After many, many years of not "getting it", I think I may understand how to Kegel.
First, if your Kegel muscles are very weak, you may not feel like you are doing it at all.
Second, if your pelvis is messed up, it is the release of the Kegel that is more significant that the contraction.
Third, for me I have figured out that a Kegel is 1. tightening my anus, 2. have my clitoris "nod down", and 3. closing up the vaginal entrance. Don't flex your butt and don't use your transverse abdominus.
If you are trying to release your pelvic floor, don't strain to hold it. Just initiate the Kegel for 1-3 seconds and then release and try for "non-doing" relaxation (i.e. don't try to consciously "enlarge" your anus). This may take a lot longer than the Kegel - 30 seconds? 1 1/2 minutes? 4 minutes?
If you are trying to strengthen your pelvic floor, then hold the Kegel just until you start to lose control and your Kegel gets shaky.
Here is where the biofeedback machine really helps as it measures your muscle contraction and relaxation through electric impulses.
First, if your Kegel muscles are very weak, you may not feel like you are doing it at all.
Second, if your pelvis is messed up, it is the release of the Kegel that is more significant that the contraction.
Third, for me I have figured out that a Kegel is 1. tightening my anus, 2. have my clitoris "nod down", and 3. closing up the vaginal entrance. Don't flex your butt and don't use your transverse abdominus.
If you are trying to release your pelvic floor, don't strain to hold it. Just initiate the Kegel for 1-3 seconds and then release and try for "non-doing" relaxation (i.e. don't try to consciously "enlarge" your anus). This may take a lot longer than the Kegel - 30 seconds? 1 1/2 minutes? 4 minutes?
If you are trying to strengthen your pelvic floor, then hold the Kegel just until you start to lose control and your Kegel gets shaky.
Here is where the biofeedback machine really helps as it measures your muscle contraction and relaxation through electric impulses.
Hi there, I am a pelvic floor physical therapist and came across your blog. I wanted to comment to let you know that I think you are discussing some really great things on here, but I wanted to provide some tips and touch on/tweak some of the things you have stated if that is alright?
ReplyDelete1. It's very difficult to simply tell yourself to relax the pelvic floor. As you know, the use of EMG biofeedback can be helpful for accomplishing such task. Unfortunately, unless you have a portable device that you can use at home and 9x/10 patients will not have this luxury (side note: you can rent them, and some insurance will cover...), you're left to your own devices. If you read any of Mary Massery's work, you will learn a lot about the soda pop can where diaphragm is on top, pelvic floor is on the bottom, and abdominal/core musculature makes up the surrounding canister/cylinder. When you inhale, the diaphragm contracts and descends. Because this reduces the space within the abdominal cavity, the pelvic floor should inherently relax and descend as well to create space. With an exhalation, diaphragm will relax and ascend, and pelvic floor will contract and ascend also. So, in your case, and many other women/men suffering from pelvic pain, the pelvic floor has a poor relaxation movement. Additionally as you know, the relaxation of the pelvic floor is just as important as the contraction to achieve healthy, normal function. Now, without the spiffy EMG BF machine, how do you train pelvic floor to relax when you're without the device? Simple! If your PT has taught and spoke with you about the importance of diaphragmatic breathing, we can maximize pelvic floor relaxation with a deep inhalation that is directly followed by a GENTLE bearing down of the pelvic floor (think of passing stool, or something familiar to child bearing women: having a baby...but to a much lesser degree AND without straining). By going past your now pelvic floor's resting point (which for you, sounds elevated potentially secondary to a short pelvic floor), you will get a stretch to the muscle. Through practice and time, your pelvic floor will learn this new resting state. Disclaimer: this is not the SOLUTION to solving your 1* vestibulodynia, rather a tool in aiding you along your healing journey.
2. It's not a RCT piece of literature, but a quick reference to touch on EMG BF: http://en.wikipedia.org/wiki/Biofeedback. To clarify, EMG biofeedback DOES NOT measure muscle contraction. It DOES provide a visual for looking at the electrical activity of the muscle. Every muscle has approximately 2 microvolts (mv) of electrical current running through it at rest. When you contract a muscle, it is initiated by an action potential generated from the brain. It is important to acknowledge that BF be used as a tool to assist the patient with a better understanding of how well your pelvic floor can recruit and maintain the contraction (kegel) whether it is sustained for a length of time (ie 10 sec -endurance) or a short quick burst (2 sec -strength) and it's ability to come back to rest at that 2 mv. EMG BF should never be used for goal setting to get pelvic floor to contract to particular microvolt number. You could have a super strong pelvic floor that measures 25 mv when it is fully contracted. Likewise, you could see a very weak pelvic floor at 25 mv as well. So, in short, it’s not all about how high your number is, it doesn’t mean you’re strong. Make sense?
THANK YOU SO MUCH! The information and clarifications here are great. I am so glad that you as a professional are contributing.
ReplyDeleteOn the Kegel: When I do the "gentle bearing down of the pelvic floor", is that on an exhale (I am guessing, yes?) What muscles does the bearing down elongate? And then is there a rest period before doing the next inhalation?
And, for those without BF machines: If someone has been living with a tense pelvic floor for a very long time, it is difficult to identify when the pelvic floor is actually relaxed. Any ideas on that? Part of what was useful and surprising to me on the BF it helped me go from having a total lack of self-awareness to some sense how to achieve relaxation.