Why Kegels Aren’t Always Enough: Breaking Through Pelvic Floor Plateaus

What are Keglas and why are we obsessed with using them in pregnancy in after birth?

Kegals! They are the number one prescribed exercise by physios in the uk and by many pre and postnatal qualified fit pros… a kegal is a contraction of the pelvic floor you may have heard them described as a squeezing of the space in front of where you wee and behind where you poo.

Others say imagine you are holding or squeezing a tampon.

You’ll probably have heard of the squeezy app if you are under NHS care.

In my personal experience and in my professional work I have noticed that pelvic floor contractions can often work for a short time and then plateau with a return of symptoms. I have also experienced regular pelvic floor contractions causing an increase in pain or symptoms if experiencing pelvic floor dysfunction.  I personally have experienced heaviness and pain in both of my pregnancies and have spent the last two years learning as much as I can about the pelvis, its muscles and how we can cure pelvic floor dysfunction by looking at the whole body! All so that I can help other women navigate pregnancy and post partum without pain or life changing symptoms. Leaking, pelvic floor heaviness, prolapse, “a little wee when you laugh” None of this is normal after having children. Common yes! But we do not just have to accept it! There is so much we can do! I can help you! I go into more detail below but If you are already keen to support your recovery you can check out my pelvic floor mini course here! Keep reading to learn golden nuggets of advice shared with love.

The Kegel Craze: Why It Started and Where It Falls Short

Dr Arnold Kegal created the kegal to support women in the 1940’s. He created a device that tracked the effectiveness of a pelvic contraction. At the time this was ground breaking work and for the first time it gave women the opportunity to do something themselves to support their healing after birth. However his device was designed to be used with analysis and support from pelvic health experts, this support is something that has faded away in recent years with the kegal given as a brush off treatment to so many women presenting with these life changing symptoms.

Now pelvic floor contractions are one way to support pelvic floor dysfunction. They will make the network of muscles and connective tissue work together locally (around the immediate area of the pelvic floor). BUT actively (that means having to consciously use your brain to contract your pelvic floor to stop a symptom) is not a good or indeed sustainable way to relieve your symptoms. It’s a management tool but it does not solve the problem!
After all when you were 10 years old and jumping out of trees or competing in a dance show or running in the park you weren’t holding one long squeeze of your pelvic floor muscles to stop the wee were you? So why should you have to do that it now? 
Some women will swear by kegals they will say that they did them all through pregnancy and had no issues after birth, And for those women that is great. Kegals have a place in treatment, and if you feel they have worked for you and you can sustain doing keglas 3 or 4 times a day for the rest of your life then this blog post may not be for you. But if you feel like this daily tasks is just one step too far for you OR doing keglas has made your symptoms worse then this blog is worth a read! Perhaps you have used the squeezy app and your symptoms improved but then they came back. Or worse after starting your regular programme of squeezes your symptoms actually became more intense (this happened to me!) Then I invite you to read on!

So why could a kegal or pelvic floor contraction make your pelvic floor dysfunction worse? 

Well it’s to do with rage of movement and tension. The pelvic floor contraction works because when you actively tense the muscles of your pelvic floor (like you may do to stop yourself from weeing) you literally force the muscles to contract. But you can’t do that 24 hours a day. Over time the muscle is going to get tighter and tighter. And a tight pelvic floor often called a hypertonic pelvic floor is likely to cause you problems. It could even cause hip, back or pelvic pain! Did you know that the pelvic floor muscles connect to the glutes and the hips? So your hip pain, bad back or even shoulder pain may actually be related to pelvic floor dysfunction. 

Understanding the full role of the pelvic floor

Your pelvic floor is incredible it supports pressure management, it holds your organs in place. It helps you to balance but it doesn’t do it all on its own it’s part of a whole body team! It has some best friends below and above it. We are going to meet the team below:

The foot and your pelvic floor

The arch of your foot and the pelvic floor are best friends. The arch of the foot is the first part of the body that absorbs the pressure of impact through the body when moving. For example when you jump it is your foot that hits the floor first. If the arch of your foot isn’t responding optimally to spread the impact then the force of hitting the ground ricochets up the body and stops at the pelvic floor. Your pelvic floor then has to manage a whole load of pressure it was never created to manage. Over time it might start to show signs of fatigue or dysfunction! 

