By the look of my stat counter it appears I've struck a hot topic with Monday's post: Pelvic Floor Party: Kegels are NOT invited. The comments have been flying and Katy Bowman has been along with us to answer questions. Katy even posted on the topic on her own blog, Katy Says (and the post has cool graphics, so you must check it out). As the conversation ensued in the comment section I had one more question for her--one I thought deserved its own post. Here--thanks to your standing ovation--is an encore question and answer.
And here's another question for Katy on the Kegels. I don't think you're saying we write Kegels completely out of the books, are you? Would Kegels be useful, say during pregnancy and, especially immediately after childbirth when the PF has been directly traumatized? But the difference is we should not go overboard and we still have to build up the other muscles surrounding the PF. Post birth we can go from the Kegel being something we do as an exercise (a few times throughout the day versus 200 times like people have been saying) to something we do in "real time" situations (to hold back urine when we sneeze/laugh/cough/etc.)
Katy, what say you?
Katy, what say you?
I can’t believe how popular this blog has become. Do you know I have friends from elementary school emailing me saying they read this posted on Facebook by people I don’t even know? And I think it is striking such a cord because 80 percent of women are facing this problem, many times silently, and are now really confused. That isn’t what we want either, is it Kara?!Thank you Katy, again, for such eye-opening and SENSIBLE information. Now, let's take a vote. The exercise Katy describes as a replacement for traditional Kegels, I'm going to hereby refer to as the Bowman Squat. Everyone raise your hand if you agree.
So now you may be wondering “who to trust.” Why would you listen to me? Why am I saying something soooo different than other “experts”? These are all good questions, and questions you should be asking. First off, let me fill you in on the Kegel exercise. Dr. Kegel, an OBGYN, had a device that he invented that he thought would help many of his (caucasian) patients recover from the birthing process.
Before I go any further: It is well documented that Western, modern-living women have much more difficult births than their less-modernized counterparts. During these times (mid 1800’s to the 1930’s) pelvic floor damage and baby-head smashing was a problem for “civilized women,” but not the “Tinkers” (Irish gypsies) or tribal-living women. The only differences in these groups turned out to be the size of their birthing space. The size of the birthing space (the obstetrical conjugate) is created by the bony surfaces of the pelvis. The sacrum (the base of the tailbone) makes up the back side of this birthing space. The cool thing is, the sacrum is not attached to the pelvis, but floating against it. Less-civilized women (like their male counterparts) have squatted to “bathroom” their entire lives. This squatting increased their birthing space by activating the glutes (pulling the sacrum back to open the birthing space). This extra space meant less pressure on their PFs during birth (less tearing of the muscles and tendons) and required less damage to the ligaments in between the bones.
Another way to say this is the life-long habit of squatting is what prevented the PF from being damaged in the first place. The balance between the perfect amount of glute contraction and the perfect amount of PF tone give you what you want. Good pelvic (and abdominal) organ support. [Kara's Note: read Katy's post about the Hunter Gathering Mama for more about squatting for birth preparation.]
Back to Dr. Kegel. Now he had all these women who were noticing weakness and invented the Kegelizer, or something like that. It was equivalent to the Kegel-exercisers you see now. Just insert and squeeze. The squeeze improved the lost mental connection between a damaged PF and one that was firing correctly. Firing correctly meant that when the PF was done contracting, the muscles could restore to their optimal length. This part of Dr. Kegel’s research protocol has been left out and the only part that has been passed on is the contracting part.
Science Note: The muscle tissue in your PF is the same as the muscle tissue in your biceps. When you’re done realllly working your biceps, you’d like your arm to go back to its original length, right? What if, when you were done doing your curls, your elbows stayed as bent as they were when your muscles were the TIGHTEST? If you equate strong with tight, then you’d have “strong,” contracted arms with bent elbows all the time. Tight muscles. Unusable arms.
That’s not what TONE is. Tone is having the MOST strength and the MOST length.
Doing Kegels all the time will get you a TIGHT, unusable pelvic floor. This is why people’s ORGANS ARE FALLING OUT OF THEIR BODY.
Probably the worst time to be doing Kegels in the way we think “Kegels” is during pregnancy. If you looked at the research for birthing mechanics it is clear that women (especially Western women) are allowing their pelvic girdle to collapse based on our lack of glute (and calf and hamstring tension). The research shows that PFD isn’t a problem in other parts of the world.
So, all you Hot Mamas-To-Be out there HAVE TO SQUAT THREE TIMES A DAY until these joint motions come naturally. That’s how you tend to your PF before delivery. To all of you Hot Mamas out there with your birthing days behind you: Don’t let your PF gripping become stronger than your glutes.
I came up with the perfect solution, Kara. Gently tense and fully release (shy of urinating) your PF 10 times while you are in a squatting position. That way you know you are keeping all the pelvic muscles balanced.
An hour after originally posting I'm back because I've had an hour to process this and have a few thoughts. What I'm hearing is (this sounds like I'm in a counseling session, which I almost feel like I need after such apocalyptic information) that Kegels aren't inherently bad, that Dr. Kegel meant well but our puritanic based society just got a little too anal (literally) about them. I mean, I know I for one think that if 10 push ups are good, then 20 are better. If I can do a sprint triathlon, then heck let's go for the Ironman! So it's easy to see how we heard Dr. Kegel (which became every OB on the planet) telling us to squeeze, but we ignored that bit about releasing. And now I'm going deep, folks... but who among us has an easy time "letting go." That, right there, is what childbirth is all about: letting our body open up and let go. But the majority of women can't do it without numbing drugs and interventions. Open up and let go? Huh, what? No, letting go just doesn't come natural to us in our society. We can clench and squeeze and get nice and tightly wound, but ask us to let go? I think what Katy is saying is that our pelvic floor needs balance, we can't overlook the benefits of lengthening and stretching while we're busy strengthening. The exercise of letting go is always a good one to practice in any aspect of life. And I'm telling you, to relax your pelvic floor just shy of urinating--holy cow!--it's super relaxing; like sinking into a tub of warm water... wait, that was water, right?