Why Kegels May Sometimes Do More Harm Than Good

by Juliana Mitchell

pelvis with flowers and crystal

I want to lay out my concerns about kegels. In brief I have a perception that kegels are concernedly unspecific, in instances where really specific is necessary for health and wellness. In fact I have a three-fold concern with so-called kegels. Here are my concerns in granular detail:

 

CONCERN #1 aka “which hole?”

As women, we have 3 different holes or ‘orifices’ in our pelvic floor, connecting to distinct and important organs, which connect to distinct and important bodily systems: i) the urethra, which is the one we pee from, and which connects to our bladder and thus the urinary system, ii) the vagina which connects to the uterus and thus the reproductive system and iii) the anus which connects to the rectum and colon and therein to the eliminative system.

 

For a wide array of issues, women are commonly instructed to “practice kegels” and told to “squeeze down there”. But what exactly is she being asked to “squeeze” and to what effect? Let’s look at two examples in which women might have kegels recommended to them.

 

We’ll call one woman ‘Woman A’, and she is having problems with urinary incontinence. (She may not be aware that there are two, very differing forms of urinary incontinence, each needing a very different approach. One is referred to as urinary urge incontinence and the other as urinary stress incontinence. There’s a possibility that the person or source recommending the kegels is likewise unaware of this. I touch on this distinction, just slightly more, farther on in this writing.)

 

We’ll call the second woman ‘Woman B’, whom ever since the birth of her child has noticed a fart-like sound escaping her vagina during certain moves in yoga class; such as rolling up into shoulder stand.  She is not enjoying this.

 

Without delving too deeply into these two women’s disparate needs, let us note that the apparatus involved in urination (the urethra and the bladder to which it connects) and the vagina (and the uterus to which it connects) are very different structures, which serve highly differing & specialized bodily purposes. But all too commonly both Woman A and Woman B will simply be told that they “need to strengthen their pelvic floor”, and to practice “squeezing down there”. Consider that squeezing the one orifice is not at all the same as squeezing the other!  But these two differing women with differing needs are unlikely to get suitably differing instructions.

 

Worse, with respect to what little kegel instructions are commonly offered, some women are told to practice “cutting off their stream of urine” in order to “find the muscles they want to squeeze”. This practice can actually cause a urinary tract infection. And if we even take a second to consider it, in the case of Woman B, that’s the wrong hole folks!

 

Furthermore due to a lack of instruction and lack of bodily awareness including the habituation of poor posture, many kegel practitioners are (unintentionally) squeezing their anal sphincter again and again. Repeatedly squeezing the anal sphincter can cause or contribute to constipation (among other issues.) And which in turn can cause hemorrhoids. For both Woman A and Woman B, squeezing the anal sphincter would be ‘the wrong hole’.  

 

After even a small amount of inquiry, it’s clear we want to work differently - and very specifically - to address matters involving urethras vs. vaginas vs. anuses. This sums up my first issue with so-called kegels, they are dangerously general.

 

CONCERN #2 aka “gimme a squeeze!”

But then let’s look at the whole idea of squeeze. Even if we assume that Woman A and Woman B have been guided to focus on the (seemingly) relevant orifice, muscular structures and organs pertaining to their particular issue; nonetheless squeezing may not be the helpful verb. In some cases, squeezing may cause new problems or further exacerbate existent problems.

 

There is this funny idea that women should want an ironclad vagina; and there is a related misconception that all female pelvic floor issues can be solved with muscular strengthening. Let’s dispel that, it’s an unhealthy myth. Actually, many women’s pelvic floors are too tight. (When I say female pelvic floor, I mean all the skin, muscles, connective tissues, nerves and the three holes that are between the pubic bone at the front, the tailbone at the back, and in between the 2 butt bones.)

