To Kegel or not to Kegel?

Kegel is something everyone has probably heard of today. Every gynecologist, physiotherapist, yoga instructor, Pilates instructor advocates these exercises for improving the tightness of the pelvic floor and to prevent incontinence. But it fails a lot of times. Why?? Firstly, our understanding of the pelvic floor itself is flawed and secondly, the way we tone it is completely wrong. I started researching into pelvic floor exercises when I was pregnant and came across a completely different and sound understanding of it. When I practiced it myself I realized the profound difference in the two techniques and how we are actually damaging our pelvic floor by doing the kegels. In the last few years, I have taught these techniques to many patients of mine and everyone has reported immense benefits from doing these.

Let’s talk some history

I always say when you want to understand something really well, go to the origin. Kegels were developed in the mid 20th century by a male gynecologist who probably did not have any intuitive understanding of the female anatomy. Women were laid on their backs, and were instructed to contract their pubococcygeus muscle around his fingers as a measure of strength of the muscle. But how this translates to anything for preventing prolapse, it is yet to be understood. Soon, an army of gynecologists, urologists, physiotherapists all started practicing this without understanding the anatomy of the pelvis. Contrary to popular belief, contracting this muscle actually pulls the organs more towards the vaginal wall thereby in the direction of the prolapse.

So, how are we mistaken?

Please bear with me as I explain you the intricacies of it.

The Tilted pelvis

Below is a picture of the human fan shaped pelvis but mind you it is not placed like a funnel below the abdomen.

pelvis tilt normal.JPG
Bony Pelvis Image source: Wikipedia  

Instead, it is slightly tilted forward such that the pubic bone actually forms the base on which all the organs are rested. The ligaments of the pelvic floor form a hammock or a wall that connects the two bony prominences. It is therefore factually wrong to say that the muscles and ligaments form the floor of the pelvis.

pelvis side.jpg

Pelvic floor the hammock

Pelvic organs resting on the pubic bone in front of the abdomen Image source:, female pelvis model  

Imagine that your abdomen is a drum wherein one end of it is formed by the diaphragm (below your chest) and the other end is formed by the pelvic floor. When we inhale, the diaphragm expands and puts pressure on the internal organs and these organs in-turn put pressure on the abdominal wall. The elasticity of abdominal wall is what keeps the internal organs intact. The pelvic floor here merely acts like a taut end of the drum maintaining this pressure. This explains why the pelvic ligaments and

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