Why Kegels May Sometimes Do More Harm Than Good

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 three primary concerns in granular detail:

CONCERN #1 aka “which hole?”

Those identified as female at birth have 3 different holes or ‘orifices’ in their 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, people with vulvas are commonly instructed to “practice Kegels” and told to “squeeze down there”. But what exactly are they being asked to “squeeze” and to what effect? Let’s look at two examples in which persons might have Kegels recommended to them.

We’ll call one ‘Person A.’ Person A is having problems with urinary incontinence. (They 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 themself and the source recommending the Kegels is likewise unaware of this. I touch on this distinction between these, just slightly more, farther on in this writing.)

We’ll call the second person ‘Person B.’ And Person B has, since the vaginal birth of their child, noticed a fart-like sound escaping their vagina during certain moves in yoga class; such as rolling up into a shoulder stand. They are not enjoying this.

Without delving too deeply into these two people's disparate needs, let us note that the apparatus involved in Person A's concern is urination (and thus the urethra and bladder to which the urethra connects) vs. the Person B's concern regarding their vagina (and the uterus to which it connects.) These are very different structures, which serve highly differing & specialized bodily purposes. But all to commonly both Person A and Person 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 people with differing needs are unlikely to get suitably differing instructions.

Worse, with respect to what little Kegel instructions are commonly offered, some 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 Person B, that’s the wrong hole folks!

Furthermore, due to a lack of instruction paired with a lack of bodily awareness plus 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 Person A and Person B, squeezing the anal sphincter would again 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 Person A and Person B have been guided to focus on the 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 existing problems.

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

This too tight pelvic floor situation can arise from 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, and for other reasons as well.) A too tight pelvic floor (aka a hypertonic pelvic floor) can cause the form of urinary incontinence called urinary urge incontinence, can interfere with breath (and restricted breath, in turn, can cause a variety of issues, anxiety among them), can create issues with posture (postural imbalances can cause any number of issues, excess muscular tension among them), can inhibit access to sexual pleasure (as habitually tight musculature is oxygen-deprived and thereby is sensation minimized) and worse can make penetrative sex painful, can cause or contribute to a condition called vulvodynia where there is tenderness, pain and perhaps itchiness in the vulva and/or can make a vaginal childbirth harder, and in some cases not possible. This is just a partial list.

Doing so-called Kegels can create a hypertonic floor. As one might repeatedly squeeze an already too-tight pelvic floor, in effect making it tighter.

And so, remembering Person A’s urinary incontinence, if it's gleaned that they specifically have urinary urge incontinence then in fact we have ascertained that they have a too-tight pelvic floor. Are we then going to want them to squeeze down there repeatedly? Nope.

Where there's 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 people 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” or "somatic anatomy".

This guide can come in the form of an 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.