It’s time we kill the Kegel hype
Photography by Jennifer Cooper
Story by Natasha Marie
“Whoever did PR for Kegels deserves a medal.”
Editor’s note: Welcome to our special four-part series that gets to the root of perimenopausal pain: our pelvic floor.
When researching and interviewing women about this series, I heard a revealing truth: “Wait, what? Perimenopause? There’s a phase before menopause? They left that part out of the brochure.”
Which brings us to the education gap. Many women are familiar with the sensationalized menopause, but no one told them about {peri}menopause. Admittedly, I didn’t know much about it until researching for this series, and I’m a perimenopausal woman!
I want to understand more. In fact, I need to. And I’m not the only one.
For such a universal experience, the conversation about perimenopause is muted. The medical industry’s focus hasn’t historically been on women’s experiences. So in many ways, modern practices and mentalities still minimize women’s experiences instead of educating them. Part of this is due to shame and stigma. Another part is because the conversations simply aren’t being had.
Women shouldn’t be ashamed of their bodies. These changes are natural, even if they aren’t picturesque. So let’s close the information gap and talk about the nitty-gritty of perimenopause.
Your experience is more than a statistic; but facts help put things into perspective.
50% of women over 50 have a pelvic organ falling into their vaginas.
20% of women are straining to poop or pooping uncontrollably.
If you are experiencing any or all of these, you are in good company. And there is nothing wrong with you!
Many of these perimenopause symptoms involve and affect your pelvic health. Pelvic health is critical for women of all ages, but specifically for perimenopausal women. As indicated by Tahirah’s doctor with the recommendation of Kegels, a proper pelvic health routine can mitigate some of the less than ideal physical symptoms of perimenopause.
So what exactly is pelvic health?
I asked Dr. Rachel Gelman, a clinician, writer, educator, and Pelvic Wellness & Physical Therapy owner. To say she’s a bit of an authority on pelvic health is an understatement.
So what exactly is pelvic health?
Pelvic health typically refers to the health of the vulva, vagina, and the pelvic floor muscles inside the pelvis. Having good pelvic health means a person is not experiencing bowel, bladder, or sexual dysfunction and is not experiencing pelvic pain.
Your pelvic floor is a layer of muscles that sits between your tailbone and pubic bone. These muscles support your pelvic organs — this includes your bladder, bowel, and uterus. The pelvic floor is a muscular bowl that has many functions:
It supports the pelvic organs (bladder, colon, and prostate or uterus)
It helps maintain continence
It provides core stability
It aids in sexual function, including obtaining/maintaining erections and orgasms.
The muscles of the pelvis are also referred to as the pelvic bowl.
Rachel, how does perimenopause affect our pelvic health?
The vaginal canal and the pelvic floor are very dependent on hormones, such as estrogen, progesterone, and testosterone. During perimenopause, changes in these hormone levels can impact the pelvic floor, vulva, and vagina, leading to a variety of symptoms, including urinary incontinence, urgency, frequency, or things like pelvic pain or pain with sex.
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Things to look forward to! Is there anything women can do to make the transition more pleasant?
Talk to their gynecologist about their options. They can work with a pelvic floor specialist to address any pelvic floor dysfunction that may be contributing to their symptoms.
Do you have any recommendations for caring for our pelvis to avoid some of the uncomfortable symptoms like urinary leakage?
Focus on keeping it healthy and maintaining a good pelvic floor range of motion. It is not always necessary to focus on strengthening your pelvic floor. People tend to only focus on contracting the pelvic floor, but these muscles need to relax and move to do their job. If a person is unsure if their pelvic floor needs strengthening, they should see a pelvic floor specialist. Even if someone is experiencing incontinence, Kegels or pelvic floor strengthening may not be appropriate. Research shows that most people do Kegels incorrectly.
“Kegels are often over-prescribed, and most people aren’t able to do them correctly with verbal instruction alone. ”
Ah, Kegels! That is a pelvic health conversation the media loves to hype. Can we talk about Kegels for a moment?
Whoever did PR for Kegels deserves a medal. Kegels are a pelvic floor exercise. More specifically, Kegels are an exercise that involves contracting and then relaxing the pelvic floor muscles. Kegels can be helpful for people that are experiencing urinary or fecal incontinence, pelvic organ prolapse, low back pain, or poor core stability. Still, there is no one size fits all Kegel exercise program.
So Kegels can actually do more harm than good?
Kegels are often over-prescribed, and most people aren’t able to do them correctly with verbal instruction alone. Many people, including those with incontinence, actually present with overactive pelvic floor muscles and need to relax the muscles versus strengthen them. If the muscles are in a guarded or hypertonic state, they are already at their end range of motion and won’t be able to contract further when needed, such as when a person needs to stop urine from coming out. So sometimes doing Kegels can make symptoms worse because you are strengthening an already shortened muscle. Sometimes people may develop new symptoms related to pelvic floor dysfunction, such as pelvic pain. Most patients with pelvic floor dysfunction typically need skilled manual therapy to help address any myofascial restrictions and neuromuscular re-education to help the patient learn to relax the muscles and know how to contract them appropriately. Furthermore, some people may need to work on strength while others may need to work on endurance, and others may need to work on coordination of the muscles, which would require different types of Kegels. So bottom-line, see a specialist to determine if Kegels are appropriate and to see what types one should be doing.
Other than perhaps, an abundance of Kegels without supervision, is there anything we should avoid? Or anything that exacerbates pelvic dysfunction?
Having good bowel habits is key for pelvic health. The thing I always tell people about maintaining a healthy pelvic floor is to have better bowel movements. I know pooping isn’t super glamorous, but it is important. So avoiding constipation, pushing, and straining to poop is very important. Pushing and straining to defecate puts a lot of pressure on the pelvic floor and can lead to issues, including urinary or sexual dysfunction or pelvic pain.
As humans, we are meant to squat to have a bowel movement. So recreating a squat-like position in the optimal pooping posture. I recommend using a toilet stool, like the squatty potty, to get you in the optimal pooping position and make it easier to go. Staying well-hydrated is also important for bowel and overall health!”
I grew up my entire life believing that Kegels was the pinnacle of pelvic health. I know I’m not alone here. Dr. Gelman dispelling the mythology (and PR) of Kegels shattered a paradigm I had accepted as a universal truth. Pelvic health involves more than just strengthening your pelvic floor. Our bodies and minds require a delicate balance of strength and suppleness to function.
My conversation with Dr. Gelman revealed a reason the education gap exists. The information gap between healthcare providers and perimenopausal women is not due to a lack of available information but rather accessibility. It’s a catch 22 situation. Doctors have the answers, but the onus is on the individual to seek the information. Here’s where the conversation gets lost in translation. How do you know what to ask if you aren’t aware that it’s part of a problem? And are the right questions being asked?
Natasha Marie is a writer making technology less nebulous and sexual health more accessible by dismantling taboos one word at a time. She’s currently a staff writer for sexual technology company, MysteryVibe, and manages media and public relations for global sextech conference, Sx Tech Eu. photo: Alex Oley