The diaphragm and your pelvic floor

The diaphragm makes up the 3rd part of the team! It sits above the pelvic floor. And should ideally be stacked on top of it. When the diaphragm and pelvic floor are stacked over each other they work together beautifully to control the pressure of breathing. That’s right breathing creates force on the body. When we inhale we add more volume to our internal vessel essentially we have to expand to create space for the oxygen! But if the diaphragm is out of line (usually because the ribs are flaring up, often due to tension or perhaps injury in the shoulders, neck or ribcage) the added force of breathing (oxygen entering the body) creates a strain that cannot be managed by teamwork and so that extra volume gets pushed into other places like forward into the abdomen (hello abdominal separation or diastasis recti) or down ( equalling leaking, heaviness and incontinence)

The wonderful trio

The arch of the foot

The diaphragm 

The pelvic floor 

They all need to be aligned (as best they can) AND working optimally to absorb impact from day to day activity, walking, jumping, running. (Feet) or pressure from breathing (diaphragm) We need to find whole body alignment in order to heal the dysfunction. If we just strengthen the pelvic floor muscle on its own it might help for a bit but it’s often the whole system that needs help to stop the symptoms. If you do take a full body approach to healing your pelvic girdle pain in pregnancy or your pelvic floor dysfunction after birth you are probably going to avoid a whole load of other wear and tear too because your body will be in it’s optimal alignment. Your pregnancy and birth are often not the cause of your problem. they simply put extra strain on an already overloaded system which then shows as pain or dysfunction. 

3 reasons your pelvic floor symptoms have plateaued

Your pelvic floor is too tight! 

We have talked already about the fact that a kegal really just gets the pelvic floor to tighten up! Which is ok if it’s super slack. But I am yet to meet a women who doesn’t have some form of continuous tension  in her posterior chain and ,as a result, her pelvic floor. Tightening something that is already squeezed to its maximum range is not going to make it get strong! It’s just going to make it more tight. In fact it might even make symptoms worse. 

So if you have constipation or often feel like you haven’t fully emptied your bowels when you poo. 

If you have a sore lower back

Or never feel your glutes in a squat 

Your pelvic floor might actually need to relax! 

I have a coupe of theories about why we all have such tight posterior pelvic floors. One is life style. Long periods sitting over lengthens the glutes so the pelvic floor kicks in to hold everything together.

My second musing and this is key to healing pelvic floor dysfunction in motherhood is stress! Anxiety. Not enough rest! Your pelvic floor as well as connecting to all the big players muscle wise like your glutes, hamstrings and hip flexors is also intrinsickly linked to your vagus nerve that runs along the spinal column. Your vagus nerve is part or your parasympathetic nervous system and supports nervous system regulation throughout the body and mind! So if you are in a constant state of fight or flight, stress. your vagus nerve is going to be pretty cross and it’s going to make the pelvic floor cross too! 

Not only do we need to really relax and then lengthen the pelvic floor we also need to soften our nervous systems to allow it to do its job properly. To help it unstick!

Breath work should be your first treatment in pelvic floor dysfunction

This is why breath work is always the first thing I give to treat people who present with pelvic floor dysfunction in pregnancy or post partum in my Northumberland pregnancy yoga and antenatal classes. Breath work over time will help the rib cage to shift back into a stack (especially if your posture remains altered after pregnancy, which in many cases it does) Taking in nice big gulps of oxygen is also going to help to down regulate your stress response. Our body loves oxygen so if it perceives it has an abundant amount its going to start to move into a more peaceful state.

Another reason your pelvic floor symptom improvement may have halted is that there is some internal injury that was not treated well during or after birth. This may require deeper relaxation techniques that pelvic health physios can provide. Trauma may also need to be explored too. Your body holds onto trauma, sexual trauma, birth trauma other trauma that occurred but did not directly impact the pelvic floor could still be contributing to your symptoms. And so working both physically and emotionally could support an improvement in your symptoms. 

Oh and a huge factor we often over look is your period!!! During your period your body is in a state of release of letting go. All the muscles loosen off around the pelvis. So this could either improve or worsen your symptoms depending on the cause.

See it really is a complex layered approach to treating. Yes internal assessment can be helpful but there are also the layers that cannot be touched, felt or seen by anyone other than you! 

Beyond Kegels: What You Should Be Doing Instead (or Alongside)

As I have already said BIG breaths. 360 degree breath works on expanding the back of the rib cage and not just the belly. Belly breath is often taught in pregnancy. It is a really simple practice that does have a great effect on the nervous system. But if you focus on only allowing the tummy to expand on your inhale especially in pregnancy and post partum you could increase the length of time you have abdominal separation, you could make it bigger! So it really is important to learn how to open the back of the rib cage when taking in oxygen. It requires slightly more refined cueing from your pre and postnatal expert. I have an online mini course that starts with the knowledge and the basics of breathing including how to take a nice big breath to both nourish the body and create optimal alignment through the torso. Details here! 

