Second Annual Pelvic Floor Party: Kegels ARE Invited!

Yes, Kegels are invited, you can bring them along like a date for your super strong booty, but only if you do them right! That means if you're following the advice of such notable experts as Dr. Oz and Dr. Laura Berman (love ya both, but ya'll need to brush up on your pelvic floor advice) then you won't get through the door.

So who decides if you get in? The Kegel Queen. She is the perfect party guest (because she wears a crown, after all). And don't even try to sneak in the back door (ha!) because she will find you and give you a royal talking to.

I know because it happened to me. Not kidding. There's video to prove it. What would you think if you saw someone wielding a skeletal pelvis at you? (The pelvic floor anatomy lesson is absolutely worth the time it takes to watch the video.)

There were a lot of people talking after that Pelvic Floor Party: Kegels NOT Invited post and the follow up post, Pelvic Floor Encore, and the Kegel Queen was one of them. After she posted the You Tube videos (the one above is part two of two), Katy Bowman interviewed the Kegel Queen on her blog. It. Is. Hilarious.

I can't help but like her. So, of course, I checked out The Kegel Queen (a.k.a. Alyce Adams, RN) and liked that her Kegel lessons did not involve the mainstream approach that Katy Bowman shuns in "Pelvic Floor Encore," where she explains her problem with Kegels which, incidentally, is also a problem for the Kegel Queen. It's nice to know that the Squat Queen and Kegel Queen are not at war over the same territory.

Loaded with all this new information, I realized I had spread that mainstream, useless approach myself in an old post I had written about Kegels in April 2009. At first I didn't concern myself with it, after all, that post was buried in the archive of my blog. Who would see it? Then, to make sure, I Googled "Kegel," and saw that my post  appears on the first page of results. Crap! Rather than delete the post, I think it needs a makeover. Who better to lead the makeover than the Kegel Queen herself?

We started with this sorry paragraph:

So how do you do Kegel exercises? The easiest explanation is to squeeze those muscles "down there" that would stop the flow of urine and those that would keep you "puckered up" in a tense situation. The pelvic floor muscles are like a hammock between your tail bone and your pubic bone. The idea is to contract or tighten up that hammock. Ideally we should all be doing 200 a day. There are two main ways to Kegel: Flicks are quick contractions and you should aim to do them in sets of 10. The other option is to hold a Kegel, ideally for 10 seconds or more.

The Kegel Queen would like to send me to the dungeon for that. For starters, I include three of the biggest Kegel mistakes in that short paragraph. Here are the Kegel Queen's list of five biggest mistakes:

Kegel Mistake #1: Moving the Wrong Muscles
Kegel Queen says that the pelvic floor and only the pelvic floor--not your butt, your abs, your hip flexors--should contract during a Kegel.

Kegel Mistake #2: Making the Wrong Movement
A Kegel, says the Queen, is a contraction that lifts the pelvic floor up and forward.

Kegel Mistake #3: Doing Hundreds of Kegels a Day
Not so, says Her Majesty. A few will do, so you don't overwork the muscle.

Kegel Mistake #4: Doing Fast, Light Squeezes
Just like any other strength training, Kegels should consist of several strong and sustained reps.

Kegel Mistake #5: Making Kegels Complicated
Devices that require you to take off your pants will eventually collect dust in the back of your underwear drawer, says The Queen.

In the next paragraph of that doomed post, I launch into another Kegel Queen No-No:

The nice part about Kegel exercises is that they don't require workout clothes. They don't require a gym. In fact, you don't have to make time to Kegel, you can do it almost anywhere, anytime and no one is the wiser. The guy taking your order at Starbucks might wonder what's up with the strange look on your face, but still, he'll never know.

To do Kegels correctly, the Kegel Queen wants her subjects to please, please not do them anytime, anywhere, especially not while driving. Why?

1. To do a strong and sustained contraction requires focus. Could you dead lift your max weight while driving? Impossible, of course, but even if you could do this move in a car, you wouldn't because it requires too much concentration.
2. Having a routine is what makes any exercise program succeed. Saying you can do Kegels anytime doesn't mean you will. 
3. A proper Kegel includes fully relaxing; letting the muscles go completely soft, and letting your mind go with it. Not something you want to do behind the wheel.

