Are You Doing Kegels Properly?
Julie Reil: It’s very much like a hammock. The front of the hammock is your pubic bone. The back of the hammock is your tailbone. So, in between there is some side attachments to the pelvic wall to your sitz bones and the very center of your hammock is basically that perineal body or the muscle that either is torn or gets cut. But it’s compromised no matter what when you give birth naturally. So, the very center of your hammock of that nice group of muscles that are anchored is already sitting lower and has less support after just one baby – one natural birth.
So, ultimately, toning those muscles, toning the side wall supports and all the anchoring structures of that entire hammock becomes our goal. So, how do we basically keep those muscles in shape? How do we get them back in shape, for instance, after you have a childbirth?
Kathy Smith: Of course, we’re taught at every Lamaze class, every Bradly Cat class that you go to and every workout that you go to now about Kegels. Talk to me about – because I know you have a point of view on Kegels and how to do them and their efficacy.
Julie Reil: Again, Kegels can be helpful, but they’re not always helpful. First of all, if you have urge incontinence, which means you’re getting up in the middle of the night to use the bathroom or all day long you’re going back and forth to the bathroom, so you have urgent or frequent urges, Kegels can make that worse.
So, you have to know that Kegels are specifically for people that are having more trouble with leaking urine when they sneeze or cough or do exercise. That’s called stress incontinence, which means basically the seal isn’t as tight as it used to be and you can leak and pressure can overcome that.
Kegels can be helpful, so really you need to be directed towards the right exercise for you. Then, there’s been some advancements of Kegels which are basically some very basic exercises put together by Dr. Arnold Kegel in 1961.
Now, there’s a program called Beyond Kegels. There are some other things out there that are basically optimizing the things that you know about, Kathy which is what types of muscles are we working on? Are these big muscles? Are these tiny, intrinsic muscles? Yes, they’re tiny muscles. Are they slow twitch? Are they fast twitch? Yes, they’re a little bit of both.
So, the more advanced toning programs are really helping people to optimize their position, optimize the way they do their exercises to get the most out of them. Then, also, educating women that this is not like working out in the gym. These muscles are very unique and basically when people say, ‘I’ve tried Kegels. It didn’t work.’ Most likely, they haven’t tried something that’s tailored for them, because most everybody thinks a simple Kegel is just squeeze those muscles and you’re out of there. But there’s a lot more that needs to go on in order to effectively tone your pelvic floor.
Kathy Smith: Let’s talk about it and maybe we can give the listeners one thing to try, because typically you’re told if you want to understand a Kegel, try when you’re urinating, stopping the flow of urine and those muscles that you’re using to do that are the ones you’re trying to tighten.
Julie Reil: Yes, it’s similar to that, but we don’t recommend you do them during urination. But, yes, you’re right, those are the same muscles that will stop the flow of urine.
Kathy Smith: I know that when I was doing my Moving Through Menopause book and video, I taught different exercises like the flutter or the elevator exercise where you would imagine that you’re in an elevator and if you imagine your vagina and going up the wall, it would be first floor, second floor, third floor. You get to the penthouse, you hold and then release one at a time.
Another one is that you just, instead of long squeezes, it would be almost like flutter kicks like squeeze, release, squeeze, release. So, things like that. But what’s interesting when we were together and you were showing me some of the postures, maybe just explain the one of where you lift your hips up and perhaps place them on a pillow or place them in a position so you change the position of your lower body. Explain why that’s effective.
Julie Reil: Ultimately, who needs Kegels the most, really, are women who had a baby. Those muscles are no longer nice and tight. They don’t communicate and they’re not as effective as they used to be, so you’re trying to accomplish some toning of muscles, but you’re challenged because you’re not starting off with the ideal that you used to have before having babies is those muscles are a little bit stretched apart, almost like fabric that is no longer completely in tone.
So, what’s interesting is people who need the Kegels also have typically given birth vaginally, so sitting up and doing a Kegel or sitting at a stop sign and saying, ‘Oh, every time I stop in my car, I just do my Kegels.’ First and foremost, this is not the position to do them in because everything sits lower in the abdomen and the pelvis once you’ve given birth even once. So, you want to be in a neutral, laying down position. Ideally, if there’s something you can prop under your lower back, that elevates the hips a little bit, now, you even have less gravity working against you.
So, sitting up, no. Laying down, better. That’s kind of a neutral. But, then, a little bit of a prop underneath the lower back where the hips kind of almost curve forward. I don’t know what you call that but if you were just doing a little bit of a flexing of the hips forward that is a very nice position because, now, you’ll eliminate gravity and even save tissues that are sitting lower, and you can really work through those full range of motion of what you’re trying to accomplish with your pelvic floor. That’s one position.
Kathy Smith: Ok. Did you have another one you wanted to share?
Julie Reil: I was going to say if you were to do one thing besides that position, it would be to do a combination like you mentioned, Kathy, of kind of a long-held isometric, like I’m going to pretend there’s a marble in the vagina. I’m going to squeeze around that marble and I’m going to pull it up towards my belly button and I hold, hold, hold. Count slowly to five and hold it. I call that more of an isometric, like a long-held contraction. Then, rest and do the same thing but do what you mentioned – the flutters – where you lift the marble up, you let it go, you lift the marble up, you let it go.
So, for most people that have tried to do Kegels in the past, they usually do them in one way. And I think most people do it in kind of a long-held fashion. I’m not sure. But when they do the combination which, then, is allowing you to work both the slow twitch and the fast twitch muscles down there, which are basically there’s 40% of one and 60% of the other – almost half and half – you’re going to be toning the muscles more effectively and getting more out of your exercises if you do that combo.