Wether you are pregnant or in your postnatal period, if you had a c-section or vaginal delivery gentle stretches to open the upper body and lengthen the glutes fully are going to be really important to support your treatment of pelvic girdle pan or pelvic floor dysfunction. Weights almost always need to be added at some point to completely irradicate your symptoms.

However a little note on strength training. It could be exactly what you need, it could also be exactly what you do not need. Especially if you are sleep deprived, over stimulated and in a high state of anxiety. Hitting the gym and lifting weights is the last place you will want to be and if you have recently had your baby (and by recently I mean in the last 12 month) Then it is completely ok to not feel ready for that step. If this sound like you and you need a more personal approach, one where your baby can stay with you and you can move gently but with precision then contact me here! I can help you. Get in touch here!

What you can do to support your own pelvic health

Understanding the bio mechanic of how your body wants to work is a great way to support management of your pelvic floor symptoms on a daily basis. For example standing up as you exhale is going to support the team work of the diaphragm and the pelvic floor. Making sure you walk with optimal gate is also going to help with spreading impact through the foot and legs. My mini course explains all of this stuff in around 15 minuets across three short videos! Its not rocket science, it’s just knowledge we have lost in a very medicalised world! 

When to Seek Support: You Don’t Have to DIY Your Recovery

Often many women go to see GP for their pelvic girdle pain in pregnancy or for their leaking and incontince after birth. Then comes the long wait for physio. You might skip the wait and pay to see private physio who then proceeds to just give the squeeze app or bridges as your treatment. 

You need to see an expert in this field, to my knowledge most of the women who seek support via the NHS are not receiving the best support. And I feel comfortable calling that out. I think the NHS is a wonderful service. We are so lucky to have it. But when it comes to womens health western medicine lets us down. You cannot apply a blanket and let’s face it old and outdated approach to healing. 

Where do you find pelvic health experts?

You need women that have trained outside of the box! That have gone further than just doing the basics! That understand the bio mechanics of pregnancy and birth and also the emotionally and energetic shifts you make as become a mother. This is where I can help you. One to one sessions in person or online to support full mind and body healing! 

You might feel a bit nervous and want to do bit more learning in the comfort of your own home. My mini course does just that with all the knowledge you need in bitesize videos perfect for those contact naps and dream feeds or squeezed around your still busy life as a pregnant women trying to do it all before your baby arrives! Then 6 movement videos will give you the initial steps to manage and ease your pelvic pain or dysfunction. 

And if you feel ready to go back into the gym then Real Fitness is Alnwick could be for you. Collette the lady who part owns the gym there is a force to be reckoned with when it comes to pelvic floor dysfunction. She helped me with my symptoms and is now going to uni to do her physio degree to change the game in the way women are treated up north! She is incredible. Details here!

Conclusion: You Deserve More Than a One-Size-Fits-All Approach

You deserve more than to be fobbed off with kegals and bridges. If your symptoms continue or get worse than seek more support. Acting now will improve your quality of life not just immediately but in the longer term. You are worth the investment now. There are people that can help you. Yes you will need to exchange money for that help, but you and your body are worth the investment. You grew and birthed a human. You need to maintain your health to support the growing child now earth side. If you are still on the fence and need more? Then follow me along on my social pages. I share lots of wisdom and mum life experiences that may help you to feel less alone, less isolated and hopefully seen in your experiences. 

If you feel ready to stop peeing yourself when your baby makes you laugh, or ease the pain in pregnancy so that you can continue to keep mobile during your labour and after birth get in touch with me here to book your one to one! 

Want to go deeper but don’t yet feel ready to wok one to one my mini course provides so much knowledge! To help you reclaim control of your body and your mind. You will realise that your symptoms are not your fault. With a small library of movements you can go to to ease your pelvic pain and symptoms when ever it is needed. This course is the first step for those of you who are tentative about seeking support. Start making the change today!

Thank you so much for being here! If you are pregnant and are looking for birth support then you can access my online pregnancy yoga and birth preparation programme here! If you live in Northumberland and are looking for antenatal sessions I host a beautiful birth retreat day in Morpeth. I also host 2 hour birth bio mechanic workshops that will leave you and your birth partner feeling confident in birth physiology and how your beautiful body will work to birth your incredible tiny human! This is my passion, my life work and I cannot wait to support you as your journey into motherhood.