Now that I am wiser about Kegels, I thought I should get more insight from Her Royal Highness.

Kara: I was intrigued by the notion that relaxing the pelvic floor is as important a step as contracting it. I understand it from the perspective of lengthening the muscles, but love incorporating the relaxation piece as described by a commenter in one of the earlier Pelvic Floor Party posts. Here's what she said:

As a counseling student, I've become aware of valuable information about pelvic floor relaxation in trauma work and in bodily health (the idea being that if we live in a constantly stressed state, in the "fight or flight" sympathetic nervous system, our bodies will burn out, hence the need for an effective way to relax). The pelvic floor is the only part of the body completely surrounded by muscle, so by relaxing the PF for 20-30 seconds, the rest of the body is triggered to relax and switch into the parasympathetic nervous system. 

You said that by incorporating this relaxing piece into a routine that it will help you enjoy it more, which of course, will help you want to keep doing it. How should we fully relax after a Kegel?

Kegel Queen: In our culture--literally starting with diapers--we’re taught to cut ourselves off from being aware of what’s going on “down there.” We’re taught that sex, pee and poo, our periods, and birth are shameful or dirty, that they should be hidden. The word “pudendum,” the medical term for women’s external genitals, comes from a Latin root that means “shame.” Seriously! Couldn’t they have named it something just the teensiest bit more positive? 

Since we’ve all grown up surrounded by attitudes like this, it’s no wonder that for most women, just consciously connecting with the pelvic floor and starting to contract and release it can be a big learning experience.

So simply becoming more aware of your pelvic floor, and giving the contraction and relaxation your full attention, is a great first step. 

Once you have a grip (oops, no pun intended) on contracting and releasing the pelvic floor, you can start intensifying the contractions and relaxing more completely. There’s a lot you can do to relax fully, and we talk about it in detail in the Kegel Queen Program. Keeping the rest of your body, and your mind, relaxed is part of it. Another piece is deep breathing in a particular way so that your breathing helps the pelvic floor relax and expand.

One thing you should never, ever, ever, ever do is push out or bear down on the pelvic floor to help it relax and expand out. Some people (yes, even professionals) will tell you to push out as part of your kegel workout, but pushing out like that can actually cause prolapse, or make prolapse worse. So you want to allow the pelvic floor to relax, but never push.

Kara: While a routine is important should you change up your position? Since the pelvic floor will be called to duty while standing, sitting, and lying down (wink, wink) should you rotate?

Kegel Queen: Yes and no. First, let me say that I’m absolutely in favor of experimenting with different positions for kegels and whatever else you might like to do (nudge, nudge). Yes, practicing kegels in different positions is a great way to prepare for those times when you’ll need to consciously engage your pelvic floor in real life. Using different positions is also a great way to understand your pelvic floor better. You’ll increase your awareness and control with those muscles.

Also, different positions affect your other muscles in different ways. Remember Kegel Mistake #1, Moving the Wrong Muscles.

What you want is to contract only your pelvic floor and no other muscles. Often there’s a certain muscle group that really wants to contract along with your pelvic floor, or instead of it.

Let’s say that for you, it’s your glutes. You can make kegels easier by choosing kegel positions that help the glutes relax. Or you can challenge yourself by choosing a position that invites your glutes to tense up, then focus on relaxing your glutes while you do kegels in that position.

All that said, the bottom line (whoops, another pun) is that kegels have to be DO-ABLE. All the different kegel positions in the world won’t help you if it makes doing kegels too complicated and you don’t end up actually doing them.

Remember Kegel Mistake #5: Making Kegels Complicated.

Anything that makes kegels complicated, whether it’s some device or worrying about your position too much, is not your friend. DOING kegels in one easy position is approximately one million times more effective than NOT doing kegels in a variety of positions. Know what I mean?

Kara: When should you "let go" of the contraction? And should you time them, to try to build on the time (like you might for holding a plank?) Or, is there a certain time to work up to?

Kegel Queen: All this is a huge part of my kegel course, and I could never do it justice in this short post.

One of the main reasons most kegel instructions don’t work is that there’s not enough detail there to show women exactly what to do. A lot of women think that if they know how many kegels to do and how long to hold them, they’re all set. But actually, if that’s all you know, odds are you’re not going to see the kegel results you want, like dry undies, relief from prolapse symptoms, and mind-blowing sex.

