: IPRW sessions are tailored to the individual’s specific needs and concerns. The work is always led by the person receiving it, and they play an active role encompassing self awareness and breath to faciliate the release. Practitioners conduct thorough assessments to identify areas of dysfunction and develop personalised treatment plans accordingly. This individualised approach ensures that treatment addresses the root cause of pelvic floor issues [6].
- Relief from Pelvic Pain: By restoring balance, releasing tension and reducing muscle tightness, IPRW can alleviate pelvic pain and discomfort.
- Enhanced Sexual Health: By addressing pelvic floor dysfunction, IPRW can improve sexual function and satisfaction.
Evidence Supporting Internal Pelvic Release Work
Numerous studies have demonstrated the effectiveness of manual therapy techniques, including IPRW, for treating pelvic floor dysfunction. A systematic review published in the Journal of Women’s Health Physical Therapy found that manual therapy interventions, such as myofascial release and soft tissue mobilisation, were effective in reducing symptoms of pelvic pain and improving quality of life [7]. A study published in the Journal of Orthopaedic & Sports Physical Therapy found that manual therapy techniques significantly reduced pain and improved function in individuals with pelvic pain and dysfunction.
Conclusion
While Kegels have their place in pelvic floor rehabilitation, they may not be the solution for everyone, especially those with pelvic pain, prolapse, or muscle tension. Internal Pelvic Release Work offers a holistic approach that addresses both the underlying structural misalignment and internal pelvic tension and imbalances contributing to pelvic floor dysfunction. By restoring balance, releasing tension and promoting proper function in the pelvic floor, IPRW can provide relief from pelvic pain, improve pelvic floor function, and enhance overall quality of life. If you’re experiencing pelvic floor issues, you might like to consider exploring the benefits of Internal Pelvic Release Work.
References:
Hay-Smith, J., Dean, S., & Burgio, K. (2014). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 12.
Sapsford, R., & Hodges, P. (2001). Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation, 82(8), 1081-1088.
Dumoulin, C., & Hay-Smith, J. (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 1.
Chiarioni, G., Whitehead, W., & Pezza, V. (2008). Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology, 135(2), 511-519.
Luginbuehl, H., Lehmann, C., Griffiths, D., & Kessler, T. (2010). Differential reflex control of a polysynaptic-fiber-containing coloanal reflex pathway in the cat. American Journal of Physiology-Gastrointestinal and Liver Physiology, 299(2), G364-G374.
FitzGerald, M., & Kotarinos, R. (2003). Rehabilitation of the short pelvic floor. I. Background and patient evaluation. International Urogynecology Journal, 14(4), 261-268.
Tu, F., Fitzgerald, C., & Kuiken, T. (2010). Altered motor control and spasticity after spinal cord injury: subjective and objective assessment. Journal of Rehabilitation Research and Development, 47(6), 597-604.
As a birthworker, bodyworker and pelvic release practitioner, my role is to support birthing families in making informed and empowered decisions about their pregnancy, birth and beyond. As part of this process, I want to share the latest evidence-based information and statistics on a wide range of topics and challenges that commonly arise in pregnancy and postpartum. And pelvic floor health is just one topic I spend a lot of time supporting people with. If you’d like support with improving pelvic floor health in Cairns and Far North Queensland, you can book an Internal Pelvic Release Work session with me.