Post-Partum Physical Therapy: Debunking the Kegel

Did you know that following pregnancy all women in France get a prescription for physical therapy? More than half of women experience urinary incontinence either during or after pregnancy. Unfortunately, in the USA most women are simply told to “do your kegels” and sent on their way, but the fact is most women end up doing them wrong, and you may be doing yourself a disservice. A kegel is a contraction of the pelvic floor; the muscular sling that sits within the pelvis. The pelvic floor consists of multiple tiny muscles and they perform two main functions: to keep your vaginal and rectal openings closed when they need to be (ex. Coughing, sneezing, running, etc.) and for postural support at your pelvis, low back, and internal organs. Performing kegel exercises without really knowing what you’re doing can lead to tightness and pain within these muscles and may only create more issues.

Here are some basic tips for starting your pelvic floor rehabilitation:

• Begin on your back. The difficulty of contracting a weak muscle will always be influenced by gravity. While performing your contractions in sitting or standing may be more convenient, you’re making your pelvic floor work against gravity. By starting out lying down (or even with your hips elevated on a wedge) you are reducing the impact of gravity and therefore more likely to isolate the right muscles, which brings us to the next point…

• Make sure you are isolating the right muscles. The pelvic floor muscles are internal, which means you shouldn’t be squeezing your glutes (your butt) or your abdominal muscles. When contracting your pelvic floor, think of pulling up, as in as if to stop the stream of urine. Testing this in the bathroom can be a good way to see if you are using the correct muscles, however this should not be performed as an exercise, as it can increase risk for UTI or bladder dysfunction.

• Start small! I’ve read some magazine articles that suggest holding a kegel for 10 seconds. That is way too long for these tiny muscles after going through the trauma of vaginal delivery or even just supporting the weight of a baby for 9 months! Start by holding your contraction for as little as 2-3 seconds and rest for twice as long. Begin with small sets- perform 5 contractions 2-3 times with longer rest breaks in between. Again, these muscles are small and they fatigue quickly, they need adequate rest time.

• Perform both slow holds and quick contractions. As mentioned above, the pelvic floor serves two functions, which means it needs to be exercised in two different ways. In addition to your slow holds, perform quick contractions (1 second on, 1 second off, fully relaxing during the off time). This will strengthen the fast-twitch fibers that we need to recruit on the spot during sneezing or coughing!

• See a physical therapist! If you are having persistent urinary leakage or are just unsure whether or not you are doing your exercises properly, physical therapy can help. Just ask your doctor for a prescription for pelvic floor rehabilitation and call Mizuta & Associates Physical Therapy.