Women need a lot more detail about working up to the full kegel workout as well as breathing, positions, how to stick with kegels over time, and more--all covered in depth in the Kegel Queen Program. Once you learn how to do kegels right, it takes just a few minutes a day. But it’s critical to get the right information, ALL the right information, so you have the best foundation for success with kegels.

Women can look up the kegel instructions on the Mayo Clinic web site to start getting an answer to the question you ask. The information there is basically accurate. But it’s only two short web pages. In my experience with hundreds of women, you need a lot more detail to make kegels really work, like what you’ll find in my two-hour kegel course. When you do have complete information and you consistently do kegels right, the results can be spectacular.

Kara: I recently caught a few minutes of the Dr. Laura Berman show and dang if she wasn't spewing the old 200 Kegels a day advice. I remember it took (and still is a problem) a long time for OB/Gyns to come around on exercising while pregnant and letting go of that 140 heart rate--is this sort of the same thing, where the research hasn't caught up with the professionals? Where's the disconnect? Why does this bad information prevail?

Kegel Queen: That 200 kegels a day thing just keeps on coming back, doesn’t it? It’s everywhere! Here’s why we don’t do 200 kegels a day. Kegels work by increasing your control of the pelvic floor muscles, and by building mass and tone in the pelvic floor. How would you build mass and tone in any other muscle in your body? As anyone who does weight training knows, you’d do a small number of strong, sustained reps. Not 200 “quick flicks,” or 200 anything! Your pelvic floor is no different. We have decades of research to tell us what types of kegel programs work. Why aren’t more people using it?

Why does bad kegel information continue to prevail? I have spent years asking this question and in all honesty, I am still looking for a decent answer. Kegels aren’t the only situation in health care where the research and clinical practice don’t match up. For example, I have a book on my shelf called Obstetric Myths versus Research Realities, and it’s almost four hundred pages describing the ways conventional maternity care is not supported by research. 

One problem is that kegels don’t make money for the health care industry, so there’s no incentive for them to get good kegel information out there. Surgery is an expensive, dangerous treatment for incontinence and prolapse that often fails. But this type of surgery is a multi-billion-dollar industry. 

Here’s another problem with the way the health care business is set up. Imagine that Doctor Jane Doe wants desperately to teach women how to do kegels right to help them with incontinence and prolapse (and better sex!). Since all her HMO employer allows her is a seven-minute office visit with each patient, she just can’t teach kegels effectively no matter how much she wants to.

Unfortunately, the market drives a lot of what happens in health care, and there’s no big market force making sure women know how to do kegels right so we can care for ourselves at home.

I know I did my readers a disservice by oversimplifying the Kegel. Knowing how to properly contract our pelvic floor is essential for a host of reasons, beyond that, a real Kegel can be a risk-free solution to incontinence or prolapse. She might be the Kegel Queen but she also makes a great Kegel Coach. More about her program can be found on her site, www.kegelqueen.com. And she offers a special deal on her program for those who watch the webinar available on her website. Party favor! Thanks for coming to the party Alyce!

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.

How's Your Pelvic Floor?

Not everyone looks this good with a pelvis on her head:
Katy Bowman rocks the look and the pelvic floor advice.

It's been more than a year since I interviewed Katy Bowman, biomechanical scientist extraordinaire and founder of the Restorative Exercise Institute. In that post, "Pelvic Floor Party: Kegels are NOT Invited," you might remember, I asked her about Kegels, expecting to hear something insightful about alignment. Instead she informed me that too many Kegels can actually cause pelvic floor dysfunction, and she said that deep, regular squats were the answer to pelvic floor strength. From that day forward this blog (hello to any of the 70,000 visitors who discovered Mama Sweat by reading that post) and my pelvic floor hasn't been the same. To be clear, both are better for that discussion.

Katy and I wanted to check in with each other via our blogs (you can read her interview with me here). A lot has happened in a year. Katy's biggest news is that she became a mom herself. Her site should be required reading for anyone thinking about thinking about becoming pregnant. She is also gestating a few books. But I'll let her explain...