 

For a variety of reasons (ranging from physical realities such as too much sitting and including emotional realities such as past trauma that’s held in the body) many women have a pelvic floor that’s very tight. A too tight (aka hypertonic) pelvic floor can actually cause the form of urinary incontinence called urinary urge incontinence. Excessive tightness in the pelvic floor can i. interfere with breath (and restricted breath in turn can cause a variety of isues, anxiety among them), ii. with posture (postural imbalances can can cause any number of issues, excess muscular tension among them), iii. with access to sexual pleasure as habitually tight musculature is oxygen deprived and thereby is sensation minimized; iv. it can cause a condition called vulvadinia where there is tenderness, pain and perhaps itchiness in the vulva and v. it can make a vaginal childbirth harder, and in some cases not possible. This is just a partial list. Doing so-called kegels could even create these conditions, as one might repeatedly squeeze an already too-tight pelvic floor, in effect making it tighter.

 

And so, remembering Women A’s urinary incontinence, if it is gleaned that she has urinary urge incontinence then in fact we have ascertained that she has a too tight pelvic floor. Are we then going to want her to squeeze down there repeatedly? No.

 

Where there is excessive tightness, we want to create space, to foster relaxation and to create the possibility of a gentle stretch. We do not want to contract the muscles further. For sure, a generalized “squeeze, squeeze, squeeze! something (anything) so long as it’s down there!” will have some kind of effect on the body. But is it the desired effect? To recap, my second issue with kegels is the one-size-fits all verb: squeeze.

 

CONCERN #3 aka “the promise of pelvic floor health in 1 easy step”

My third concern about so-called kegels is that the simplistic instructions do not take the time to aid women in building sensitive and deep awareness of their own pelvic floor, of their breath and of their emotional life. Pelvic floor awareness and health deserves and takes time. It cannot be (and should not be) like fast food.

 

It takes compassionate awareness, as well as time, to get to know our own pelvic floor and to begin to work thoughtfully and specifically with its structures. I am describing the delicate process of awakening and befriending our own feeling-body. For someone to embark on rebalancing and reawakening their pelvic floor, they will need the support of someone who can create a safe space for the process. That guide must also be someone who is savvy about anatomy and kinesiology. It must be someone who has skills at teaching anatomy & kinesiology, not as a cerebral exercise but as “felt-anatomy”. This guide can come in the form of a occupational therapist or physical therapist who specialize in internal pelvic work, and/or in the form of a pelvic floor yoga teacher. Or... perhaps other individuals with specialized training and skills in this arena.  

Night Owl Citta Vrtti; My Two Cents on Insomnia

By Juliana Mitchell

women at window at moon

Night owl chitta vrtti; 1 Yoga teacher’s 2 cents on insomnia

A friend shares that she hasn’t slept, “I couldn’t stop my mind from spinning about.” When my husband can’t sleep it’s “Squirrels running around his head.” I heard one person explain their insomnia as “My brain on an all night roller coaster ride.” And still another as “Thoughts spiraling about.” Spinning. Running around. Roller coasters. Spirals. Insomnia has the nature of swirling.


A few thousand years ago a sage named Patanjali canonized a classical definition of Yoga, in a written work known as The Yoga Sutras of Patanjali. He wrote Yoga chitta vrtti nirodha or Yoga is the containing of the swirling of the mind. ‘Chitta’ means Mind-state or Consciousness. ‘Vrtti’ can be understood as Spiraling. Chitta vrtti is the energy of our consciousness; which when unchecked becomes mental turbulence. ‘Nirodha’ is to quell, contain or soothe.

Yoga then is to quell the inner chaos, leaving our natural Peace-state to shine forth. If quelled chitta vrtti equals the peaceful Yogic-state, then I say Insomnia is a state of being painfully ensconced in uncontained chitta vrtti. The mind is swirling and agitated, like a little boat in a stormy sea. What’s needed are ways to contain, quell and direct ones energies toward the simplified mental patterns of sleep.

