Kegels for pelvic pain?

By Bryn Zolty, PT, DPT

• High muscle tone pelvic floor
• Increased muscle tension in the pelvis
• Levator ani Spasm
• Hypertonic pelvic floor

​
If you have been told you have one of these in your pelvic floor, you were hopefully also educated on pelvic floor releases.  ​That means letting go of tension in the pelvic floor.  ​​Releases along with diaphragmatic breathing, meditation, stretching, and pelvic floor glides are an excellent way to lower muscle tension in the pelvis.  All of these are the opposite of Kegels - which are contracting and squeezing the pelvic muscles strongly.  

However, there is research that suggests that women who have painful penetration and have not yet had children, three maximum Kegels can significantly lower vaginal resting pressure and surface EMG(1).  Lower resting pressure and surface EMG, or biofeedback, translates to lower muscle tension, improved function, and less pain.

Biofeedback can be a very helpful tool to determine if this type of treatment is right for you.  Small electrodes (stickers) are placed on either side of the anus.  These electrodes connect to a computer that measures the muscle activity in the pelvic floor. As you watch the computer, a therapist will guide you through how to contract and relax your pelvic floor and try the three maximal contractions.  If the tension in the pelvis is reduced, the therapist will provide you with your home exercise program that includes the three maximal contractions.  
 
Can maximal voluntary pelvic floor muscle contraction reduce vaginal resting pressure and resting EMG activity? Naess, I. & Bø, K. Int Urogynecol J (2018) 29: 1623.