KARA: OK, smarty pants big-brain biomechanical scientist... Now that you've been pregnant and birthed a super-adorable human does the real-life experience change the text-book experience? That is to say, were there any surprises about pregnancy and postpartum? You have fantastic info for pregnancy and postpartum moms on your site, does it change at all now? (And how many different ways can I phrase that question?)

KATY: I'm glad you called me smarty pants big-brain as opposed to big-pants smarty brain. I DID have a wonderful birth, at home. (In fact, he's looking at me now, all nestled in his very own bean bag chair, wondering why I am typing on the computer instead of cooing at him all the time which is what I am usually doing.) I am also super-happy to say that I gave birth au naturel. Well, I wasn't super-happy at the time because MAN that was some intense sensations (WTF!) 

KARA: I know, huh? A little like hanging over the crater of a volcano and just when you think you might fall in you heave yourself back over the top. And while as unbearable as it could possibly be the exhilaration prevails. It's some kind of awesome. A reward in itself, along with the baby, of course. And from what I can tell, you got yourself a cute one. I hope he got your brains, too. But what I really want to know is what did that big-brain cutie pie baby do to your pelvic floor?

KATY: In regards to my pelvic floor (hey, thanks for asking about my perineum) I didn't have a tear or a rip or nada. So, no, I wouldn't change anything about my pregnancy prep, which, of course, includes alignment throughout my pregnancy and lots of correct pelvic floor use via my glutes.

KARA: And all that pregnancy pre-birth prep will soon be found in a great prenatal package through the Restorative Exercise Institute, and I might add is much more useful than knowing how the size of your embryo at different weeks compares to various types of fruit. Like a good scientist you tested all that great information out on yourself. Thanks for that scientific contribution. Any observations to share?

KATY: Well, I'll have to admit that, I WAS NOT PREPARED for how birthing felt afterward. I truly believed I would feel up to going to go hiking the next day. Turns out that a cough or a sneeze was causing panic--my body was that out of whack. It is amazing to think that, in a few hours, you can totally lose touch with a part of your body. I guess that's what happens to the pelvic floor and the core muscles after delivery. And I was glad that my pelvic floor wasn’t super-tight, fighting against me during deliver. That would have caused actual damage to the muscle, instead of just weakness due to stretching.

And, fun fact: It took me about four weeks to be able to Kegel and find these muscles.  Even then, it felt like my pelvic floor was in the other room. That’s a cool feeling...not.

So, professionally--while my pelvic floor info remains the same--everything else has changed. Like sleep. And my hair (chop). And other important things that I can't remember right now. Oh yah, memory. That's different, now isn't it.

KARA: What was the question again? I can't remember much anymore, either. I lose things all the time, too. But sometimes that's the kids' fault. Just wait till your adorable son starts taking off with your keys, cell phone and favorite lip gloss. But I'm getting ahead of myself. You're not chasing him around the house yet, but you ARE a Hot (Sweaty) Mama now and I'm quite certain you're finding ways to get your body moving. How have you been able to sneak in fitness so far?

KATY: Well, I made the mistake of opening my big hunter-gatherin' lovin' mouth and started quoting research about the peoples waaaay back and how women used to walk over 900 miles a year, carrying their babies, and that strollers were anti-alignment and natural strength (which is true, but...) 

So now in my quest to use my human body in the way it was designed to be used, I carry this kid all of the time. That is a huge workout. That, and I haven't driven my car in two months, which means you can find me walking 3-5 miles a day running my errands while working out my arms. Which are buff now. (Hunter-gatherin' Bonus!)

Because I am walking tons, my glutes and legs are super-strong. My arms and abs are super strong carrying the little man. The one piece of fitness that was totally lacking was the stretching part though. And I am a stretching freak (strength is all about those muscles being the right length, after all.) So, after reading your book I realized that I was not going to be given a magical Why-Don't-You-Go-Take-A-Yoga-Class while I sit here quietly sleeping, not pooping or crying or needing you (and that's just my husband) moment. And I started stretching in one or two minute increments. And doing my exercises when and where I could--a squat here and there, a pull up when I pass by the bars. I even stretch my chest and shoulders (great for that breastfeeding neck tension) when I'm done changing the little man, he coos on the table and I stretch like this: 

Or, I lay him on my mat and do downward dogs over him, taking breaks from one-minute holds to give him kisses. And, P.S. I mean the kid, not the hubby.

