Training Equipment For Your Pelvic Floor
NOTE: this was written in July 2021 and new products and research are since available.
Kegels, kegels, kegels! When People think about pelvic floor physiotherapy or bladder issues, they typically think of kegels (aka pelvic floor contractions). Kegels are the voluntary contraction of the pelvic floor muscles and can indeed be an important part of improving certain bladder and bowel symptoms.
There is endless research showing that kegels are helpful for improving prolapse, bladder/anal leakage and also sexual function. However, if you have been following me you hopefully know that kegels are not for everyone and that there can also be other factors to improving symptoms than just kegels. For example, if you have an over-active pelvic floor with too much tension, then doing excessive kegels can potentially make your symptoms worse. With urinary leakage while running, yes your pelvic floor strength and tone/tension is important to help create closure to the urethra, but so is your foot strike and how you absorb the impact, your hip rotation, abdominal tension and dynamic pelvic floor responsiveness. That may seem like a lot of factors, but that is the value of having a pelvic floor physiotherapist to assess and help guide you through the process.
So to help improve the function of your pelvic floor muscles doing kegels can be PART of the process. To make strength gains to your pelvic floor that requires doing multiple repetitions of the contractions to challenge the muscle fibres so that they build up bulk, strength and endurance. This is the same as if you wanted to get stronger at the gym or run longer…. You have to challenge and progress (Progressive Overload) your system, otherwise growth just plateaus….and symptoms don’t improve!
Unfortunately, many of my clients find it challenging to get their kegels in, others may struggle to have the confidence that they are doing the kegels properly once they leave the treatment session, and some may be looking for the quick fix. I get it, really I do! Life is busy and if you’re a “giver” making time for yourself is put on the back burner. Plus, who wouldn’t want to put an end to that annoying leakage as quickly as possible. As such, many will ask me about different devices that proclaim to make your pelvic stronger, more quickly.
There are devices that provide stimulation (electric current) to invoke a muscle contraction of the pelvic floor, there are others that provide feedback on your contraction (bio feedback) and some that you just leave in for a period of time. I am not going to go into a full review of each of these or of the research that surrounds them. Rather, I want to leave you with some general considerations if these are something you’re interested in.
First off, before using any of these devices it is recommended that you see a pelvic floor physiotherapist to properly assess your pelvic floor. They will help determine your muscle state and function can definitely help you in your decision making process.
Biofeedback Devices
These devices typically have a probe that you insert vaginally that provide feedback on how you are contracting and relaxing your muscles. They will often have an app that the probe syncs to and some even have games to play that respond to your contractions. They can provide motivation and help track your progress which, can be helpful if you are goal orientated. They can also help ensure you are relaxing properly if that has been an issue identified by your physio. A couple of the more popular devices are Elvie and Perifit.
However, you need to consider if your life allow you to undress, and lay down in a quiet, private space to insert the probe and do the training. If you are struggling to get your kegels in while sitting, dressed, this likely will end up sitting in your drawer……I know mine has!
You also need to consider the cost as many can be between $100-$250. Kegels are free!
Lastly, because it has to be inserted vaginally, you need to consider if you can comfortably accommodate the probe. Some of them are quite large in circumference and may not be comfortable, especially if pain is a symptom for you (but doing kegels likely aren’t something you should be doing anyways then) or if you have poor tissue quality.
Electrical Stimulation (E-stim)
These devices are again typically a probe that you insert vaginally which emit a current to cause a contraction of the pelvic floor muscles- think of the Doctor Ho commercials when you see the muscles twitching. The stimulus is not painful and can be helpful for feeling a contraction. A couple of the more popular devices on the market are YoniFlex or Pelvitone.
I find them particularly helpful for women who have very weak pelvic floors and need to get to the point where they can feel a lift while doing the contraction. The goal is typically to use them for a period of time and then to wean off as your strength improves.
Again, these units have similar considerations as the biofeedback units. Does your lifestyle afford you the privacy to use the probe? Is cost a concern as they can also be a couple hundred dollars?
One other factor may be whether or not you have a significant prolapse. If your prolapse is quite large it can be challenging to get proper contact with the probe. It can still be worth a try, but there seems to limited research on E-stim alone improving prolapse.
Weights/Eggs
These are cones or balls that come in different sizes and weights that are inserted vaginally and your pelvic floor muscles keep them inside while you continue on your day. The most common devices are the Yoni Egg and Aquaflex.
The bonus to these is that you can use them with your clothes on! However, it is important to consider how you are using it. It is not beneficial to use them for prolonged periods of time as it can make your pelvic floor too tight. You are essentially making a sustained contraction which isn’t how the pelvic floor works. It is constantly contracting and lengthening in response to movement/pressure.
One way they can be helpful is while doing some functional tasks ie gardening or during a workouts to feel how your pelvic floor has to engage or to see if you are pushing it out (bearing down), but again there is debate if the muscles are truly working dynamically with it in.
I will be honest I rarely recommend these, but they do have their benefits if used properly.
So there you have it! I hope this has shed some light on some of the different options that are out there to help strengthen your pelvic floor. If you take nothing else from this, its the same message I’ve preached before, please check in with a pelvic floor physiotherapist before trying one of these devices. Let me know your thoughts or if you have any questions!!!!
By Laura Powers, RPT
Higher Function Women's Health