Kegel exercises to strengthen the pelvic floor are widely recommended as a panacea as well as a preventive for female pelvic organ prolapse and or incontinence.
What are kegel exercises? They are basically just repeated clenching of the muscles of the pelvic floor (the same muscles you use to stop the flow of urine in midstream). The object is to strengthen those muscles to reduce or prevent pelvic organ prolapse and/or incontinence.
They have several significant advantages. They are free; they are easy; they are unlikely to cause any harm.
But do they work?
That depends. (It’s not meant to be a pun).
It depends on who, what and when, among other things.
The pelvic organs are held up by a sling of internal muscles that cover the pelvic floor. The theory behind Kegel exercises is that prolapse and or incontinence are due to a weakening of the pelvic muscles. Such weakness allows the uterus (or the bladder or rectum) to fall through the normal openings in the sling that accommodate the urethra, the vagina and the rectum.
Whether or not Kegel exercises work depends on:
1. The fundamental cause of the problem.
Although prolapse and incontinence can be the result of muscle weakness, they can also be the result of permanent muscle injuries like tearing. Exercising any muscle can strengthen it but it cannot repair permanent injury. Therefore, Kegel exercises are useful when the cause is simply stretching of the muscles (as occurs in pregnancy) but not if the cause is tearing (as occurs from a forceps delivery or a vaginal delivery of a large baby).
2. The severity of the prolapse.
Once the pelvic organs are significantly displaced — for example if the cervix has descended enough to be visible at the opening of the vagina — no amount of pelvic exercising is going to reverse the problem.
3. The type of urinary incontinence.
Kegels can help prevent or improve stress urinary incontinence which occurs with increased intra-abdominal pressure due to coughing or sneezing. But Kegels can do nothing for incontinence that results from an overactive bladder or nerve damage to the sphincter.
4. The timing of the problem.
Kegels can be effective in reducing incontinence in pregnancy or the immediate aftermath but is far less effective in reducing incontinence long after pregnancy.
5. Age.
Pelvic organ prolapse and incontinence might not manifest until the time around menopause. That’s because the reduction of estrogen leads to weakening of the ligaments that hold the pelvic organs in place. Kegel exercises have no impact on ligaments.
The bottom line is that kegel exercises are hardly a panacea for pelvic organ prolapse or incontinence. They are an excellent first step in treatment, but depending on the cause, the severity and the age of the woman they may ultimately prove ineffective.