If night owl chitta vrtti has you down, some of these suggestions might help to quell (nirodha) that whoooshy mind-state (chitta vrtti) and usher in a space of deep true Peace (Yoga), allowing you to sink into the restful arms of sleep.


SELF DEFINITION

I was informed that the human brain is inclined to bouts of certainty. The moment I heard it, I knew it was true.

• Give up your self-definition as ‘an insomniac’. “But that’s the truth!” you might protest. Starting NOW, work with truth and burgeoning possibility. Redefine yourself “As someone rediscovering the path to restful sleep.” Watch your language as you describe your night’s sleep or your sleep patterns to others and especially watch the language you use inside your own mind to describe your sleep experiences to yourself.

• Consider whether you’re attached to ‘being an insomniac’. If you have a strong negative reaction to this suggestion, if it feels aggravating (aggravate is another translation of vrtti!) then REALLY consider it.

• Journal about this topic, and about your restful, newly re- emerging, sweet sleep patterns.


LIGHT/DARK & WAKE/SLEEP

We’re hardwired to sleep when it’s dark and to awaken to the light. This bodily cycle works in tandem with the subtly increasing then decreasing amounts of available sunlight each day, as well as with the actual angle of light shining into the brain via the eyes as the sun rises and sets. Slowly emerging darkness organically quiets the chitta vrtti, quieting the body-mind’s energies for the coming, passing of night. The light stimulates our mental and physical energies. Sleep-wake cycles are deeply coded into the body-mind in relation to light/dark and so our bodies can’t fathom an emerging nighttime in the presence of bountiful indoor lighting. Our body can’t make sense of it being evening when electronic devices or computer screens direct rays of light straight into the back of the eyeball.

• Expose yourself to daylight every day. If you have to be inside, try to be by a window. Take walks in the sun.

• Where possible, avoid nighttime work and graveyard shifts.

• Put indoor lighting onto dimmers and/or change your lamps to 3 way bulbs. At sunset, turn off or dim overhead lights and turn lamps onto the lowest setting. Switch to dimly lit lights that are close to the floor. This more closely mimics the angle and quality of light dipping toward sunset.

• Stop checking your e-mail, searching the net or looking at electronic devices after sun down. Just don’t stare into artificial sources of light when you want the brain’s energy to wind down.

ADDITIONAL TOOLS
• A regular meditation or Yoga practice tames unwieldy chitta vrtti. Restorative Yoga can be especially effective at this.
• Lavender oil dabbed onto your pillow before sleep is deeply soothing.
• After sundown, don’t strategize on logistics or finances or any topic that gets you ‘wound up’.
• See the prior post on Viparita Karani, a powerful and healing pose. Practice this before bed.
• Even color can stimulate the chitta vrtti. Consider an all white bedroom with pure white bedding. Keep your bedroom serene.
• Keep a regular sleep schedule.
• Cut out or cut down on caffeine and sugar.
Good night and best wishes for sweet dreams.

Body Rests, Mind Watches; an Interview with Judith Lasater, Ph.D., P.T.

By Juliana Mitchell

my beautiful teacher

Much loved by her students around the world, Judith Hanson Lasater, Ph.D., PT, has been practicing yoga since 1970, teaching yoga since 1971 and helping to train teachers since 1974. The author of nine books on yoga, she was a co-founder of Yoga Journal Magazine, received a Senior Teaching Certificate personally from BKS Iyengar, co-founded the California Yoga Teachers Association and was an early board member of Yoga Alliance. Perhaps best known for her teachings on Restorative Yoga, her many, long-time students are inspired by her insights, realness, compassion and humor. Judith has also been my primary teacher since 2006, so this opportunity to share her words with you, totally rocks my soul! 

Juliana: For anyone who’s unfamiliar with the practice of Restorative Yoga, how would you describe or define the practice?

Judith: My joke that I like to make is, “Why do we have to have something called Restorative Yoga?  What’s the other Yoga, Destructive Yoga?  Isn’t Yoga inherently restorative?  

