This is an older post from 2010 that was part of The Great Kegel Debates. It's been lightly edited for updated resources and because it's hard to look at my own bad writing from 10 years ago and not want to fix it! For context (and to find exercises and information you can start using right away), I recommend starting with My Pelvic Position in 2020 and then reading through Our Best "Healthy-Pelvis" Resources.
Has anyone out there heard of The Kegel Queen? Well I hadn't, until someone forwarded me this YouTube video where KQ counters my MamaSweat interview and takes me on. You can tell she's the queen because she's wearing a crown. No, really. She wears a Kegel Crown. It is still unclear if she was born into Pelvic Floor Royalty, or elected, but I swore I'd find out.
I can, of course, understand why the Kegel Queen might be upset. I'm sure the article made her feel like someone was storming her castle, and who was I? Some Squatting Court Jester with a large derriere! Here's her video (it's great).
I'm not sure if any of you out there have ever had someone "take you on" in a YouTube video, but it can be quite startling to hear someone you don't know say your name on film. Deemed Katy Bowman, Kegel Critic by the KQ, I want to point out that while my position on Kegels is they are a short-term band-aid for PF disorder, I am actually not in favor of weak pelvic floors or organs falling out of women. Katy Bowman=Women's Health Advocate, not The Grinch Who Stole Bladder Control.
After watching the video, I did what any person mentioned in a Kegel Queen video would do. I emailed her. And then I waited for her return email. What was the KQ going to be like? Heavily guarded? A royal pain? Did she even return her own calls (does the Q of England?) or would I have to deal with her court? So many questions!
Finally, we connected for a nice long chat, and who knew how awesome the KQ was going to be? (Actually, I did. No one stutters bogus a la Max Headroom and wears a crown unless they are awesome...) We talked over many things and I wanted to share a bit of my interview with you.
1. Was your mother also Pelvic Floor Royalty, or did you marry in?
My reign is actually the result of a coup. With an army of like-minded women, I've been working for years to end the rule of high-tech, dangerous options like unnecessary hysterectomies and cesareans. My rise to power is a victory for every woman who wants to keep her body, and her power, intact and use the wisdom of her own body to heal herself.
I certainly have been inspired to use that word whenever I see the made-up "information" that is commonly presented as kegel instructions. Actually the word I'm inspired to use is best avoided in polite company, but "bogus" is an acceptable substitute to describe virtually all the kegel instructions you'll find online, and in medical offices, childbirth classes, magazines, and on and on.
First: In the Kegel Queen Program we use No Devices, Ever. Women looking for kegel instructions online will be barraged with ads for all manner of things you can put in your vagina and squeeze. But some types of devices can damage the pelvic floor, and inevitably they end up gathering dust at the back of the underwear drawer when women get sick of taking their pants off to do kegels, washing the device, packing it in their overnight bag and having to explain to airport security that it's not a bomb.
Another major difference is that my program is based on scientific studies, and designed to be done in minutes a day. People who recommend hundreds of kegels or hour-long kegel sessions haven't studied the research, and they also must not know any actual women if they think we are all going to quit our jobs and do kegels all day! I also emphasize the importance of breathing and correct positioning, and teach how to successfully make kegels a habit -- all of which are generally overlooked in most kegel instructions.
Of course, I was already familiar with the way the sacrum moves with squatting or pelvic floor contraction. But your perspective on muscle physiology is new and fascinating to me, and something I'm very excited to learn more about.Because of the way kegels have profoundly benefited me and my students -- eliminating prolapse symptoms, curing incontinence, and leading to radically better sex -- the idea that you can squat INSTEAD of doing kegels will be a very hard sell for me. But working with positioning and other aspects of body mechanics to optimize pelvic health is a brilliant approach, and something women badly need. Kegels AND squatting? I'm all over it.
Go to www.KegelQueen.com, and watch a short video in which I explain the Kegel Queen's Top Three Reasons You Should Never Do Kegels while Driving Your Car. I'll send you a free PDF with even more detail about that too. You can also order my free "Kegel Myths & Facts" DVD.And if you want to learn all about the correct way to do kegels, you can order my two-hour audio course, which comes with a Study Guide, two months free access to my members-only web site and live Q & A calls, and other awesome goodies available only with the course, including my book, Keep It Simple Kegels: The Complete, No-Devices, Fast and Easy Guide That Shows You How to Do Safe, Effective Kegels so You, Too, Can Stop Peeing Your Pants, Get Help with Prolapse, and Have the Most Incredible Sex of Your Life.
Now, my two cents. I think it's pretty revolutionary to interview oneself, don't you think?
1. Why do you hate the Kegel? Are just you a bad person?
I don't hate the Kegel at all, but what people need to know is there is a poorly understood, much larger whole-body issue going on in those with PFD that the Kegel doesn't even touch. If this larger whole-body issue were addressed, you would never need to kegel to keep your junk in place.
