Kegels vs Surgery vs Pessaries vs Natural Healing

One of the most commonly prescribed remedies for PFD is Kegel exercises.

The rationale behind Kegels is straightforward: if the pelvic floor muscles are weak, strengthening them through targeted contractions will restore function and resolve issues like incontinence or prolapse.

But what many women, and even some healthcare providers, don’t realise is that not all pelvic floor dysfunction stems from weakness. In fact, a significant number of women suffer from over-tensed or hypertonic pelvic floors —a condition where the pelvic muscles are too tight, rather than too weak.

A hypertonic pelvic floor is characterised by muscles that are constantly in a state of contraction, similar to how tension in the shoulders or neck might lead to chronic pain.

For women with this condition, performing Kegels can actually worsen the problem by adding to the already excessive tension in the muscles.

Instead of providing relief, Kegels can intensify the symptoms, leading to more pain, discomfort, and even increased urinary or bowel dysfunction.

A pelvic floor can also lack strength and this can be because of being overstretched during childbirth or because of chronic constipation. Or the timing may be out of alignment perhaps the muscles are engaging too slowly, this can be due to nerve damage, persistent cough or ageing.

Being overweight can also create a weakness in the pelvic floor muscles especially if the extra weight you are carrying is meaning that you are moving less.

Radiotherapy can also have an effect on the fascia and muscles of the pelvic floor creating weakness.

It’s crucial to understand that pelvic floor dysfunction is not always a matter of strength or weakness; it’s often about balance and functionality.

Just like any other muscle group, the pelvic floor needs to be both strong and flexible to perform its job properly.

When these muscles are over-engaged—whether due to stress, trauma, or poor posture—they can become rigid and unable to extend, which is essential for normal bowel and bladder function.

This is not the only time they need to be functional in extension they also need this ability to lengthen during coughing, laughing and jumping.

The common prescription of Kegels assumes weakness, but for women with over-tensed pelvic floors, this approach is not only ineffective but potentially harmful.

Yet, despite this knowledge, Kegels remain the go-to recommendation in many medical settings.

Women are often told to "do more Kegels," without any real assessment of the underlying issue—whether it’s weakness or hypertonicity.

The result is frustration and a lack of meaningful progress, with many women continuing to suffer unnecessarily.

Research is increasingly supporting the notion that Kegels are not the ideal solution for all forms of pelvic floor dysfunction, especially when the problem involves an over-tensed pelvic floor.

One notable study, published in the *Journal of Women’s Health Physical Therapy* in 2016, found that many women with pelvic pain or hypertonic pelvic floor muscles experienced worsened symptoms when performing Kegel exercises.

The study followed 56 women who had been diagnosed with chronic pelvic pain and hypertonicity, and it revealed that 72% of them reported an increase in discomfort and muscle tightness after incorporating Kegel exercises into their treatment plan.

The researchers concluded that while Kegels may be effective for weak pelvic muscles, they are contraindicated for women with hypertonic pelvic floors, as they exacerbate the tension rather than relieving it.

Another study, published in *The International Urogynecology Journal* in 2018, highlighted the prevalence of hypertonic pelvic floor muscles among women with PFD.

The study showed that 45% of women diagnosed with PFD actually had over-tensed pelvic floor muscles rather than weakened ones.

The researchers emphasised that pelvic floor physical therapy aimed at **relaxation techniques**, **breathing exercises**, and **manual therapy** produced significantly better outcomes for these women than Kegel exercises alone.

These studies underscore the need for individualised assessments and treatments based on whether the pelvic floor is weak, hypertonic, or a combination of both.

For women with more severe cases of PFD—particularly those experiencing pelvic organ prolapse—surgery is frequently presented as the next logical step after conservative treatments like Kegels fail.

The most common surgical procedures for PFD involve repairing or reinforcing the pelvic floor with mesh or sutures.

Whether it’s a prolapsed organ, incontinence, or chronic pelvic pain, the prevailing medical advice often points directly to surgical intervention.

It’s presented as the definitive answer, a way to “fix” the problem once and for all. But is it really that simple?

And more importantly, is it the best choice?

In the world of modern medicine, where efficiency and quick results are prized, surgery can seem like a straightforward and logical option.

After all, it’s tangible—something that can be scheduled, performed, and checked off a list. But this narrative, while convenient, often oversimplifies the complexity of pelvic floor dysfunction.

It ignores the fact that surgery is not without its risks, and it overlooks the many women for whom surgery may not be the best or only solution.

One of the major reasons surgery is so often recommended is due to significant gaps in the current medical system.

The healthcare industry, particularly in public systems, is designed to manage large numbers of patients efficiently.

Doctors, burdened by tight schedules and heavy caseloads, may not have the time to explore non-surgical options thoroughly.

This time pressure leads to a situation where surgery becomes the go-to recommendation because it’s seen as a more “definitive” solution.

But pelvic floor dysfunction isn’t just a mechanical problem to be fixed with a scalpel.

It’s a condition that is deeply intertwined with a woman’s overall health—physical, emotional, and even psychological.