LINK HERE FOR FULL ARTICLE

Julianna Mitchell
Easy Breathings; On Trying to Cast My Ballot for Obama from India in 2008

by Juliana Mitchell

Shiva at Sunset

Indiscipine of any kind will not be tolerated reads the sign outside the Atma Vikasa Center of Yogic Sciences.  Inside, three of us finish five breaths in a pose that is partly a seated forward bend and partly a long-hold sit up, and then we move into a resting pose.  Our teacher “Acharya” approaches us.  His face is serious, mustache shiny, dressed all in white.  “Why can you not stay in pose for more than 10 seconds, hmmmm?” he inquires.  Remaining rooted, he gazes intently at us, we’re three yogis from across 3 continents studying in India.

To be clear, he told us to stay in the pose for five breaths. We did as he said. A petulant part of me feels shocked by the question. But a truer part of me knows I breathed a bit faster to get to five and to get to rest.

He’s waiting.

Finally to my furthest left, a painter from Ireland, “It is because of the Mind.”

Next, the fire dancer from Taiwan directly to my left, “It is because of the Breath.”

My turn. The 6am sun pours through the window, casting rays across my shaking and exhausted legs.  “Sometimes it’s the Mind.  And sometimes it’s our Body telling us it’s time to come out of the pose.”

“Go back into pose and find answer,” Acharya commands and walks away.  We’re aware he hasn’t given us a breath count. Up until now, he has always gives us a breath count. So back we go. We’ve no idea how long he’ll keep us in this pose. Long enough, it turns out, to thoroughly mull over his question. I find my answer in a memory.

For the first time ever, I lift from Standing, Separate Leg Forward Bend into Tripod Headstand.  With considerable effort.  Through an upside down huffing and puffing, I note the feet of Christie our teacher approaching me.  To praise my progress, I assume.  She kneels and says softly, “Come out of the pose. You’re working too hard.” I fold softly into Child’s Pose and find my way back to a steady breath.  This lesson settles into my bones, it becomes some of the marrow of how I practice and how I teach.

Acharya returns, “What is the answer?” In the same order as before:

The painter: “The Mind”

The fire dancer: “It is the Breath reacting to the Mind”

Me: “Sometimes it’s the Mind and sometimes it’s our Body Wisdom”

“No.” he says, “There is no such thing as the body, the body is dead. There is only the Mind.”

Keeping the Breath, Body & Mind steady and calm is essential in Yoga.  One simple way to maintain and develop this is to listen keenly to the Body and come out of the pose when it feels right.  Right? But if I cling to my definition of how to practice, am I even practicing Yoga?  Can I expand myself enough to incorporate Acharya’s way of practice into mine? What would that even look like?

I’m finalizing my trip to India, but I don’t know where I’ll study.  I ask the advice of Guta, a teacher of teachers.  She tells me about a strict and devoted Yoga Master living in Southern India named Yogacharya Venkatesh.  Not interested in being called Guru, he expects his students to call him “Acharya” which simply means Teacher.  Renowned for his Back Bending classes, Acharya, along with his wife Hema, teach what they call Atma Vikasa Yoga.  Atma Vikasa translates as ‘Evolution of the Self’. Switching topics, Guta asks me, “How will you vote in the upcoming elections if you’ll be there in November?”

Each morning, the other students and I go to a sidewalk chai shop to discuss what we’ve learned in class. Acharya considers memory to be a key component of the practice and wants us to remember precisely what he’s taught. 

“Do you know what you are doing wrong today?” he’ll ask. We’re expected to engage the Mind as precisely as we engage the Body.

“Will you not be able to vote?” a Yogi from Vietnam inquires, passing me a steaming chai.  Everyone has taken interest.  The man I hired to drive me to Mysore craned his neck toward the back seat to discuss the McCain vs. Obama election with me.  I eventually got in the front seat, to avoid a collision.  Days back, it was the fellow at the book kiosk who wanted to share his thoughts on the topic.  The woman running the silk sari shop on the corner asked me about it yesterday. 

