A new pelvic floor product is getting lots of press called the KGoal. I have to say I am not that excited about yet another product that sells isolated pelvic floor strengthening. I am sure the KGoal and all products of its kind do a great job at what they are sold to do…teach you to find and isolate the pelvic floor…over and over and over again (Now bigger, now smaller, now longer). But there is so much more. Sexual dysfunction, incontinence, and prolapse are ALL multifactorial, multifaceted issues (how bout that for making sex sound boring). Treating them as a one muscle problem misses the boat. I feel the same way about regular old low-tech Kegels. I will not promote them, retweet or post anything about them. There I said it. Anybody else ready to move beyond Kegels. Please?!!

 I agree women need help locating and reconnecting with the PF, products, like KGoal, can do that (and I acknowledge, for some, so can a standard Kegel). But the long held  premise promoted by these types of products, programs, and Kegels, etc. is that pelvic floor health starts and ends with pelvic floor isolated contractions.That’s it. They are offered as THE final solution, the alpha and omega. 

 Muscles do not have an optimized output or function when asked to contract in isolation. Try this: Everyone straighten your arm at your side. Now without clenching your fist, moving your wrist, elbow or shoulder, contract your bicep. Harder than you thought right?? Did you get a maximal output?  Would you grade it as very weak?? But your bicep is good, right? Healthy, capable? Why did it score so low? That is what we ask when we ask a woman to do a Kegel. We are familiar with our bicep, we can see it, yet we could hardly make it contract. We have learned that women don’t have a brain map for their pelvic floor, in part because they can’t see it, adding to the difficulty of finding it and isolating it. According to this...many haven’t even looked at their lady parts. Does an isolated contraction actually give us an accurate idea of the health and capacity of a pelvic floor? Now…visualize that you are lifting something with your straightened arm, but don’t move. A little more bicep action, right?? So visually imagery can really help women connect. But it is still not gangbusters, right? Now clench your fist. Ah ha…now we are getting somewhere! Muscles work better together. The pelvic floor is no exception.

 The word Kegel has certain meanings in our culture like: clench, hold, 3 sets of 10, 3x/day…forever!! The word also carries emotion (frustration, failure, disappointment) and history (they don’t work, never have worked, none of my friends can do them either, neither could my mom). In my humble opinion, Kegel communicates isolated muscle strengthening (all or nothing holds). We need to change the language if we are to change the culture and perception. My current go to phrase is to call it ‘pelvic floor engagement’. And we shouldn’t sell that as the end of the road. Once you get it, you need to integrate it…immediately. Think about your fist-to-bicep connection. You changed from ‘weak and hard to engage’ to ‘ready for action’ in an instant.

 Well-meaning colleagues have said to me “When I say Kegel, I don’t mean the old version of Kegel…I mean with breath” or “with TA” or “with alignment”. I simply disagree. A word means what the person hearing it brings to the table. If you say  ‘This is a Rose’ the listener immediately conjures images, smells, experiences associated with a Rose. But if you meant a Gerber Daisy…then you are not communicating what you meant to communicate. I have also heard some redefine Kegel saying it actually means an integrative way of doing things (breath, TA, alignment…etc). I suggest that this word, this exercise has been around so long (since 1948, people) that it is generationally embeded in our pop culture, health culture, etc. Using the same word to mean something new…doesn’t mean something new, as hard as you try. A Rose is not a Gerber Daisy. 

Solving issues like incontinence, prolapse or sexual dysfunction must be multifaceted, because the problems that create them are multifaceted. The poor pelvic floor has taken the heat for these issues for years…but it can share the blame with many others. And supporting its function doesn’t or shouldn’t only involve a focus on simply strengthening it, and it alone. You improved your bicep contraction because you used other muscles and your brain to make it happen. The pelvic floor needs that kind of support.

 My colleague Sandy Hilton suggested a flyer should come with products like these that helps women understand the role of this product in a comprehensive program and to see a Pelvic Health physical therapist if there is no improvement (real, measurable change) in 2 weeks. That would be awesome!

Folks ask me ‘What do you suggest?? What else is there? Waiting for some direction!’ I have lots of helpful suggestions on my blog, videos, follow the #pelvicmafia on twitter and I have a comprehensive, integrative program for incontinence offered as an online course/DVD. And I would make the same suggestion on my own program. If you don’t see improvement quickly, go see someone* and demand more than Kegels from them!

Change the language, change the culture. Change your expectations folks, isolated contractions is not the beginning and the end of what we can do to help you with these issues.

*Find a pelvic health pro here:

USA Physical Therapists
Canadian Physiotherapists
UK Physiotherapists
Australian Physiotherapists
New Zealand Physiotherapists