Kegels: The Controversy

The Kegel – the first exercise that any woman is advised to do when they are suffering with pelvic floor dysfunction, urinary incontinence, symptoms of prolapse and much more. It sounds simple, but the Kegel is a controversial exercise in itself.

I find that most women know how to perform a Kegel but very few know how to relax the PF muscles afterwards. Simply strengthening the PF muscles with Kegels will just create muscles that are tight and inflexible, often worsening the symptoms that you feel.

For every action, there is a reaction.
For every Kegel there must be a Reverse Kegel.
This is one of the most important laws of pelvic rehabilitation.

Learning to relax the pelvic floor after contraction is known as the Reverse Kegel and is a necessary component in very woman’s pelvic rehabilitation. There has to be balance, a yin and yang. Although the Reverse Kegel can be challenging it is not impossible if you have the right guidance.

Your ability to have conscious release of the PF muscles is a critical part of your pelvic program. You must learn to focus on and relax these muscles before they can become healthy and strong again. Relaxation and lengthening of the PF muscles is also known as down-training.

The Reverse Kegel down-training will help you gain awareness and control over your PF. At first this exercise will be extremely difficult to visualise and perform. You may have had tension in these muscles for a very long time. As with everything, the more you practice these exercises, the easier they will become to do and to implement. All of the exercises in the series are design to help achieve balance in the PF muscles – these are the most effective methods that have brought success to my patients.


The Importance of Breath

To more effectively perform the Reverse Kegel series, you must couple the techniques with proper breathing. When I teach my patients the basics of down- training, I emphasise diaphragmatic breathing to ensure their success. Diaphragmatic breathing can be defined as a type of breathing that involves the abdominal muscles instead of the ribs, shoulders and neck muscles.


Diaphragmatic Breathing

To practise diaphragmatic breathing place your hand over your belly button. On the inhale, let your belly gently rise out into your hands and on the exhale let the belly flatten. Don’t let the breath raise your shoulders.

The best way to consciously release tension from the PF muscles is to do the Reverse Kegel while you inhale. Do not be discouraged if you find this difficult to perform – most people struggle at first. Just image that when you inhale properly your diaphragm lowers to make room for the air, so it is natural to also lower and relax the PF muscles.


How To Do The Reverse Kegel

Imagine your pelvic floor as an lift that starts at a lobby and can go up two floors, or can go down to a light-filled, completely non-threatening basement. Your baseline level of pelvic floor tension (i.e. no contraction and no relaxation) is the “lobby.” Start here.

Imagine the lift doors sliding closed as you begin your pelvic floor muscle contraction. Gently raise your pelvic floor lift up to the first floor by contracting your pelvic floor muscles halfway. Do not fully contract; in other words, do not allow your pelvic floor lift to go all the way up to the second floor.

Next, relax fully and visualize your pelvic floor lift lowering past the lobby and going all the way down to the basement. Really, fully, and deeply let go. Release any tension that might be held in the pelvic floor as you imagine the lift doors sliding open to reveal a light-filled basement. Relax your pelvic floor enough that you stop just short of urinating.

Repeat this 5 to 10 times several times a day

Note: If you feel like you might actually urinate while practicing this exercise, empty your bladder before completing it so that you feel more comfortable and more able to fully relax the pelvic floor muscles.