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To Kegel or Not to Kegel?

Low & High Tone Pelvic Floor Disorders

Mira Pearce, PT, DPT

We’ve all heard of them.

Maybe you’ve recently been to the gynecologist to talk about leaking. Or maybe you Googled them once, then opened up Instagram to find it in the middle of your Explore page. Some people swear by them, some swear against them. So - what is a Kegel and what should you know about it? 🤔

First of all, let’s dispel some mystery.

The Kegel (pronounced “kay-gull”) is named after Dr. Arnold Kegel, an American gynecologist in the 1940s. Dr. Kegel was one of the first physicians to research pelvic floor muscle strengthening as a form of non-surgical management for urinary incontinence and pelvic organ prolapse. Ever the opportunist, Dr. Kegel decided that instead of telling his patients to do “pelvic floor muscle contractions,” he would rather name the exercise after himself. Thus, he cemented his legacy in gynecological offices and pregnancy groups until present day. 

Female pelvic floor anatomy

Your pelvic floor is the hammock-like, intertwining group of muscles across the floor of your pelvis (think: between your sit bones). These muscles are voluntary, meaning you control when and how much to contract & relax them. You contract these muscles when you want to stop the flow of urine or avoid passing gas.

The pelvic floor muscles have several important jobs, including: 

  • Pelvic organ support (including the bladder, rectum, and uterus - if you’ve got one)

  • Pressure management inside your abdomen

  • Continence control

  • Sexual function & arousal

So how do pelvic floor muscle contractions (Kegels) tie into this?

If you are unable to perform a strong muscle contraction, your muscles may be weak and have “low tone”, meaning the tension in your muscle is lower than normal. You may experience pelvic organ prolapse or incontinence, especially when performing activities that increase your abdominal pressure (think sneezing, coughing, lifting, etc). If that is the case, you may need to work on your pelvic floor muscle strength. Kegels may be a part of your strengthening program, in addition to improving the stability & coordination of your deep core, glutes, and other hip muscles.

However, that’s just one side of the story!

Like every other muscle in your body, it’s important to be able to both contract and relax your pelvic floor muscles. For many people, the problem is having abnormally high tone/tension in the pelvic floor muscles. This means that the muscles are not able to relax completely. There are many potential factors that may contribute to difficulty relaxing, including muscle overuse, stress or tension, impaired coordination, or weak core muscles.

If you have high tone, you may experience:

  • Pain with penetration 

  • Urinary urgency/frequency

  • Urinary or fecal leaking

  • Difficulty urinating

  • Straining or “power peeing”

  • Constipation

  • Lower back or hip pain

  • UTI-like symptoms

  • Pelvic organ prolapse (yup, you read that right! This can be caused by low OR high tone)

Having too much tension in your pelvic floor muscles reduces their contractile efficiency, meaning they are often weak as well. For those with high tone, the first goal is to “downtrain” the pelvic floor muscles to release the excess tension. 


Downtraining usually includes:

  • Diaphragmatic breathing

  • Relaxation techniques

  • Spinal, pelvic, and hip mobility work

  • Internal or external soft tissue release

  • Ribcage mobility

Trying to strengthen your pelvic floor with Kegels would NOT be effective at reducing your symptoms if your muscles are already too tense. First, you need to be able to control relaxation - then you can strengthen!

So, moral of the story:

Kegels can definitely be beneficial, as long as they are performed at the right time in the right program for your individual needs. If you’re experiencing any of the symptoms mentioned above or have any concern about doing Kegels correctly, you may benefit from seeing a pelvic floor therapist! With their guidance, you can improve your understanding & awareness of your pelvic floor and make the steps towards improving your pelvic floor health the right way. Schedule your appointment today!



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