Obama’s name falls from many lips. They say his name with hope. I do too.  

My husband and I take the subway to The Board of Elections to pick up my absentee ballot.  Walking through those government doors, I’m ready to cast my vote! But the absentee ballots haven’t been printed. They won’t be ready until I’ve already left for India.

After chai, we return to the studio for 8:45am Pranayama.  Chatting outside until Acharya intones, “Come.”  We enter the studio and sit for half an hour with specific breathing patterns.  “It will take you five years to learn Pranayama,” he advises.  By the time he calls us out of our seated poses, my legs have no feeling. I need my arms to move them. 

One student, a Yoga teacher from the American South, asks Acharya privately how to know when it’s time to come out of the pose.  “You stay in pose until you think you will die.  And just before you die, you come out of the pose.” We hoot and holler as she relays this to us, made all the more charming because she tells it in her soft drawl.  But that’s just the surface.  Below that, we’re hooting and hollering for our Teacher whose ferocious devotion to Yoga lights a fire in us. 

In Pranayama, I do remain still even when my Mind swirls like a cyclone or when my legs feel like a zillion bee stings.  But in 5pm Back Bending, it’s another story.  We stand at the front of our mats, with arms, chests and faces lifted toward the ceiling.  Acharya guides,  “Now, look back, look out window behind you. Steady! Now, see back of your mat. Eeeeeasy breathings!”

I don’t go as deeply into these backbends as he invites.  It doesn’t feel physically possible for me and to force it feels like I would injure myself.  I also don’t hold them for anywhere near the length he asks.  It’s just physically exhausting and at a certain point, if I feel a loss of steady calm, I opt to be the sole soul in a resting pose.

My husband Travis and I concoct the only possible plan.  My ballot will arrive at our apartment in Queens after I’ve left and he’ll send it to me in Mysore by courier.  But because of certain logistics - there’s no way around it - he’ll have to send it to my hotel in Mysore so that it arrives before I even get there.  Will it be there when I arrive? Will I be able to get it sent back? Some friends try and dissuade me from this complicated and costly plan.  I’m told New York will go for Obama by such a margin that my vote won’t matter. But my vote matters to me. Voting for Obama matters to me.

Today, Acharya comes downstairs to the yard before class where we are gathered and chatting merrily.  He pauses in front of us, until we fall silent.  “Come.” We follow. Afterwards, he lectures, “How can Mind be calm for class if you talking before? Hmmmm? Before class, be quiet and focus Mind on Yoga.”

A broad quiet reigns before classes now.  We converge in silence outside the studio.  By the time class starts, I’m steeped in a juicy clarity and am ready to focus.  From this place, I revisit Acharya’s earlier question.  Why am I not able to hold the pose? Is it Body or is it Mind and what’s the difference? Aren’t they One? This leads me to ask myself: Is it actually the intense backbends that cause me to feel un-steady and un-calm? Or might it be the way I’m thinking about the Back Bending — might it be my Mind — while I’m doing it? Can I possibly maintain a steady calmness and also stay in the most difficult of poses? I try.  The door to exploring ease within an outrageous zone of challenge has been cracked open.

But as I deepen in my Back Bending, Acharya deepens what he demands of us.  We stand at the front of our mats; our arms, chests and faces lifted up and back.  That row of windows behind us. “Now look back, see out window.  Careful. See back of mat now.  Steeeeady! Now see back of ankles. Eeeeeasy breathings!”

When I arrive into Mysore and check into my hotel, I’m tickled to find an envelope waiting for me.  Inside is my ballot! It also contains a note from my beloved husband.  I read the note and hold it to my heart. I read the ballot. I hold it to my heart.  Today is actually my last chance to get help sending back my ballot or else it cannot arrive in time to be counted.  After Pranayama, I skip chai and head to the hotel.  Mohan at the front desk tells me, “Courier comes by once a week, on unpredictable day.” I explain I hope to send my envelope today. His eyes tell me this is unlikely.

