by Juliana Mitchell

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.