Wednesday, June 29, 2011

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, 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,


Anonymous said...

Another way to ensure you're doing the exercises correctly is by using a pelvic floor exerciser - however, these *aren't* suitable if pregnant and they are quite expensive.

But both yourself and the Kegel Queen are absolutely correct - it's very important to perform the exercises correctly!

Revon said...

You have got very excellent recommendation and guides. I recommend, do not go any exercise methods unless it is trusted. As the video says, there are many possibilities, where pain and outer sexual discomfort happen when not done right.

Pelvic Treatment houston said...

Quite worthwhile information, thanks so much for the post.

Kegel Queen said...

Hi Anonymous, I must respectfully disagree about using a kegel exercise device. While some of these do, yes, help you establish that you are contracting the PF, kegel devices have a number of fatal flaws. First, they are a total pain in the butt! For kegels to work, there are two requirements: 1. Do kegels correctly, 2. keep doing them. For women who use kegel devices, the story ends with the device gathering dust in the back of the underwear drawer, because who wants to get undressed and wash some gizmo every time you do kegels? If you have kids and you can't even pee alone, how on earth will you find a private moment to put this thingy in your vagina every time you do kegels? I'm in favor of making kegels as simple and accessible as possible, and devices definitely make kegels complicated.