Kathy Smith: I love those combos…and you’re right, it’s so important to switch up your kegel exercisses to work both the fast twitch and slow twitch muscles! Just like any other muscle in the body, the PC (pubococcygius) muscle, which is the muscle you work while kegeling, needs regular exercise to remain firm. And having a strong pelvic floor is extremely important because when done correctly, “Kegeling” can alleviate up to 90 percent of stress incontinence. And of course, it’s going to heighten pleasure and sensitivity during intercourse!
I think the best of the best things out there because Genityte was something developed right here where I practice myself. The other things have kind of just come as a little bit of a spinoff, if you will. I think the best things that can be accomplished, you just have to work one on one with your physician in terms of what’s safe for you. What you don’t want to risk, of course, with any of those thing is that something might get worse.
There is a difference between urgent incontinence and there’s a difference between stress incontinence and, then, there’s a difference between vaginal wall prolapse. The person doing the procedure needs to be a physician, and they need to know how to actively diagnose and, then, steer you in the right direction.
There are some home product, which you might be referring to as well. There’s something now that can help you, let’s say, optimize your Kegeling ability and it connects to your iPhone. I think it costs only about $150. It’s essentially a biofeedback device. It’s used by the physical therapists, and it can give you feedback as to how well you’re squeezing those muscles. I think that’s kind of exciting. It’s something you can actively do along with your Kegeling program at home and give you a sense of are you making strides, are the muscles getting stronger, are you registering, on your biofeedback scale, a higher score?
Kathy Smith: Is that called a dilator? Just for the audience, what would they look for? I’ve read about them. I’m actually going to order one. That’s a great idea. I read about them.
Julie Reil: They came out in Europe first, but I know the physician in Vancouver has been using it, meaning recommending it to patients and feeling like it’s a little bit of a step up. Certainly, it’s affordable, which is nice. The other units I’ve seen that are available to order off the internet in the U.S. look more like a vibrator. You insert it. But they’re a little bit bulky and, then, they don’t have the blue tooth. So, what I like about the one he was talking about–I think it’s called eFIT or something. I’m going to look it up and see if I can find it on my phone.
Kathy Smith: We’ll track it down and we’ll put it in the liner notes here.
Julie Reil: Yes, because of the affordability, first of all, I think that’s amazing. And, then, the fact that most everybody has an iPhone now or some kind of a blue tooth device, so it just seems like it would be easy to use and, then, have some immediate feedback as to how you’re doing.
Kathy Smith: So, I guess the message is start with a program to strengthen the pelvic floor, to strengthen the muscles of the vaginal wall. Think about the dryness element of where you are on the spectrum and whether you need a little bit of estrogen cream. You might also try vaginal moisturizers, which are called “face cream” for the vagina. They work by binding vaginal cells and holding water.
Then, if things are to the point where you’re finding you’re embarrassed because you can’t hold your urine or your bowels, then the idea is instead of just going out and getting the Depends or getting a pad or something to stop the leakage – or to not even stop it but to catch the leakage – the idea is to now start to go to a doctor, to perhaps go to even your website, which is ShilohMedicalClinic.com or subscribe to Women’s Voices Magazine, and start to get more information about what are some of these techniques that you can do now to really help with the strengthening of this area. Because it’s a fascinating brave new world, and I encourage everybody to listen up, not be embarrassed about it and perhaps start the dialogue with your girlfriends or even with yourself or with your doctor.
Julie Reil: Right.
Kathy Smith: Any last parting words before I have to let you go?
Julie Reil: No. Once again, Kathy, I just applaud you because you are so proactive for women. You’re broaching topics here, I think, everybody needs to hear about. But the common denominator is these are really embarrassing topics, and I think people are often not reaching out for the help they need because of the embarrassment. So, everything that we can do to encourage each other as women and let them know there are other things.
Doctors like myself, I’m nothing wonderful but I certainly have a heart for women. Because of my women’s health category, I’m just one of many out there who are trying to make life better. I just want to thank you again for what you do for women. I think just continuing to be a resource for women as to what’s coming out, what’s coming down the pike. I think there’s a lot of interesting things out there and everything has to be taken with a grain of salt. I think looking at things critically, talking with your doctor, making sure things are safe, number one. Then, beyond that, just being proactive for yourself and your own health is what it’s all about these days.
Kathy Smith: So well put. On another note or just to add to that, I would love to track down the Kegel exercises you’ve mentioned. We’ll also put all those in the liner notes just so people know where they have access to find these newer techniques.
Julie Reil: Absolutely. The website that you can research is called PhoenixCoreSolutions.com. This is a physical therapist from Missoula, Montana who did this research a good 30 years ago. A very successful program called Beyond Kegels and little things like the wedge to prop under your lower back is all available on here site and the books and what not. She is an interesting woman who basically has done very well as a physical therapist and she said, “In my younger years, I said I’m going to make a million dollars.” Well, then, after she made a million dollars, her next goal was to help a million women.
That’s what Beyond Kegels has been about. It has been just kind of her giving back to women. I think it’s the best program out there and the easiest to do. She has research to back it up and I would say have hundreds of patients to also credential that it’s something that is realistic, you can do it at home, it works and it can fit into anybody’s everyday life. And you only do it three times a week, which is another helpful thing, so it’s not laborious to do this.
Kathy Smith: It sounds like a remarkable woman. Once again, it’s great. I’m going to have to fly out to Montana. I need a Dr. Reil fix, so I’ll have to come see you. Thank you so much.
