To Kegel or Not to Kegel?
To Kegel or Not to Kegel?
When it comes to the pelvic floor, there are a variety of different types of conditions and dysfunctions that can occur. However, unfortunately it’s fairly common for people to receive the same piece of advice for these different types of issues – “just do your kegels!” This is problematic because quite simply, not all people with pelvic floor issues will benefit from kegels – and in some situations making a habit of doing kegels can actually make certain symptoms worse. With this blog I hope to describe the difference between hypertonic and hypotonic pelvic floor muscles, the typical signs and symptoms associated with each and outline in which cases doing pelvic floor strengthening is actually helpful.
Hypertonic vs. Hypotonic Pelvic Floor
To start, it’s important to outline the different types of dysfunctions that can occur with the pelvic floor muscles. Generally, if there’s an issue at the muscle level it either falls into the category of hypertonic (overactive) pelvic floor or hypotonic (under-active) pelvic floor. Broadly speaking, hypertonic muscles are tense or tight (like the muscles in your neck after a long day of working at the computer!), whereas hypotonic muscles are more lax and weak. As you can imagine, having either abnormally high or low tone in the muscles creates issues for how the pelvic floor is able to function. Typically, when the muscles are hypertonic or overly tight, symptoms like pelvic pain, urinary urgency, constipation, and pain with intercourse can be present. In contrast, when the muscles are hypotonic or weak, a person can experience vaginal heaviness and pressure, urinary incontinence with things like sneezing and coughing, and reduced bowel control. In both of these situations, the muscles aren’t functioning properly and are causing issues, but the underlying causes are different. Something that is important to note is that unfortunately pelvic floor dysfunction is not usually as binary as outlined above, and exists on more of a spectrum of hypo- and hypertonicity. For example, sometimes the muscles of the pelvic floor can appear to be weak, but also tight. In this scenario it’s likely that once the underlying tightness is addressed, the muscles will be able to return to normal strength. Because it is not uncommon to have complexities like these present beyond the scope of this blog post – it’s important to see a pelvic floor physiotherapist if you have symptoms to have a thorough assessment of the pelvic floor muscles to determine what dysfunctions may be present.
As we now know, the underlying causes of pelvic floor dysfunction are opposite when it comes to hypertonic and hypotonic muscles. Therefore, the treatment approaches and goals must be different to appropriately address each scenario. The main goal when rehabilitating a hypertonic pelvic floor is to relax the resting tone of the muscles to restore function. This can be accomplished with the guidance of a pelvic floor physiotherapist, who can educate on strategies like pelvic floor muscle relaxation and diaphragmatic breathing, and can perform soft tissue release to the pelvic floor and surrounding muscles. If someone has a hypertonic pelvic floor and is experiencing the associated symptoms, this is not the time to be performing kegels! Taking an already tight muscle group and attempting to perform a strengthening exercise does not help the underlying issue of excess tension and can actually contribute to the muscles becoming more tight. That’s why kegels are not the answer for someone who falls into this category of pelvic floor issues. In contrast, when someone has a predominantly hypotonic or weak pelvic floor, the goals are often to strengthen the muscles and increase the tone and therefore support. In this scenario, it is usually appropriate to employ pelvic floor strengthening in the form of kegel exercises.
In summary, there are a variety of conditions that involve pelvic floor muscles that are either hypertonic or hypotonic. The degree of pelvic floor muscle dysfunction exists on a spectrum and therefore each individual case is unique! The treatment to effectively address symptoms needs to be specific to each person and includes much more than just doing kegels. Pelvic floor physiotherapists are experts at assessing pelvic floor muscles to determine if they are hypertonic or hypotonic, and implementing a well rounded treatment plan to address whatever dysfunction is present.