Do you have questions about Kegel exercises after childbirth?  You are not alone.  Most women have heard they should be doing “Kegel” exercises to strengthen their pelvic floor muscles, especially after having a baby in order to reduce urinary leakage and pelvic organ prolapse risks.  However, more often than not, the instructions given by the OB/GYN or childbirth educators are too vague or not specific enough to treat the real problem, and some people should not do Kegel exercises.  If you have pelvic pain, exercising might be making the pain worse.  Seeing a physical therapist who specializes in the pelvis may be the answer to your Kegel questions.
 
How do I know if I am doing them correctly?  How many should I do?  What position should I be in?  Are you supposed to do them when you pee or when you are at a red light-which is it?  Will it help with my urinary leakage?  What about with my sex life? 
 
These are common questions I hear in my practice as a pelvic floor physical therapist.  I specialize in treating the muscular dysfunctions of the pelvic floor.  A group of over 20 separate muscles that lie underneath the pelvic organs (the bladder and the bowels, the uterus and vagina in women, and the prostate in men), the pelvic floor acts to support the organs and gives us voluntary bowel and bladder control. Most people think their bowel, bladder, or genital troubles are due to problems in the organs themselves.  Your bladder problem may really be a muscle problem.
 
The most frequent question I hear is, “What on earth can a physical therapist, of all people, do about my bladder or bowel problem or my pelvic pain?” A lot, actually. 
 
The American Urological Association recently recommended pelvic floor physical therapy as an early treatment option for pelvic floor dysfunction, especially in those with pelvic pain. The pelvic floor muscles are skeletal muscles, which mean they are under your voluntary command.  They are controlled by your thoughts, just like the muscles in your arms and legs, which means they can have the same type of problems as any other muscle.  Weakness, poor endurance, poor coordination, and even painful tender points and scar tissue adhesions can occur in the pelvic floor muscles.  Instead of causing difficulty with walking or lifting, pelvic floor muscle dysfunction can cause incontinence, pelvic organ prolapse, and even pain with intercourse. 
 
So, what does a pelvic PT know?
 
Pelvic PT’s know that most bladder problems are really muscle problems. 
Like pinching a garden hose, the pelvic floor muscles contract around the urethra (your bladder tube) to give us bladder control.  When you have the urge to urinate and “hold it”, your pelvic floor muscles are doing the holding. 
 
If your pelvic floor muscles don’t have adequate strength, they can’t pinch the urethra tight enough to hold urine inside the bladder.  If you have poor endurance in your pelvic floor, you might have trouble making it to the bathroom on time.  If you have poor coordination, your pelvic floor muscles might not squeeze fast enough to counteract that cough or sneeze.  The same can be said for bowel control, too.
 
Your average Kegel program is too simple to address these muscle complexities. Bladder and bowel control is dependent on the pelvic floor muscles working in harmony, not just being “strong”. 
 
Think about it-does it make sense that just doing biceps curls would fix every arm problem?  No, it doesn’t.  Kegels can’t fix every pelvic problem, either.  There are many  types of pelvic exercises.  Kegels are just one type of exercise a pelvic physical therapist might prescribe.
 
 
Pelvic PT’s understand pelvic pain.
To put it simply, pain inhibits normal muscle function.  When we hurt, we don’t move normally. 
It is easy to see if someone has pain in their knee or ankle – they limp!  The pelvic floor is an inside muscle, which makes seeing its dysfunction more difficult. 
 
If your pelvic floor muscles are painful due to an episiotomy scar or other birth trauma, repetitiously contracting the muscles may make your pain worse.  You may need exercises that stretch rather than strengthen your pelvic floor.  Only a trained pelvic floor physical therapist can evaluate your pelvic muscle function and then prescribe the right type of pelvic floor exercise program for you. 
 
 
Pelvic PT’s know how to individualize an exercise program.
A Physical Therapist uses movement to treat the body the same way a doctor uses medicine.  Exercises are prescribed and are individualized to the patient.  A triathlete or cross-fitter should, and will, have a different program compared to someone who has never really exercised.  Your “movement medicine” is designed to fit your life and the demands your lifestyle puts on your body. 
 
The pelvic floor is not an isolated muscle group.  It is anatomically connected to your hips and is a part of your inner core of muscles.  Knowing how connected the pelvic floor is to the spine and legs, it is no surprise that back pain and balance troubles are linked with incontinence. In a recent study, 52% of people with low back pain also reported having some form of pelvic floor dysfunction (voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation). Over 80% of those with pain said their pelvic floor symptoms began about the same time as their low back or pelvic pain did. 
 