For my birthday, November 1st, this yoga crew and I have dinner outside under a beautiful moon.  A lone firework, left over from Diwali, bursts in the air.  We debate: Is the body to be overcome? Or rejoiced in as a temple?

“Once Prana exits the body, the flesh is a goner.  The body is already dead, but for Prana.” This is from a yogi at the far end of the table, as he spoons rice from a clay pot onto his plate. 

“Sure, but while we have life, Grace courses through our veins.” That’s my two-cents at the other end.

With only 48 hours to go until the election, our discussion turns to politics.  A young American couple is disappointed that they weren’t able to vote. “Let’s have a voting ritual,” the young woman suggests brightly.  I agree to participate.

They ask if I managed to vote.

I explain to Mohan what’s in the envelope. And this man, whom I have never met before now, hears the name ‘Obama’ and springs to a different alertness.  “They’ll pick up your very important documents by 2:30pm.” Somehow he will get them to come by today. I am so relieved. And that gives me plenty of time to give my documents to the courier and then get back to the studio for 5pm Back Bending.

But…2:30 comes and goes. So does 3. I consider whether I may have to miss class.  I recall that ‘my vote won’t count’. Should I let it go?

3:30 comes and goes.

So does 4. If I can be en route by 4:30, I should make it. I don’t want to miss class! I think of the people who risk their lives to vote in parts of the world.

I’ll miss class.

It’s November 2nd.  After a grueling Back Bending hour, we gather for our Voting Ritual.  Simultaneously, clear around the globe, the voting booths in New York City are opening.  We take over a corner phone booth.  One at a time, six yogis from four countries solemnly enter the booth with a hand-drawn ballot.  Each vote cast is a prayer. I play voting official.  Upon exiting, they hand their ballot to me.  We stand in the twilight on the sidewalk as I tally and announce, “Mysore has gone unanimously for Barack Obama!” We cheer and hug and cry and then go home to bed. Hopeful…

The courier arrives at 4:15. They tally my total and ask for several thousand more rupee than I have on me.  I offer my credit card, but it’s cash only.  4:20. Bolstering myself, I think of the woman in Iraq whose grandsons carried her to vote in a barrel because she had no wheelchair.  “I will go to the cash machine and I will miss my Yoga class, “ I say aloud, practicing acceptance.  Hearing this, Mohan fronts me the money from the hotel’s petty cash!  “Thank you! Thank you, Mohan!” He nods his head side-to-side, meaning “Ok.” And he smiles. My ballet submitted, I make it to class, slipping through the studio door just before Acharya locks it.

November 3rd, I walk to the studio with morning moon still in the sky.  After class, instead of chai we drink news.  The returns look good.  But nothing is definitive.  We tear ourselves from CNN for Pranayama.  Twenty minutes later, with eyes closed and legs crossed, I think I hear honking in the streets that’s different than usual, chronic honking. Can that be… might that be… celebratory honking? Yes that is riotous honking. But we must remind perfectly still, Mind on our Breath. Has he won?! After class, my friend the fire dancer tells us she thinks Acharya had a special smile turning up the corners of his mustache.

I go directly to the phone booth, our voting booth the night before.  Across thousands of miles of phone line, my beautiful husband’s voice cries out, “He’s won! He’s won!”

My journey home is long.  Staring out the airplane window, in addition to the sky I see the events — both political and personal — of the past month.  Images involving Acharya weave together with musings on Obama and the different ways these two men inspire transformation.

Inevitably, the solid thud of wheels touching down on New York City tarmac announces this journey’s end.  Spits of snow flounce about in a late autumn sky.  Crossing through customs, I’m aware I’ve changed since I left and that my country has changed, too.  

Atma Vikasa