Occasionally, a patient will ask me: ‘if I just do pelvic floor exercises, is that enough to fix my incontinence, prolapse, SI joint instability, or pelvic floor dysfunction?’ The short answer: no. Are pelvic floor exercises going to help? Yes absolutely, if they’re suitable for your specific symptoms. Doing something is always better than nothing. But are pelvic floor exercises going to be a fix-all kind of exercise? Sorry to disappoint.
Let me explain why.
Oh, the infamous pelvic floor exercises. If you’re wondering what on earth we’re going on about, I’m talking about pelvic floor muscle contractions. Your pelvic floor muscles naturally contract on a daily basis for a variety of reasons: holding in pee, poo or gas; coordinating with the muscles in your trunk for posture and stability; achieving orgasm; and supporting your pelvic organs. Pelvic floor exercises practise these contractions in order to improve all of these different functions.
Pelvic floor exercise can be really helpful for improving various symptoms. But each person’s situation is unique and we should be encouraging a little more personalisation than a one-size-fits-all approach.
Your body is a complex machine. All the gears and individual components have to work together in order to function correctly. The pelvic floor muscles coordinate their tasks with the deep hip and core muscles, which are coordinating with the other hip, thigh, core and back muscles, which are also coordinating with the other leg, trunk, neck… you get the idea. One gear off can affect the whole machine.
This means that while performing pelvic floor exercises is great, you will likely see greater symptom reduction and health improvements if you are doing your kegels alongside other forms of exercise, like walking, balance training, general hip/leg strengthening and general core/back strengthening. Even arm strengthening exercises can improve your pelvic floor muscle strength and endurance!
While you’re performing these other exercises, your deep core and pelvic floor coordinate for postural stability and controlled movements. This means that not only are you strengthening your pelvic floor, but you’re also improving your body’s automatic engagement of these muscles while you’re doing other daily tasks! And that is exactly what you’ll need for true correction of your symptoms.
Another thing to bear in mind is that over-fatiguing your pelvic floor is not productive. It is important to respect your fatigue point! If you were at the gym and couldn’t complete a bicep curl with a 50 lb dumbbell, would you just keep doing 100 more incomplete reps anyway? Attempting to work past your fatigue point in your pelvic floor muscles can actually lead to bad habits (like butt clenching!) that will not help to improve your symptoms.
What’s more, the fibers of the pelvic floor muscles fan in many directions. So when you’re in different positions, different muscle fibers are working harder than others. When I work with someone who says they’ve been doing their pelvic floor exercise for years, I always ask, in what position?’ Because they may show a sitting kegel who’s boss, but can’t find their pelvic floor muscles lying on their side or standing up.
In the end, pelvic floor exercises aren’t always the answer! If, for example, you did a complete bicep curl so that your bicep is all the way contracted and then I asked you to contract it further, well, you’d have nowhere to go, right? So if the pelvic muscles are in spasm or restricted, you will not reap benefits from those 500+ kegel-a-day programs. You must have the full mobility of the muscles first!
If you add pelvic floor exercises into your routine, you could definitely see some improvement in your symptoms. Again, something is better than nothing. But, just for a second, imagine how much more improvement you could see if you tuned up the whole machine.