What is pelvic floor physical therapy, other than Kegel’s?

The term “Kegel” was coined by a gynecologist named Arnold Kegel in 1948. For decades, and unfortunately still today, they are the most commonly recommended treatment for incontinence. It is now well known that performing Kegels is a way to strengthen the pelvic floor muscles, and that remains true. In practice and later in this article, I refer to this exercise as a pelvic floor contraction. Thankfully, we have learned so much more about how the pelvic floor and deep core works since the term Kegel first came about. Yet, I still often see patients for their initial evaluation who do not know what to expect in pelvic floor physical therapy. “Are we doing all of the exercises on the floor” and “What will we do besides Kegels,” they ask. My short answer is usually, “We will be doing so much more than Kegels in your sessions here and you will see results much faster!” 

The problem with doing only Kegels, or pelvic floor contractions for incontinence is two-fold. First off, if we prescribe Kegel exercise for all patients with incontinence or prolapse without having physically examined the strength, endurance, and coordination of those muscles with an internal exam, we actually have no idea whether strengthening is indicated. In some patients, they have incontinence and even prolapse, but have tight and painful pelvic floor muscles upon exam. The pelvic floor muscles may not be functioning properly because they are already too short or rigid to contract to their full potential. Additionally, if we don’t examine the pelvic floor strength and we don’t provide real time feedback regarding how to properly contract the pelvic floor muscles, we leave the patient susceptible to worsening their symptoms by performing the contraction incorrectly. Secondly, patients who have been practicing Kegels on their own are often doing so in stationary positions when they have a free moment, like a waiting room or at a red light in their car. Though some pelvic floor contractions are better than none, practicing them in situations that you don’t normally leak in or when you don’t necessarily need to contract the pelvic floor, you are missing a big piece of the puzzle. We need to practice contracting those muscles with dynamic movements and in positions that are more functional. For example, if you experience incontinence when you step quickly to catch the elevator door, you need to practice pelvic floor contractions in standing positions and progress to dynamic movement such as taking a small step and gradually increasing speed and distance over time. 

Much like any other muscle in our body, our pelvic floor muscles do not work in isolation. We know that our pelvic floor works in tandem with our diaphragm and our deep abdominal muscles. And we also know that our body works as a whole and training one muscle at a time is just not efficient or effective. At Phocus Physical Therapy, we treat the whole person and we always perform a thorough assessment to determine what each individual needs. If you are not sure if Phocus PT is a good fit for you, give us a call and we can determine that together!