Kegels: Pelvic Floor and the Voice

In 1948 Dr. Alfred Kegel developed the pelvic floor contraction exercise for people with vaginas that we now call Kegels. It was a pretty big deal because before that it was surgery or nothing for those who were dealing with incontinence and prolapse. His exercise gave options and empowerment through the sense that there is something out there that could help to restore function to the body.

But, kegels have become a bit of a hot button issue in the fitness and women’s health world. Some people say you should absolutely NOT do kegels. Some say you absolutely SHOULD do kegels. Some say you only need to squat and not to kegels.

The whole debate will leave you wondering, will kegels help me? Should I be doing them regularly? How exactly do I do a kegel? Please, FTLOG, someone just stop me from wetting my pants!

Pro Tip: Save yourself the pain of googling “how to do a kegel” because you will get 95,000 answers, each one a bit different.

I have written before about the connection of the pelvic floor to the singing voice so I won’t get into that here. Here’s what I have gleaned about Kegels and you can make an (hopefully) informed decision about their role in your life and the health of your pelvic floor.

Kegels are a targeted, spot treatment, focusing on the musculature of the pelvic floor. The theory behind them being that the reason incontinence is happening is due weakness in the muscles of the pelvic floor and therefore the muscles have too little tone. Of course, what we need to do when something is weak is strengthen it, right?

I attended a conference where Women’s Health PT (WHPT) after WHPT was interviewed and shared that they see far more hypertonic (too much tone) pelvic floors than hypotonic (too little tone) pelvic floors (especially in those in the fitness world, interestingly enough). Those pelvic floors that are too tight will still register as weak if they are tested because the muscles are already tightened to their max and they can’t engage MORE than they already are. So, kegeling in those cases is no good because it will just further add tension to tight muscles.

For some, kegels are enough to solve the problem, though there is some research out there showing the long term viability of kegels is questionable – meaning it might shore you up for several years, but after that things can start to go downhill. Sometimes we forget that it is equally as important to release muscles as it is to engage them. Kegels are also not always great for prolapse either. If you are prolapsed and squeezing the pf muscles, you may just be strangling (for lack of a better word) the organ that is prolapsed and that can make things worse.

Every moment of training I have attended over the last 18 years has emphasized that the places where we experience pain and problem in the body are only a small part of the whole picture.

Solutions to problems in the body come when we consider the WHOLE body, the breath and the brain.

I have seen and experienced the truth in that statement in my own body and in other bodies.

When we apply that to the issue of pelvic floor weakness, we get this: when you have a group of muscles like the pelvic floor that are meant to engage in response to the information (loads) they are receiving from the rest of the body via movement and breathing we will find a long-term solution when we engage in practices that address all of the following: upper body tension, calf tension, rib cage position, core strength and how the breath impacts all of that. After all, over 34 muscles in the body are sending input to the pelvic floor. And, believe it or not, how you think can also impact how the body functions and how you perceive pain. So, your belief in your body’s ability to heal will impact the rate and level to which you get better. Plus, a group of muscles that are meant to fire reflexively will simply not do well when we try to spot treat them by isolated movements.

Might kegels be a part of what you do? Maybe, if a WHPT determines that you have pelvic floor muscles that will benefit from them, but I would hope that he or she has you do them in conjunction with being mindful of the position of the body, the breath and the movements you are doing.

Might kegels be a good thing to do if you are seeking to reconnect to your pelvic floor (like soon after birth or if you have disconnected due to years of pain and discomfort). Yes, they can help your brain re-establish a connection to the pelvic floor.

Might using a kegel-type exercise like the pelvic floor ruler be a useful way to assess how much control and ability to engage you have in those muscles? Yes, it can be very useful to track how well you can engage and release the muscles.

Can you solve your pelvic floor problems without doing a kegel per-se, because you are re-coordinating your body through a whole body approach where the pelvic floor might go along for the ride when you are breathing and moving? Absolutely.

The Core-Voice Connection

In my opinion, the core-voice connection lies at the heart of a voice that is easy to produce. There is a close relationship between the pelvis, ribcage and throat, through all of the tissues that span from the pelvic floor to the larynx.

The deep core is the deepest layer of muscles and includes the pelvic floor, the transverse abdominus as well as the diaphragm, the psoas, the multifidus and the muscles of the throat. We can extend this farther using Tom Meyer’s Deep Front Line and exploring fascial connections that run from the soles of the feet up to the tongue and neck. Truly the whole body is connected!

When vocal technique isn’t solving your voice issues, we often need to look at the rest of the body and the deep core is the first, most important place we can explore.

Habits that we have in the body can interrupt how well these parts relate. These include:

  1. Sedentary living – none of us move as much as our body is designed to move.
  2. Excess tension – we all carry extra tension in various parts of the body – bum, back, neck/shoulders belly, etc.
  3. Stress Level – never underestimate the ways stress shows up in the body – usually it is our body trying to get our attention, but most of us are experts in disconnecting from the body to keep moving through our lives.
  4. Breathing patterns – gripping in the belly and being a belly dominant breather can both have a huge impact on how the core and voice work together.

When we think about the core-voice connection we want to consider:

  1. How the ribcage is stacked over the pelvis.
  2. How well integrated the deep layer of the core is.
  3. How the ribcage moves when we breathe – are we missing one or more plane of movement?
  4. How the deep core responds to resisted airflow.
  5. How the deep core responds to vocalizing.
  6. How the deep core responds to movement.

A few very common patterns I see in singers bodies include excess tension in the shoulders, neck and throat/jaw, a belly that moves first and most when breathing, a ribcage that is thrust forward (like a bell that is rung forward), and a pelvis that tends to live in a tuck or a duck position and has a hard time finding neutral. Any or all of those tell me we could stand to do a little work on the deep core.

To get you started here’s an exploration to connect the pelvic floor and throat.

 Pelvic floor – Throat Connection

  1. Lie on the floor in constructive rest or sit quietly in a chair and stay for several cycles of breathing, letting the body release into the ground or chair.
  2. Bring your attention into your pelvic floor (every body has a pelvic floor, you can either focus on the vaginal opening or where the testicles are). Continue to breathe easily and notice the pelvic floor.
  3. Grip the pelvic floor and release it a few times.
  4. Now bring your attention into your throat. Keeping your attention here, grip the pelvic floor. Can you feel the corresponding grip in the throat?

Let’s try it another way:

  1. Lie on the floor in constructive rest or sit quietly in a chair and stay for several cycles of breathing, letting the body release into the ground or chair.
  2. Bring your attention into your vocal tract. Continue to breathe easily and notice the vocal tract from vocal folds up and out to the lips.
  3. Strongly purse the lips and release them a few times.
  4. Now bring your attention to your pelvic floor. Keeping your attention here, purse the lips strongly. Can you feel a response in your pelvic floor?

Evolutionarily, the throat and belly work together because a secondary function of the throat is as a valve that can close to give us leverage when lifting very heavy things (called a valsalva maneuver). That action helps increase intra-abdominal pressure (pressure inside the abdomen). And, a big part of singing with ease is managing pressure.

If your deep core isn’t well integrated, the muscles in the shoulders, neck, throat and jaw get recruited in to try and help you when you breathe, move AND produce your voice. What they are actually doing is getting in the way of your optimal sound.

To work towards an integrated deep core we want to address elements of our alignment, our breathing and begin to move in ways the help the body to work well.

To explore more about the deep core please see the post The Importance of Core Training for Singers, visit my Instagram page for a series of reels on the Core-Voice Connection, and when you are ready to address your deep core, the Singer Synergy Movement Series a 9 week movement class series focuses on this exact issue for singers!