KARA: Quick though--can I make an appeal here for the best way to carry your baby? I didn't figure out till the fourth kid that I needed a baby-carrying device that distributed the weight on my hips as well as back. There are certain carriers (like Ergo and Moby) that are so much more comfortable and functional. The carriers that just drape over your shoulder seem to cause more problems, at least they did for me. I'm sure you're right about the stroller, but there is a time, there is a place (says the woman who once had three children under 2). So, how can a stroller-pushing-mum save her spine/strength?

KATY: Well for starters, use the stroller to push the kids and not as a crutch. Remember when people used to hang themselves over the stairmaster? That’s what I see a lot of. Running with the torso leaning forward of the legs...really bad for the back and, funny enough, is minimizing caloric expenditure cuz you’re using gravity to help you fall instead of your muscles to push you forward. And there’s no BUTT muscles working in a woman fallin’ forward. You catch my drift?

KARA: You got into with a lot of Kegel lovers last year. Bottom line, what's your Kegel policy? 

KATY: My kegel policy is unchanged from last year as referenced in your post because it wasn’t my "opinion" as in "Hey! I like orange cats because they're pretty..." as it is a theory based on, you, know, the physics and physiology of muscle.  


KARA: Readers can learn all about that policy, by the way, in Katy's online course, "No. More. Kegels." 

KATY: In order for the pelvic floor muscles to function properly, long term, you have to (HAVE TO) have strong and supple gluteals and deep hip rotators (like your piriformis). When you are having a pelvic floor issue, yes, the pelvic floor muscles are weak, but most likely due to the fact that the opposing muscle group is affecting their ability to contract correctly, i.e. shorten and release.

So, I don't have a Kegel policy as much as I have a butt policy. It's called, Get One for optimal pelvic floor function. Now contracting your pelvic floor is something you need to be able to do. If you can't "find it", then you need to increase this motor skill, but any good physical therapist will be able to tell you that the research shows that people who can't contract their pelvic floor (a Kegel) is more often associated with OVER TENSE muscles, not under used ones. Unfortunately we've got people getting their health information from fitness magazines or reading the abstracts of research articles they don't thoroughly understand.

KARA: I think a lot of people (and I used to be one of them) believe the Kegel is something as easy as swallowing. We oversimplified it, and in doing so took some short cuts (the relaxing/stretching part) that rendered the exercise useless or even in some cases problematic. It's our sound bite culture. I also think a lot of women kinda resented being told to do them all the time. When the Pelvic Party Post happened last year, we (all females, everywhere) were in the process of a collective eye roll over being told to keep Kegeling when we intuitively knew that something wasn't right. Now we (all females, everywhere) are thumping our heads with the heel of our hand and saying, "of course!"

KATY: I agree--pelvic floor function has been oversimplified to “do your kegels” and really, you are talking about an area of the human body that you can study at the university level for YEARS. I was actually surprised by the number of people saying stuff like they didn’t believe that kegels could cause Pelvic Floor Disorder or that needing to squat was not research-proven. I don’t think people really understand what gets researched, what that research means, and how things not yet researched are not false. But, if your kegels work for you, then keep doing them. For those who are doing their kegels and still having problems, being open to new science-based theories are a good idea. And from the volumes of positive feedback, I am so glad you ran the post Kara.

KARA: Those Kegel posts got the attention of a lot of people for sure and I hear a book deal for you. How did that come about?

KATY: Well, the phone rang and a publishing fairy said "can I pay you to write down a bunch of stuff you love to write about?" It was amazing. And then the fairy gave me one million dollars, which was exciting, because I got into pelvic floor science to make money and not because women's health was my passion.

Just kidding.

I actually just finished writing "Every Woman's Guide to Foot Pain Relief: The NEW Science of Healthy Feet," in which I allude to the fact that your Pelvis is attached to your thighs and your thighs to your knees and feet, so you should start down at the bottom. The next book on Pelvic Health via da Butt and correct gait patterns (not via Kegels) will actually be a self-publish on Amazon. 

