To kegel or not to kegel?

Hi kiko,

I don't want to sound dismissive of your post, but I only have a minute and this topic has been discussed *extensively* before. Try putting kegels in the search and see if anything discussed before helps you out. Also see Christine's article "Why Kegels Don't Work" in the library. The short of kegel discussion seems to be: some women find them harmful, some women find them helpful, they will not correct prolapse. Personally, I do a few when I remember, but could go a long time without and notice zero difference in strength or lack thereof. They have not worsened my POP, but they sure haven't helped either.

I too find this a bit confusing. I have read Christine's essay on why Kegels don't work. In her book, she offers explanations and diagrams about the x-axis and the y-axis. At one point she does say that if Kegel-type contractions are practiced, it would be better to do them in a 90-degree sitting position with the lumbar curve in place. So, should we do that, or should we just not bother? Based on her extensive anatomical research, she has probably arrived at some conclusion with regard to whether doing so works with, or against, the WW principles; I would like to know.

One of the problems with lying down to do any exercise is that prolapse is not generally a problem when you are lying down, and there is no gravity acting down your vagina when you are lying down. Gravity is working to push all your organs against either your sacrum or your abdominal wall, depending on whether you are lying on your back or on your tummy. There is an argument that says that you have to load a muscle to exercise it. If there is no resistance then there is no strengthening benefit.

The lumbar spine spine tends to flatten when you lie down, because gravity is not reinforcing the lumbar curve, the way it does when you are vertical. You can test this yourself by lying down first on your back and then on your front, and insert a finger as far as you can into your vagina each time, to ascertain which way your vagina is pointing. For me it was exactly the same both times, and it was almost straight in, which puts the pelvic organs in positions where their spot is not reinforced by vertical posture.

That is why I see little benefit from Kegels lying down.

However, in sitting position gravity is acting on your innards and there is some resistance to the contraction of the pelvic floor muscles. In sitting WW posture the only differentiation from standing is that the femurs are flexed instead of straight. The pelvis is in exactly the same position, but it may be more stable because you are sitting on it, rather than having it wobbling around on top of your legs!

When you are in WW posture all the time, and particularly if you move around a lot on your feet during the day, the two halves of your pelvis move in opposition to each other, the two halves nutating and counternutating on the sacroiliac joint and in relation to the spine as you put one foot forward, then the other. This stretches and relaxes the two halves of the pelvic floor muscles alternately, so you are exercising them all day, *as long as you are in WW posture all day*, with your pelvis 'wound up' and none of your muscles floppy.

Pelvic floor muscle exercises do have a role in making these muscles active again, after, say a difficult pregnancy, which I had for my second. They also close more effectively the sphincters around the urethral opening, the vagina and the rectum, which can help with continence, but there is no research evidence that Kegels will allow a woman to keep her prolapsed organs inside by keeping the pelvic floor muscles strong enough to remain in continual contraction. This is not healthy because these muscles are largely made of sheets of thin sinewy muscle like the abdominal muscles and the diaphragm, so they need to be able to distend and bounce back, just like the abs, like a trampoline. To make any of these muscles less bouncy is to make intraabdominal forces push the pelvic organs down the plug hole.

If you have a raw sausage in a natural skin, that has a curve to it, and you squeeze the top, the filling will still squeeze out the bottom, as long as the skin stretched taut and in spite of there being a significant curve in the sausage. The curve would normally have the effect of slowing the flow because a force can only work in a straight line. This is an important reason why our combined abdominal and pelvic cavities which are continuous, but have almost a right angle bend where they meet at the top of the sacrum. If the skin is not taut the filling will move into the curve and make that part of the skin taut, before it squeezes out through the bottom. Go get a raw sausage with a natural skin (made out of animal intestine - yes, curved once again!) and try it!

Hey, hang on a minute, isn't having super strong abs and pelvic floor counterintuitive?

Sure is! The raw sausage illustration is one way that super strong muscles can work against a woman's natural design (and men too!)

Hope I have explained this OK. Please feel free to ask more questions or criticise my arguments if you think they are wrong. I am still learning too.

Once you have your pelvic floor muscles responding to the command to move there is little point in doing Kegels, as long as you do your day in WW posture.

Louise

Thank you Louise for the in-depth response. I myself never even thought of doing Kegels lying down, in fact I only ever did them while urinating (trying to stop and start the flow of pee). I must admit that years of doing that didn't seem to have much effect. This was all pre-WW for me.

I think kegels are one of the most popular topics on the forum. I did the "kegel or not to kegel- that is the question" some time ago. I had read Christine's information and read up on the posts. So I went to visit a physio who specializes in women's health. I lent her my book and she seemed interested. This is part of her email response to me-

"I agree that pf ex's are not the whole answer to prolapse. I agree that postural improvement ( and the whole woman workout is good for that) is very important as part of the treatment. However I would have to say that pf ex's are an important part of the ex routine and should not be dismissed.They should definitely be practised in correct postural alignment, as should all exercises. Unfortunately this is not always understood or practised.
There are a couple of studies under way looking at pf ex's alone for treatment of prolapse and showing initial promising results.These were referred to in The Australian & New Zealand Continence Journal, Spring 2009 vol 15 Number 3. I have attached a copy. The basic idea is to reduce the size of the genital hiatus(measured as the circumference of the vagina). The larger the hiatus the more likely things can fall out of position ie prolapse. It is measured by how many fingers width within the vagina at rest - both horizontally and front to back, ideally less than 4 fingers."

Personally, I have found that if I do a strong pf contraction while standing, I can "draw" up my cystocele. I can feel with my finger, the cystocele at the introitus and as I do the contraction, I can feel the cystocele pulling up inside.

Recently I spoke to our local women's health doctor. She agreed that pf are not the solution.

There are just so many people pushing kegels as the solution to prolapse which is not the case. I can see that they have a place for some people.
It is however the WW posture that is the major factor and it needs to be supported and promoted.

I gotta go to bed now, but I don't want to forget to think on this for a while. How many fingers within the vagina at rest. hmm. What the heck does that mean? Night :)

I am not sure what it means exactly- this was part of the response from the physio. I have the copy of an article from the Australian and New Zealand Continence Journel the physio sent me. It is a short editorial which I can email you if you want it.

Hi gardengirl; Just read your post of Sept 13/11. I have recently been diagnosed with cystocele and had been doing the kegel exercises unfortunatly while lying down until I read Christine's article explaining why they will not help with prolapse. I would like you to email me the editorial you mentioned in Sept. if possible as I have just started the WW posture and am willing to do anything else that may be helpful to improve my drated condition!!!

Life is so amazing- I have been away from the WW site for quite some time as life was diverted to other activities. WW was never forgotten just on hold. So here I am back for a quick look and what do I find, the old kegel question is back!
WW look has changed a lot since I first logged in. It is wonderful site and it is nice to see some of the old stalwarts still at it.
Re that article, I actually found it on my computer which is also amazing. It is not spectacular but at the time I found it interesting. It gives reference to :
"A multi-centre randomised controlled trial of a pelvic floor muscle training intervention for women with pelvic organ prolapse".
Known by the acronym of Poppy Trial ( also found this reference -NCT00476892). If you google poppy trial you get miscellaneous reference to the study but as yet, I have not found the results online.

I need reminding as to how to email through WW so energeticmarg, if you can figure it out, email me and I can give it a go
Di

Email me, louiseds at wholewoman.com, if you want to make contact with another Member, and I will get the appropriate permissions and send it along. The Email Tab is still not working.

L