It depends! Internal assessment and treatment are valuable in clinical practice, offering insights into a patient’s condition and guiding therapy. However, patients may prefer alternative approaches for reasons like comfort or personal beliefs. Incorporating methods like external assessments and holistic therapies can enhance outcomes and support patients. By providing a variety of options, clinicians can better cater to individual preferences and create a more collaborative therapeutic environment.

Devices that may be used internally:

• Biofeedback
• Dilators
• Vaginal weights
• Wands (vibrating, thermal)

What are kegels?

Kegel exercises strengthen a weak pelvic floor but are unsuitable for a tight or hypertonic pelvic floor, which may worsen symptoms. Individuals with hypertonicity should focus on muscle relaxation techniques rather than Kegels and may benefit from internal massage and education on pain management.

When teaching Kegel exercises, emphasize the importance of squeezing and lifting the pelvic floor simultaneously. Encourage patients to visualize actions that engage these muscles, such as trying to stop gas or urine flow. Ensure they do not practice Kegels while urinating, as this can confuse pelvic floor signals.

If discomfort arises during Kegels, it may indicate excessive tension and warrant alternative methods, like deep breathing or mindfulness practices. Adapting techniques to individual needs promotes better pelvic floor health. This video (video 1) provides a detailed demonstration on how to effectively perform a kegel exercise. It emphasizes the importance of both squeezing and lifting, while engaging the muscles of the pelvic floor from the front to the back for optimal results.

Are kegels appropriate for all patients?

It depends! Kegel exercises can be challenging for patients, especially if they lack proper instruction or understanding, as the pelvic floor muscles are internal and hard to visualize. Over 30% of women seeking help for urinary incontinence have difficulty activating their levator ani muscles, often engaging other muscle groups instead. This highlights the importance of guidance in effectively strengthening the pelvic floor. While Kegels can help some, they shouldn’t be the sole focus; training the inner core muscles (diaphragm, transverse abdominals, multifidus) along with additional techniques like targeted exercises, manual therapy, dietary adjustments, and posture education often leads to better outcomes.

Alternatives to kegels:

Kegel exercises are beneficial for strengthening the pelvic floor, but there are alternative exercises that can enhance both pelvic floor and core muscle strength.

For example, squats engage the lower body and activate the core, promoting pelvic stability. The cat-cow stretch improves spine flexibility while encouraging synchronized breathing, enhancing pelvic floor engagement. Bird dogs also foster stability and balance by coordinating the upper and lower body through arm and leg movements.

Prioritizing proper breathing techniques during these exercises is essential, as it deepens the connection between the mind and body and places the pelvic floor in proper positioning, maximizing workout benefits.

References:

Core Exercise Solutiosn. (n.d.). Five ways to master pelvic floor strength by mastering a kegel. https://documentcloud.adobe.com/spodintegration/index.html#

Mojo Pelvic Health. (2021, August 5). Why kegels are not always the answer. https://www.mojoph.com/post/why-kegels-are-not-always-the-answer