If you have pelvic pain, back pain, tailbone pain, or genital pain, it is very likely your pelvic floor is part of the problem. Seeing a pelvic floor physical therapist who can tailor a program for you can be a part of your solution.

Pelvic PT’s know a lot about Kegel exercises. 
 
A short history lesson
There was a Dr. Kegel.  He was a Mayo-trained surgeon who became interested in finding non-surgical treatment options for incontinence in post-partum women in the 1930’s.  He did not “invent” the exercises. Therapists in England had been teaching pelvic and pelvic floor exercises since the late 1800’s to new mothers in the maternity wards.  He was, however, the first to apply the scientific method to prove pelvic exercises actually worked to reduce urinary incontinence.  After decades of research on the best methods on how to teach the exercises, he published his results in 1948. His approach was 84% effective in curing incontinence symptoms. 
 
So what happened?  
The methods Dr. Kegel developed in the lab just didn’t translate well into modern medical practice Unfortunately, in today’s post-partum healthcare world, Dr. Kegel’s methods of teaching pelvic exercises have been replaced with a brochure that new moms are handed as they leave the OB/GYN’s office.  Most well-meaning doctors didn’t have the time or resources to duplicate Dr. Kegel’s methods in their clinics. Over the years, the verbal or written description of how to “squeeze down there” started to replace the individualized approach Dr. Kegel was able to take in his research.  
 
Dr. Kegel advocated that without one-on-one instruction physical instruction by a trained practitioner, most women would not be able identify the right muscle, therefore making the exercises ineffective.  Decades after this assertion was published, multiple studies now support Dr. Kegel’s early observations.  One study found that in women who were given only verbal and written instructions on Kegel exercises in an OB/GYN’s office, less than half could demonstrate a correct pelvic floor contraction.
 
How would Dr. Kegel teach you how to do Kegel exercises?  First, he would look at and palpate your pelvic floor to make sure you were using the right muscle group.  He would then use an internal vaginal pressure sensor called a perineometer, an early type of biofeedback, allowing you to “see” your internal pelvic floor muscles working.  He would progress your exercises as you became stronger.  You would be instructed several times over the course of weeks or even months.
 
If you have tried Kegels on your own and not gotten the results you wanted, maybe you need a “Kegel coach” – a pelvic physical therapist who has the time (our appointment are an hour long), the equipment (we use modernized biofeedback methods), and the knowledge (it’s our specialty) to evaluate your Kegel skills and then develop an exercise plan especially for you.
 
***
 
Dr. Heather S. Rader, PT, DPT, PRPC, BCB-PMD   was a former pelvic physical therapist at Sher Pelvic Health and Healing.  She holds certifications in pelvic rehabilitation and biofeedback for pelvic muscle dysfunction.  She has been a pelvic specialist for over 15 years and is a pelvic floor rehab educator. 

Have questions or want to make an appointment? Call (407) 900-2876 or email [email protected].
 
 
References:
1.Bump R, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel exercise performance after brief verbal instruction. . ;:–329.

1. Hanno, Philip M., et al. "AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome." The Journal of Urology 185.6 (2011): 2162-2170.
2. Kegel, Arnold H. "Progressive resistance exercise in the functional restoration of the perineal muscles." American journal of obstetrics and gynecology 56.2 (1948): 238-248.

1. Pool-Goudzwaard, A. (2003). Biomechanics of the sacroiliac joints and the pelvic floor.

 
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We receive many questions about postnatal exercise concerns and online programs.  We hope you find this information helpful!

The  American College of  Obstetricians and  Gynecologists has general guidelines on this topic.

In addition to those general guidelines, it is important to remember that  having a baby  via  C-section or vaginal delivery is a  big deal! Your body is incredible, strong and beautiful. Honor your body during this time and allow the tissues to heal  ( vaginal delivery as an extreme sport  and  returning to exercise after a C-section). 
​Movement is very beneficial to healing  such as  walking, breathing  exercises and pelvic floor exercises.  Generally, after 4-8 weeks (based on  your  medical  visits), you can  increase to higher intensity aerobic exercise and weights.  If you try to go back to  the same exact exercises that you were  doing during pregnancy or  before, you may  realize you have changes affecting the way you move and feel such as: scar tissue  adhesions at your abdomen,  a prolapse starting, separation of the abdominal muscles,  leaking with jumping.

