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What are Kegels
image credit: https://www.continence.org.au

What are Kegels?

Kegels are a contraction of the pelvic floor muscles, sometimes referred to as “PC Contraction”. PC is short for “pubococcygeus”, the name of one of the many pelvic floor muscles.

However, after over a decade of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough. Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels. This finding has been confirmed by Bump et al in an August 1991 article from the American Journal of Obstetrics & Gynecology, Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”.

The results of verbal instruction were 60/40 (60% could/40% could not perform a pelvic floor contraction or, Kegel, correctly). This article also stated that a very high percentage of women that were doing Kegels incorrectly were not only doing them wrong, but doing them in such a way that they were actually making their incontinence WORSE. I have seen this initial frustration with many of my own patients over the year, not realizing before they started physical therapy why they were getting worse. I continue to site this study, as despite it’s age, it was really revolutionary in identifying why so many women think Kegels do not work.

How do I know if I am doing Kegels correctly?

Chances are if you have basic stress, urge or mixed incontinence, and see no improvement in your symptoms, you may not be doing your Kegels appropriately. This is not to say that you don’t know how to do a Kegel, but you many not be doing the proper routine based on your strength levels.

How many do I do? How long should I hold them for? There are different types of Kegels?!

This is where physical therapy comes in. Yes, there are different types of Kegels. Some that work better for increasing overall power and others that are designed to improve endurance. There is even a type of Kegel that helps more with controlling and slowing downward forces on the muscle. How many and what type you do depends on your current level of strength and endurance. This can be determined by a trained women's health physical therapist.

In the July 2003 issue of JAMA, an article entitled “Effect of Behavioral Training With or Without Pelvic Floor Electrical Stimulation on Stress Incontinence in Women” discussed the benefits of using biofeedback, perineal electrical stimulation and behavioral training as a package in order to achieve the quickest recovery with better long-term follow-ups.

At Femina Physical Therapy we utilize all 3 techniques to provide our patients with the most comprehensive care available. Treatment of urge and mixed urinary incontinence will include learning how to correctly utilize urge control strategies. We additionally offer a unique pilates-based regimen in the treatment of pelvic floor weakness diagnoses, such as incontinence or pelvic organ prolapse (also referred to as cystocele, urethrocele, urethrocystocele, or rectocele). With some patients, physical therapy has been a welcomed alternative or adjunct to pelvic floor surgery.

Other Women’s Health diagnoses we currently treat include post c-section and hysterectomy adhesion pain; pre-natal/post-partum related musculoskeletal disorders, such as lower back pain, hip pain, SI joint dysfunction, pregnancy-induced carpal tunnel syndrome, diastasis recti, post-partum pelvic pain, other pelvic pain (vaginismus, vulvodynia, vestibulodynia, vulvar vestibulitis, overactive pelvic floor, hypertonic pelvic floor disorder, etc); osteopenia/osteoporosis postural and strengthening programs. We also offer a pilates-based approach to the treatment of general musculoskeletal disorders. All treatment sessions are one-on-one with a licensed physical therapist. Support staff is never used, which keeps the standard of care we provide at the highest level.

What Our Patients Have to Say

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Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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