The current medical model, which tends to focus on treating symptoms rather than addressing root causes, often fails to take these complexities into account.

There’s also a lack of comprehensive care. Many women aren’t fully educated about the nature of their condition or the range of treatments available.

They might not be informed about alternative pelvic floor physical therapy that is not Kegel-based, lifestyle changes or other holistic therapies that could help them manage or even overcome their symptoms without surgery.

This lack of information leaves women feeling as though they have no other option but to undergo a procedure that might not be necessary.

Moreover, the healthcare system doesn’t always adequately prepare women for what surgery entails. The risks, the long recovery time, and the potential for complications are sometimes glossed over.

Women are often told that surgery will fix their problem, but they’re not always informed about the limitations of surgery or the fact that it might not address the underlying causes of their dysfunction.

This approach can lead to unrealistic expectations and, in some cases, disappointment when the surgery doesn’t yield the hoped-for results.

Another common treatment for pelvic organ prolapse and related PFD symptoms is the use of a pessary.

A pessary is a small, removable device that is inserted into the vagina to provide support for the pelvic organs.

Pessaries can be useful in alleviating the symptoms of prolapse, such as pressure or discomfort, and for some women, they provide significant relief without the need for surgery.

However, it’s important to recognize that a pessary is not a long-term solution. While it can provide temporary physical support, it does not address the underlying cause of the dysfunction.

The muscles and tissues of the pelvic floor remain weakened or damaged, and the pessary serves as a crutch rather than a cure.

Over time, reliance on a pessary can even contribute to further weakening of the pelvic floor, as the muscles may not be engaged or strengthened while the device is in place.

Moreover, pessaries require regular maintenance. They need to be cleaned and refitted periodically to ensure they are functioning correctly and not causing irritation or infection.

Some women find the process of inserting and removing a pessary to be uncomfortable or awkward, which can add to the emotional and physical burden of managing PFD.

While pessaries can be an effective temporary solution, they do not offer the long-term healing or restoration of pelvic function that many women hope for.

They are best understood as a stopgap measure, rather than a sustainable approach to pelvic floor health.

The common thread between these treatments—Kegels, surgery, and pessaries—is that they all focus on managing symptoms, rather than addressing the root cause of pelvic floor dysfunction.

Whether it’s performing repetitive Kegels, undergoing surgery that creates more scar tissue, or relying on a pessary for support, these solutions tend to overlook the fact that the pelvic floor is a complex system of muscles, nerves, and connective tissues that require more than a one-size-fits-all approach.

For many women, the real solution lies in restoring balance to the pelvic floor.

This means not only strengthening the muscles but also improving flexibility, reducing scar tissue, and promoting healthy circulation.

It’s about understanding that PFD is often a result of over-tensed muscles that need to learn how to relax, as well as weak muscles that have checked out and need to be reminded how to engage. It’s about focusing on the overall health of the pelvic tissues, rather than just treating the symptoms as they appear.

Surgery and pessaries can provide short-term relief, but they come with trade-offs that are often not fully communicated to patients.

The emotional toll of relying on these treatments can be significant, especially when they don’t deliver the results women expect.

The anxiety surrounding these procedures and devices—whether it’s the fear of undergoing surgery, the worry of the pessary shifting out of place, or the frustration of Kegels not working—can leave women feeling disempowered and unsure of where to turn next.

Instead of relying on these conventional approaches, women need to be empowered with the knowledge and tools to restore balance and vitality to their pelvic floor.

This means working with pelvic floor physical therapists who understand the complexity of both hypertonic and hypotonic conditions. It also means exploring alternative therapies that focus on tissue health, flexibility, and circulation, rather than just muscle strength.

We recommend the HEAL Method which can indeed help women regain their health back for good.

H = Holistic

E = Empowered

A = Aligned

L = Liberated (& relaxed)

Dive deeper into a holistic approach to managing pelvic floor dysfunction—one that moves beyond the limitations of surgery and offers a comprehensive, empowering solution.

The HEAL Method is based on the idea that true healing requires a holistic approach that addresses the whole person—body, mind, and spirit.

It’s about understanding the root causes of pelvic floor dysfunction and taking proactive steps to manage the condition.

Rather than relying on surgery as a quick fix, the HEAL method emphasises education, lifestyle changes, and natural therapies to empower women to take control of their health.

Whether you’re dealing with pelvic pain, incontinence, or prolapse, the HEAL Method empowers you to take control of your health in a way that works *with* your body, not against it.

What makes the HEAL Method so powerful is its ability to adapt to your individual needs, regardless of your age or the specific reasons you’ve developed pelvic floor issues.

By addressing both the physical and emotional aspects of pelvic floor dysfunction, HEAL goes beyond mere symptom management to foster deep, long-lasting recovery.

This method recognizes that PFD isn’t just about weak muscles or over-tension—it’s about the body’s overall balance and its capacity for self-repair.

The HEAL Method taps into this innate potential for healing by focusing on the foundational principles of homeostasis, or balance within the body, to restore optimal pelvic floor function.