 Once you are cleared by your OB medically,  we highly recommend you see a  Pelvic  Physical Therapist  (Women's Health Physical Therapist). This is exactly what we do! We help you maximize your pelvic, abdominal, and back health to be able to return fully to your daily activities, including exercise programs. We  can do postnatal screenings to  identify  these conditions  and provide individualized  treatment and home programs for you. 

There are numerous  postnatal exercise programs out there,  which is why we want to highlight the very best!  The programs  listed here are  ones that specifically take  pelvic health into consideration. They are  developed by  fitness trainers  or PTs we trust.
**  These exercise programs are  not just for  up to 1  year postnatal. They are safe for  most people at any age because they are meant to  facilitate proper form  and optimal pelvic/core health. 
** Concern: Classes that focus on the  BOOT  CAMP mentality . Some of the exercises can be okay, but often women  are pushed to do crunches, planks,  high-intensity jogging and jumping with the motto "get your body back into shape quickly." These  exercises  are typically not appropriate  for many women  in the first year after baby.  Many women go to  countless exercise classes  for their abdominals  only to learn that it was making the diastasis recti and pelvic floor issues worse.  
**  We receive questions about the Tupler  Technique often.  It involves using  a splint  for a certain period of time while doing specific exercises. It can work for some, but we find that it is not  applicable to  daily function and many women have difficulty adhering to the program.  We  didn't feel comfortable putting it on our "best" list. 
 * We will  continue to  modify and add to this list. 

"Had enough of the baby belly? Strengthen your core, improve pelvic floor function + get strong, fit + body confident… however long ago you had your baby!"

Click on the Banner Below to Learn More! 

We recommend this  to  new moms  in conjunction with our  pelvic PT sessions OR  this program can serve as a stepping stone to  more advanced exercise programs (getting back to high-intensity weight lifting classes  and/or aerobic exercises) . Tracy Sher serves as Medical Advisor for  MuTu  and affiliate and fully endorses the program.  The online program also includes access to  a very active  online  support  group. The founder, Wendy  Powell, is very passionate  about this system and  heavily involved in online support. 
* We will soon offer  LIVE MuTu  classes in Orlando starting in  July/August of 2016! 

"Wholesome fitness for the whole family.  You crave modesty, affordability, and accountability." 

Another  program that is always rated with high satisfaction  is Fit2B , by Beth Learn.  The primary feature is a monthly or yearly membership that provides online options such as:  access to over 100  workouts,  a supportive Facebook community, discounts on eCourses , and  a  Fit2B mobile app. 

"Hab-it: Pelvic Floor is a DVD [now digitial download] that gives women suffering from the symptoms of a weakened pelvic floor (urinary incontinence, pelvic prolapse) the experience of working with a physical therapist from the comforts of home. The intent of the DVD is to help, if not eliminate, the symptoms of a weakened pelvic floor...designed with input from physicians, physical therapists, and real patients to ensure that viewers receive expert guidance that addresses the most common mistakes and frustrations of physical therapy"

The website features  a  series of  digital  download exercise programs:  Hab-It  Pelvic Floor Exercises,  7 Day Advanced Stabilization Program,  Interval  Cardio Workout,  Interval Plyometric  Workout. 
We  heard a lot about  this from patients. They enjoyed the program, but  were looking for more individualized programs as well. 

"The pelvic floor has long been the only muscle targeted in the battle against incontinence, and yet ignored in our pursuit of a strong ‘core’. New research has helped us understand that the pelvic floor is actually a critical part of the ‘core’ team and collectively that team works together to keep your center anchored and dry. Integrated teamwork, linked to the up and down pistoning action of our breath, provides a sturdy foundation that supports our joints and movement, accelerates fitness, and keeps us dry.  Also recommended for minimal to moderate prolapse, diastasis, and pelvic pain."

Physical Therapist Julie Wiebe is a leading clinician and educator on the topics of returning to high-level athletics after changes at the pelvic floor and core.  Foundation for Fitness is your first step toward resolving leaks and restoring a strong foundation for your movement and fitness.
* This is an educational online course rather than an exercise system.  Highly recommended to understand the pressure system of the core.  You can view  this as a great complement to the full programs listed above. 

We hope this has been helpful!  
If you would  like to set up a  consultation with  one of our Pelvic  PTs , you can fill out the  registration form on our    welcome page HERE or call 407-900-2876

​~  Tracy Sher and the Sher Pelvic Health  team!