To Kegel or Not To Kegel--that’s the question you may be asking yourself. If you’re reading this, chances are you have been told to “do Kegels” following prostate surgery, prostatectomy, or even to improve sexual function. But do they work? Or rather, do they work as they should, the way they are usually prescribed? The short answer: not usually.
In this article I want to tell you four reasons why Kegels may not be working for men to reduce or eliminate incontinence. I’ll also give you some ideas on how to go beyond the Kegel to get that bladder control back in a way that makes sense and works for many men.
Let’s get straight to it: For some men, Kegels DO work. If that's you, fabulous! Keep it up. On the other hand, you may be doing Kegels now and they’re not working. Or you may be preparing for prostatectomy and wondering if Kegels are really the magic answer. For many men, they do not deliver the results. Here’s why:
Reason #1: Kegels were not designed for men. They were actually made for women! The Kegel, or pelvic floor contraction, was designed by (you guessed it) Dr. Arnold Kegel, and he created them in the late 1940’s as one part of a much more comprehensive pelvic floor rehab program for women after childbirth. Since they were created for a woman's pelvic floor, they don't do the best job of activating the muscles that a man needs to quickly regain his bladder control or sexual function. So that might be one reason why Kegels aren't working for you, they may not be targeting the right muscles.
Reason #2: Kegels are only about strength. But there's a lot more involved than just strengthening the pelvic floor muscles when you're talking about bladder control or sexual function. After prostatectomy, the prostate is no longer there. In its absence, the pelvic floor now has to assume a "new identity" as the main structure to maintain bladder control. You really need to retrain it in a more complex way than just doing Kegels. For example, can you activate your pelvic floor muscles at the right time when doing things like coughing, sneezing, even sitting up in bed? That involves more than strength. Can you coordinate the movements of your breathing muscle (diaphragm), your abdominals, and your pelvic floor when lifting something or exercising? Do you know if the way you breathe is helping your pelvic floor to work well, or making things worse for it?
Just focusing on strengthening--and that's it--might not get you the results that you were hoping for. There’s also an important question that is rarely addressed: are your pelvic floor muscles actually too tight? This problem, called pelvic floor hypertonicity, happens more often than you would think. Holding tension, “power peeing”, pain, or poor sitting habits can all contribute to this problem. In this case, strengthening could make the problem worse!
Reason #3: Kegels are only one tool in your rehab "toolbox". Now, imagine if you had a big home remodeling project, and all you had in your toolbox was a hammer. How effective would that whole remodeling project be with ONLY a hammer? That's the same way with Kegels. They're designed to really do one thing. One tool in your toolbox of your rehab program. And that's it. You need the right tool to do the job!
Finally, Reason #4, (and this is what I think is a real disservice to you guys.) There's really no training or guidance given on how to do a Kegel. It's not like we were born inherently knowing how to do a Kegel. Most people do not automatically know what that means. Going into the doctor's office, and then getting a pamphlet, or maybe a few words amongst a long list of post-op instructions does not help you learn how to activate those muscles. It does not help retrain the diaphragm, pelvic floor and deep abdominals to work together as a SYSTEM.
It's kind of like learning how to play golf by reading a brochure about it. How effective would that be?
I harp on this because probably 99% of the men who come here to my practice for treatment have been doing Kegels (some for over a year), and we find out that they're exercising every single muscle BUT the pelvic floor! Then you have to retrain everything and start back at square one. And that can be pretty frustrating.
Most guys are given no training or one-on-one guidance in how to do Kegels, leaving them -- leaving YOU -- to try to figure this out yourself. And if you're reading this article, my guess is you haven't figured it out or It's not working for you. You're looking for a little more help.
So what do you do now? What is your next step in getting beyond just Kegels and really getting a handle on this bladder control situation? Next time you have a visit with your doctor, ask him or her to be referred to a pelvic floor physical therapist. (Or better yet, call their office NOW and ask!) Yes, pelvic floor rehab is a thing! There are physical therapists like myself who specialize in this. We can help both men and women retrain their pelvic floor, get their bladder, bowel and sexual function back, and get back to enjoying the activities they love -- without leaking.
Yes, it is possible to go beyond Kegels. In fact, we recommend it! Even if you've been doing Kegels for a while and haven't gotten any results, there is still hope to get that bladder control back. Maybe it’s time to give pelvic floor PT a go. What have you got to lose--except for a drawer full of Depends?
If you're in the Kansas City area, contact us to learn more about our physical therapy for men's health.
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We help active men and women get control over leakage, pain, or other problems “down there”, even if other treatments haven't worked. Even if they've been told nothing can be done. Even if it seems hopeless.
Laura McKaig PT
Specialist Physical Therapist