Should you try pelvic floor exercises at home?
Are you one of the many women who are curious about at home pelvic floor exercises? Do you want to try it on your own before seeing a pelvic health physical therapist? If so, there are some key things you need to know about exercise and your pelvic floor.
The most important thing to understand is that not everyone will benefit from pelvic floor strengthening exercises, commonly known as Kegels. If your pelvic floor muscles are tight Kegel exercises can aggravate things down there, especially if you have pelvic pain.
So how can you tell if your pelvic floor muscles are tight?
Check for pelvic floor tension before exercise
The best way to determine whether your pelvic floor is tight is to have an internal exam performed by a Doctor of Physical Therapy who specializes in pelvic health. You do not necessarily need to see a general practitioner or gynecologist beforehand. And if you have had an annual exam by a gynecologist recently, we still recommend an internal pelvic exam by a pelvic floor PT. This is because a muscle assessment is not always part of the typical internal exam you receive from your gynecologist or obstetrician.
Not familiar with physical therapists who specialize in pelvic health or do exams?
Pelvic floor physical therapists treat women and men during all stages of life who are struggling with pain or bladder and bowel symptoms. With a physical therapist’s internal pelvic exam, you can expect them to use a gloved finger to assess the muscles, connective tissue, and organs inside the vagina (for women) and anus (for men). Your pelvic floor physical therapist should also examine the surrounding joints and muscles including the hips, spine and abdominals to get a clear picture of all the muscles involved.
Not ready to schedule a formal assessment or feel hesitant to receive an internal exam? You can ask yourself these questions to get a sense of whether or not Kegels and other generic pelvic floor exercises might be appropriate for you:
Do you experience pain with sex or when wearing a tampon?
Do you have back, hip or groin pain that has lasted more than 3 months?
Do you urinate frequently?
Do you have difficulty emptying your bladder or bowels (peeing or pooping)?
Do you leak on the way to the bathroom or when you first walk in the door?
If you answered yes to any of these questions, your pelvic floor muscles may be tight and generic pelvic floor exercises could do more harm than good. Do not worry, though. There are exercises for you outside of Kegels and the generic exercises you might find on the internet. In the event of a tight pelvic floor, a pelvic floor PT would recommend focussing on training these muscles to relax rather than strengthen.
Pelvic floor exercise and urinary incontinence
The most popular reason women and men start pelvic floor exercises is because of urinary incontinence and there are three main types: stress, urge and mixed. Stress incontinence is urinary leaking associated with a downward force like jumping, running, sneezing or coughing. Pelvic floor muscle strengthening is usually a great way to begin addressing this type of incontinence. This differs from urge incontinence which is connected to the sudden urgency to urinate and the inability to control it. Mixed incontinence is a combination of both stress and urge incontinence.
No matter the type of incontinence, every leak is an awkward experience-but thankfully treatable. But remember, fixing leaks is not as simple as doing Kegels. How you train your pelvic floor muscles depends on what is going on with your individual muscles as well as the organs, muscles, and tissue around the pelvis.
Before you start doing “at-home” pelvic floor exercises
If you decide to try pelvic floor exercises on your own first, here are some common mistakes to avoid:
1.Contracting the wrong muscles:
Many women and men make the mistake of contracting the muscles outside (for example the gluteus muscles, abdominals or inner thighs) rather than the pelvic floor muscles on the inside. Your pelvic floor muscles are found inside the vagina and anus in women and through the anus in men. To identify them and make sure you are contracting here, try inserting your finger in your vagina or anus, then intentionally squeezing the muscles around it.
2. Maintaining contractions too long and not resting in between:
Strengthening the pelvic floor muscles requires not only contracting the right muscles but also making sure the muscles relax. Gaining this coordination is the first step to gaining strength and control. A good exercise to start with is contracting the muscles inside for 3 to 5 seconds, and then consciously relaxing them for 10 seconds. Can you feel both the contraction and release? Most women I see in the clinic struggle initially but improve with the proper guidance and training.
3. Holding your breath with the contraction
Although this is a common mistake and may even work at times to prevent a leak, holding your breath is a bad habit to continue with for a couple of reasons. Holding your breath creates a downward pressure on the pelvic organs (bladder, uterus, and rectum) and can worsen conditions like pelvic organ prolapse or urinary incontinence. Try to maintain a steady breathing pattern while keeping your pelvic floor muscles engaged.
Should you do at-home pelvic floor exercises or see a pelvic floor PT?
While Dr. Google or Dr Kegel may suggest Kegels or other at-home pelvic floor exercises, it is not a one-size-fits all solution. The best approach is to consult a pelvic health physical therapist who will identify the root cause of what you are experiencing and develop a personalized plan specific to your body.
If you decide to do it yourself and you want to try strengthening on your own, begin slowly and pay attention to how your body is responding. Awareness of what is happening down there- and tracking to see if symptoms are improving or worsening- is crucial to your program.
If you are having any negative effects, stop the exercises. Unfortunately, every week I hear from at least one client whose symptoms worsened after trying exercises independently or following ones given to them by another provider. This should not be the case. Whether it is the beginning or the middle of your routine, we strongly recommend having an evaluation by a pelvic floor physical therapist to ensure you are on the right track to improving your pelvic health.