The Problem with Kegels

Kegels aren’t bad exercise. However, most people's instruction in this important exercise has been limited, leaving many with a rudimentary understanding. The result is weakness in part of the pelvic floor or, worse yet, exercising the wrong muscles altogether. However, creating proper tone in this complex set of muscles is easier than most people realize. The ease of part of what’s confusing, but it can be corrected with good information. Keep reading for exercises that will get you on your way to improved bladder control, sexual satisfaction, and relaxation. (Please also refer to the previous post with important background information.)

The floor of the pelvis is made of small, tonic muscles, which are designed to make small, sustained contractions, not at all like the quads, which are designed for quick, fast movements. The first mistake people make it to try to contract the pelvic floor hard and fast, but that usually leads to using the buttocks or abdominals. Try it this way instead.

Sit down and put your fingers on your public bone and tail bone. Contract your pelvic floor. Do you feel the muscles under your hands moving? If so, you’re trying too hard. Relax. Contract more slowly and gently until you feel a contraction away from the seat, but not under your hands.

Six muscles make up the floor of the pelvic bowl. Most people don’t contract them equally, so Kegels strengthen some parts more than others. How can you tell? Try this.

Contract your pelvic floor and notice your pattern. Do you contract back to front, front to back, or some other way? Also, notice your pattern as you relax the muscles. If you contract back to front and let go front to back, the front part of the floor doesn’t get strengthened as much as the back. You can easily remedy the situation by contracting opposite of your normal pattern. Better yet, include variations such as contracting from your sit bones in toward the center (outside in) or radiate out to all four corners: tailbone, pubic bone, and sit bones (inside out). Remember to relax between each contraction.

The final misconception about the pelvic floor is that it needs to be tighter. That may be true for some portions, but chances are that parts are held in chronic tension. (They didn’t used to call me a tight you-know-what for nothing.) Constant tightness restricts breathing and sets up a cycle of whole body tension that ironically reduces the ability of the pelvic floor to contract when needed. Kegels should focus on relaxing the bottom of the core as much as strengthening.

Even though this muscle set is usually ignored, playful attention to the complexities and ease of movement will set a buoyant foundation for your health.

Exercises to Prevent Incontinence

Few things feel less graceful than wetting your pants. Unfortunately, 10% of Americans of all ages and more than 35% over age 65 suffer from urinary incontinence, which ranges from leakage when sneezing to total loss of bladder control. Most people can prevent pelvic floor dysfunction and minimize incontinence issues with the right type of exercise. This article gives you the basics and several good resources. A future article, "The Problem with Kegels," will provide more detailed information and exercises.

The pelvic floor is a group of muscles slung between the tailbone, sit bones, and pubic bone. Although it’s the base of the torso, the word “floor” is misleading for several reasons. A floor is usually flat and hard, but the pelvic floor works best when it can flex up and down like a kite in the breeze. Also, the muscles are interconnected and overlapping, more complicated than a layer of tile.

You can think of the pelvic diaphragm as the bottom and the breathing diaphragm as the top of a cylinder. If the bottom is loose and weak, the contents of the abdomen aren’t well supported, the core muscles remain flaccid, and the bladder doesn’t have good control. On the other hand, if the pelvic diaphragm is tense, breathing is restricted, constipation is likely, and it’s hard to control the bladder during forceful motions like sneezing or jumping.

Exercising the pelvic floor will improve its tone and your bladder control. Fortunately, you can strengthen and relax the group of muscles during everyday activities: while waiting in line at the grocery store, watching TV, or sitting at a desk.

One simple exercise is to use your pelvic floor to start every exhale. Simply contract between your sit bones (think of drawing all four corners of the kite together) to start the out breath. It’s a very small movement, less than a quarter inch from each corner. Then remember to relax the pelvic floor completely at the top of your inhale.

My favorite book of pelvic floor exercises is Pelvic Power by Eric Franklin. His imagery makes subtle exercises easy and is never boring. On Amazon at http://www.amazon.com/Pelvic_Power_Exercises_Strength_Flexibility/dp/0871272598.

This Canadian Women’s Health Network has an excellent website with comprehensive information about urinary incontinence. Check it out at http://www.wowhealth.ca/myself/ui/index/html. You can also print their exercises at http://www.health.ca/pdf/kegel_en.pdf.

Core Exercise

I recently went to a Core Yoga class offered by my chiropractor, Jill Massengill, D.C. (http://www.straightchiropractors.com/jill.html) As I was driving to her studio, I wondered if it would be a “hard core” or “real core” type of class. Most people think that working the core should be strenuous (as in this slide show from the Mayo Clinic http://www.mayoclinic.com/health/core-strength/SM00047), but actually core muscles contract subtly. Feeling them is more an experience of turning down intensity rather than revving it up. I wasn’t surprised, but I was pleased, when Dr. Jill helped us slow down and sink into subtle sensation so that we could activate the real core.

The core consists of four muscle groups: 1) the diaphragm, 2) pelvic floor, 3) transverse abdominus, and 4) multifidi. They act like a cylinder to stabilize the low back and abdominal cavity. The diaphragm is the top of the cylinder, the pelvic floor the bottom, and the transverse abdominus and multifidi make the circle part.

Unlike muscles that get worked at the gym, the core is designed to work slowly and for an extended period of time. That’s why many people fail to find or develop their cores when using the exercises like the ones from the Mayo Clinic—and the first 25 Google entries I found.

After much searching, I found an article by Susie Hately-Aldous that describes the incongruity between what people think a core exercise should do and what the core actually is. You can read it at: http://ezinearticles.com/?The-Ultimate-Core-Exercise&id=716075.

I gave up my search before I could find a good core exercise for you from the internet. Here’s one that I teach my clients:
Engage Your Core by Using Your Feet, Part 1
1. Lie on your back with your knees bent and your feet comfortably close to your buttocks.
2. Push down through your feet to push yourself “up,” as if you were getting “taller.”
3. Push with your heels only and notice how the line of force travels through your back.
4. Push with the balls of your feet and notice how the line of force travels through your front.
5. Push equally with the balls of your feet and your heels. Notice how much is on the inside and how much is on the outside arches.
6. Push evenly with your heels and balls with 60% weight on the inside arch, 40% outside.
7. Also try experimenting to find the push that travels up through your spine the most.

This is much easier than what most expect from a core exercise. But since so many of us are disconnected from our cores, we have to start by tuning into it.

Feel free to share your favorite core exercise.