The publishers I talked to said that they thought people weren’t really interested in the pelvis. And then I said, “you mean the 80 percent of the population who will eventually have a pelvic floor disorder aren’t interested?” and then they hung up the phone. No, really, I just decided that women need this info NOW and not in a couple of years by the time a book gets published. Soon you can just download it. Bam. Isn't technology amazing?

And, by the way, if any of you readers would like to submit "your story" of how your switch from Kegels to squats, or doing the "Down There" exercises from my DVD helped you with PF or hip issues, I would love to include it in the book. And, if I use your story, you get a free copy! Does that motivate you? How about if I sign it. How about if Kara signs it too?

KARA: You're getting my squat story. Where should we submit them and what's our deadline?

KATY: You can share your story on the "Pelvic Floor Party Anniversary Special" post on my blog and I will be taking your stories through the end of August.

KARA: While there has been a lot of pelvic floor talk on my blog this last year, Katy has been super busy answering questions and addressing issues. Here are links to a few of the follow up posts she did:

The Hunting and Gathering Mama

You Don't Know Squat

1234 We Like Our Pelvic Floor

And the conversation continues between Kara and Katy over at Katy Says! How have those squats worked for you?

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.

Update #6 from Mamacat

The last report from Mamacat had us all a little worried as she struggled to keep up with fitness with her hectic business travel schedule. That was six weeks ago. Here’s what she had to say:

I've been too busy working out to write you an update. For more than a week, my Polar Activity Monitor has been doing the boogey woogey dance with no less than 2-hour workouts each day. I've been getting back to spin class, hiking, going to Moms on the Run and general all around time for ME. When my project in Boston wrapped up and I got the Iron Girl training schedule, I had no choice but to catch up on lost time after those late Boston evenings in the office instead of the gym. 

The training scared me...not that I couldn't do it but just that I should be farther along by now. I got scared straight to the gym! AND I’M ALL THE BETTER FOR IT. I've been enjoying the work break (but miss the Boston gals) and putting fitness first every single day, sometimes with workouts in the morning and again in the evening. It's been awesome. 

You'd think the weight would be melting off but it's doing the opposite and I don't even care (that says a lot for my mood) because I feel better regardless of the stupid f-ing scale. 

I'm still a pokey little runner that can only handle a few minutes at a time but the minutes are growing longer with the walking time becoming less. When I'm tired, I looked to my MOTR peers and they help push me—it's really quite awesome. 

Oh—and check this out—I ORDERED vegetables on my chicken at lunch today. A first. (You don't have to post this part, it's actually quite embarrassing that I’m such a veggie hater. But oh, am I trying.) 

Of course I have to post that part! Can you hear the enthusiasm come through? I can. However, my hunch is that she’s going to want to see that “stupid f-ing scale” reflect her increased activity level. Still, I know she can feel other benefits at work. Here’s a little more from Mamacat:

I am having a good week. It's full of variety and activity. It is almost like one workout isn't enough. I have so much more energy and therefore so much more motivation. (My knees hurt, though.) 

Focusing in on your chapter 13, we (hubby and I) both have fitness goals and we are appreciating each others efforts with support. He helps me make time (and helped me to pick out my swank new bike) and I have put his fitness way ahead of his massively growing honey-do list. And likewise, I am out the door to the gym long before I tackle laundry or dust bunnies. The children are also getting in on it...helping more with their own chores and—get this—keeping track of how many Diet Cokes mom has. If I have too many, I get assigned extra sit ups before bed. There is a new chart in the kitchen to track it! Hub and I have even had a few riding dates and it is awesome.

Since Mamacat brings up Chapter 13 from Hot (Sweaty) Mamas: Five Secrets to Life as a Fit Mom, which is “The Sweat on Significant Others,” I’ll elaborate on the content, which is about “Couples who do it together and those who don’t (workout that is).” The chapter offers “sweaty vows” for those couples where only mama sweats and for those that have sweat equity. Make no mistake, one situation is not easier than the other! One vow for the couples who sweat together is to go on sweaty dates. And if they end in such a way that you’re swapping sweat, well, all the better!

So I love that Mamacat is recruiting the support of her family. Having cheerleaders at home makes becoming a Hot (Sweaty) Mama all the more enjoyable.

Let’s keep cheering for her too!