“Preventive” Kegels: A Cutting-Edged Concept

Andrew Siegel MD  8/25/18

prevention                        Attribution: Alpha Stock Images – http://alphastockimages.com/

“People whose diseases are prevented as opposed to cured may never really appreciate what has been done for them. Zimmerman’s law: Nobody notices when things go right.” …Walter M. Bortz II, M.D.

“To guard is better than to heal, the shield is nobler than the spear!”                                  …Oliver Wendell Holmes

Achieving a fit pelvic floor by strengthening and toning the pelvic muscles is a first line approach that can improve a variety of pelvic maladies in a way that is natural, easily accessible and free from harmful side effects. Although it is always desirable to treat the symptoms of pelvic floor dysfunction, it is another dimension entirely to take a proactive approach by strengthening the pelvic muscles to prevent pelvic floor dysfunction.

Pregnancy, labor, childbirth, aging, menopause, weight gain, gravity, straining and chronic increases in abdominal pressure take a toll on pelvic anatomy and function and can adversely affect vaginal tone, pelvic organ support, urinary and bowel control and sexual function.  Humans have a remarkable capacity for self-repair and pelvic issues can be dealt with after the fact, but why be reactive instead of being proactive?  Why not attend to future problems before they actually become problems? Isn’t a better approach “an ounce of prevention is worth a pound of cure”? Why not pursue a strategy to prevent pelvic floor dysfunction instead of fixing it, not allowing function to become dysfunction in the first place?

To be the “devil’s advocate,” the answers to the aforementioned questions posed may be:

  1. Why bother at all, since pelvic issues may never surface.
  2. Being proactive takes work and effort and many humans do not have the motivation and determination required to pursue and stick with any exercise program.
  3. If I put in the effort and pelvic issues never surface, how do I even know that it was my efforts that prevented the problem.

In the USA, over 350,000 surgical procedures are performed annually to treat two of the most common pelvic floor dysfunctions—stress urinary incontinence and pelvic organ prolapse.  Estimates are that by the year 2050, this number will rise to more than 600,000.  These sobering statistics provide the incentive for changing the current treatment paradigm to a preventive pelvic health paradigm with the goal of avoiding, delaying or diminishing deterioration in pelvic floor function.

If birth trauma to the pelvic floor often brings on pelvic floor dysfunction as well as urinary, bowel, gynecological and sexual consequences, why not start pelvic training well before pregnancy? This runs counter to both our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring.

Realistically, pelvic training prior to pregnancy will not prevent pelvic floor dysfunction in everyone.  Unquestionably, obstetrical trauma (9 months of pregnancy, labor and vaginal delivery of a baby that is about half the size of a Butterball turkey, repeated several times) can and will often cause pelvic floor dysfunction, whether the pelvic muscles are fit or not!  However, even if pelvic training does not prevent all forms of pelvic floor dysfunction, it will certainly impact it in a very positive way, lessening the degree of the dysfunction and accelerating the healing process. Furthermore, mastering pelvic exercises before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the post-partum period, as the exercises were learned under ideal circumstances, prior to pelvic injury. Since there are other risk factors for pelvic muscle dysfunction aside from obstetric considerations, this preventive model is equally applicable to women who are not pregnant or never wish to become pregnant.

Preventive health is commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc.  In this spirit, I encourage those of you who are enjoying excellent pelvic health to maintain this health with a preventive pelvic training program.  For those working to improve your pelvic health, continue forward on the journey.  Regardless of whether your goal is treatment or prevention, a pelvic training program will allow you to honor your pelvic floor and become empowered from within.

Bottom Line: You can positively affect your own pelvic health destiny.  It is better not to be reactive and wait for your pelvic health to go south, but to be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor training program into your exercise regimen—it’s like a vaccine to prevent a disease that hopefully you will never get.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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