2. What about all the research that says Kegels work?
I am assuming that most people who say "the research shows that kegels work" are people who have actually not looked at the research beyond the abstract or know the difference between what the research finds (the numbers and measurements) and what the researcher extrapolates (their thoughts on what those numbers and measurements mean). There is actually very little research showing the long-term ability for a PF "strengthening" program to continue to keep women from surgery. (And FYI, having the surgery doesn't seem to keep you from needing more surgeries either, so there.) Research that shows "Kegels work" typically show that Kegels in a particular scenario, e.g. those done under the supervision of someone (maybe using an insertable device) can teach someone to be able to squeeze well. Which is different than other ways "Kegels work", in that doing them has long-term success, by providing the squeezer improved quality of life (being able to do more things) or saving a surgery in this area.
What a statistically larger number of people experience is a short-term (and I'm talking years) positive experience, that, over time begins to decrease. The positive benefits decrease because the Pelvic Floor cannot, like any muscles in the body, contract indefinitely. For long term PF function (which requires regular, varied force generation), eccentric (muscle lengthening) function is needed, which requires the muscles on the other side of the sacrum to be working at the same rate that the PF is working.
3. What is a Kegel, actually?
This is one thing those looking at research should know--different papers use different definitions. Thus PF muscle training will use different protocols (aka definitions) for the Kegel. Some use devices. Some use long holds. Some use flicks. Or flickers (which is flashing the lights as you rapidly clench and unclench your PF. Just kidding.) Some teach the relaxation portion. Some don't. Some say do it using a trigger, like a stop-light. Other evidence shows that using a stop sign (or a shower situation or stopping and then releasing your urine stream) creates an incorrect neurological dependence on these items, interfering with the natural motor programming. Who knows if the method by which you are executing a Kegel (that your doctor or midwife or best friend or latest issue of Fitness Magazine describes) was even the method researched for health benefits? The whole science/research thing has become extremely (and ironically) subjective and has resulted in poor exercise prescription.
4. Why do Kegels work for some people and not for others?
PFD is absolutely multi-factorial, meaning there are a lot of things that happen to result in the situation at hand. To maximize your short-term PF strength benefits, you should receive in-depth instruction and follow a correct, well-thought out protocol (like the KQ has created). The person for whom it works might not have had excessive PF displacement during labor, or might have been an exerciser or more body-aware before they had an issue. It could be that some pelvic floor issues aren't movement-related at all, but include biochemical or psychological elements that need to be addressed.
5. Is there any time a Kegel is a good thing to do?
Of course! Any time you have lost your somatic ability to find your body parts (i.e. finding and moving your body parts with your brain) as in, "I have no idea how to feel my PF," doing a Kegel is a first step to building a brain-body relationship. The original use of the Kegel was for women just after delivery, probably the best time to begin a somatic lesson in finding your pelvic floor through good guidance. Also, as people decrease sexual activity, the muscular walls of the PF may have also lost "contact" with their brain. If you find yourself needing to sweep away the cobwebs "down there" an introduction to pelvic floor somatics may also be in your best interest.
6. What is the "bigger issue"?
The pelvic floor is not supposed to be a muscle you "train". It is a muscle meant to be working continuously based on the correct use of the lower limbs and muscles in the trunk: diaphragm, psoas, TVA and TVT, lumbar extensors, multifidus, intercostals, latissimus, gluteus maximus, TFL, etc. Because of years of mal-alignment and incorrect lower leg muscle development, your larger muscles are not bestowing the PF with the space and support it needs to maintain a healthy tension. That tension is necessary to its ability to generate force. A Kegel is a good way to "fake it", but the PF is too small to make up for the work not being done by the larger, slacking muscle groups.
PFD is a sign that your entire body is collapsing, from the inside-down. The Kegel exercise is a drop in the bucket to what someone with PFD needs to do to heal all their structures. PFD is a whole-body situation and for optimal, whole-body outcome, the body has to be treated holistically. Otherwise it's like putting a new roof on a termite-ridden frame.
Where do the KQ and I stand (or squat)? Pretty much on the same page. She's for improving Women's Health, as am I. She's taken lots of time to develop a detailed, easy-to-use program with great results. I like to think I've done the same. It is essential that women realize normal aging does not have to require organ removal or surgeries to accomplish what your muscles should be doing. Recognize that these are all dynamic parts, if not some of the most moved parts in your body once you get moving. This situation is changeable. The conversation between the KQ and me should prompt you to look at the entire problem thoroughly, know your equipment (all of it, not just where your trouble seems to be located) and choose the correct prescription based on lots of information. Visit KQ’s website and you can sign up for some free PF info, and maybe order her Kegel course. I’m going to be working with her on the bigger alignment portion, so stay tuned to the KQ's email.
The Kegel Queen and I have decided to become allies, which makes me some country that I could think of had I paid more attention in World History. How about I be Australia, then I can be Queen of Down Under, which is kind of like "Down There." How do you like my crown?
Keep reading! But again, I recommend starting with My Pelvic Position in 2020 and then reading through Our Best "Healthy-Pelvis" Resources.