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France, Great Britain, the USA and Kegels

July 7, 2021

France recognizes its utility, as does Great Britain. It’s high time that the United States gets on-board and acknowledges its importance. I’m referring to pelvic floor training to prevent and/or help manage the pelvic consequences of pregnancy, labor and delivery.


The pelvic floor muscles are vital to vaginal tone, pelvic organ support, sexual, urinary and bowel function and positively impact core strength and stability, spinal alignment and posture. Pregnancy, labor and delivery can wreak havoc on the female pelvic floor with possible health consequences including altered anatomy, urinary and bowel control issues, drooping pelvic organs, and sexual issues. Pelvic muscle conditioning strengthens the pelvic floor muscles and has the potential to stabilize, relieve, improve and even help prevent future problems. Pelvic floor training prior to and during pregnancy can help minimize the occurrence of pelvic floor dysfunction and pelvic floor training after childbirth can help hasten the resolution of pelvic floor dysfunction.


France: More reactive than proactive, but clearly a major step in the right direction


In France, the government subsidizes the cost of pelvic floor muscle training after childbirth. The program is called La rééducation périnéale après accouchement. The French program covers up to 20 sessions of pelvic physical therapy intended to help restore the integrity of the postnatal pelvic floor muscles and “re-educate” the vagina. This program has been successful on an individual and national basis, as new mothers are thrilled to have pelvic health professionals at their disposal.


Great Britain: Proactive and reactive


The National Health Service of Great Britain is committed to the prevention, identification and treatment of pelvic floor issues, so that fewer women experience ongoing issues after childbirth and with aging. Recently, the National Health Service established 14 pelvic health clinics throughout the country to enable pregnant women and new mothers to manage the pelvic consequences of pregnancy and childbirth. This pilot study will likely lead to an extended program throughout Great Britain.


These pelvic clinics offer a one stop shop for women where care is provided by pelvic floor physical therapists, midwives and physicians. Women can self-refer themselves avoiding the necessity for physician referrals. Care and guidance are provided throughout the course of pregnancy. Pelvic physiotherapists are responsible for instructing pregnant women how to properly train their pelvic floor muscles in order to minimize the occurrence of pelvic problems. These specialized physical therapists also provide training and support for general practitioners and midwives.


Additionally, officials at the National Institute for Health and Care Excellence have recommended that girls aged 12-17 be taught pelvic floor anatomy and pelvic muscle exercises as part of the school curriculum, possibly as part of sex education classes. Bravo, Great Britain! Get that muscle memory going early on.


The ideal world: Pure proactive


Achieving a fit pelvic floor by pelvic muscle conditioning is a first line approach that can manage a variety of pelvic maladies in a way that is natural and free from side effects. Although pelvic training is a vital component of treating pelvic floor dysfunction, it is entirely another dimension to condition the pelvic muscles to prevent pelvic floor dysfunction.


Pregnancy, labor, childbirth, aging, menopause, weight gain, gravity, straining and chronic increases in abdominal pressure take a toll on pelvic anatomy and function and can adversely affect vaginal tone, pelvic organ support, urinary and bowel control and sexual function. Why not be proactive instead of reactive? Why not attend to future problems before they actually become problems? “An ounce of prevention is worth a pound of cure” is appropriate in the pelvic domain. A strategy to prevent pelvic floor dysfunction and not allow function to become dysfunction is an admirable goal.


The USA government would do a great service to its female constituents and save major health care resources if it was to adopt the British approach, underwriting the cost of proactive, preemptive, preventive pelvic floor training and physical therapy. Now that the government is considering a massive infrastructure bill to improve bridges, highways, railways, airports, public transport, power grids, and broadband, it is also time to consider this vital aspect of human “pelvic infrastructure” that is often neglected at great cost to human health and health care dollars.


I am a HUGE advocate, enthusiast and supporter of pelvic floor conditioning, having witnessed the potential benefits that may accrue when the proper pelvic floor conditioning exercises are done correctly. The key words are “proper” and “correctly.” In an effort to direct people towards proper and correct pelvic floor conditioning, I have written abundantly on this topic including several books.

When I identify a female patient with any form of pelvic floor dysfunction, she is given a free paperback copy of my female Kegel book (I will continue to do so until supplies run out), since these conditioning exercises are a first-line approach to pelvic floor dysfunction and can really make a difference.


Female book:

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health




A surprise to many is that pelvic floor training is equally beneficial to men, specifically to help manage sexual, urinary and bowel issues. Pelvic conditioning may prove advantageous for erectile dysfunction, premature ejaculation, male stress urinary incontinence, overactive bladder, post-void dribbling, and bowel urgency and incontinence.


Male book:

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health


I highly recommend the following male pelvic floor exercise training programs (disclaimer: I am co-creator of this program): PelvicRx (www.PelvicRx.com). Well-designed and easy to use, it is a follow-along and interactive pelvic training DVD that offers strengthening and endurance pelvic floor exercises. It provides education, guidance, training and feedback to confirm the engagement of the proper muscles and is structured so that repetitions, contraction intensity and contraction duration are gradually increased over the course of the program. This progression is the key to optimizing pelvic strength and endurance. The streaming version with digital access can be obtained at Private Gym.


If a patient has difficulty with pelvic floor muscle conditioning, additional help can be obtained using biofeedback, offered in our Saddle Brook office. Biofeedback uses special sensors and a monitor to display information about pelvic floor muscle activity to ensure that one is contracting the proper muscles.


Another option towards achieving pelvic fitness is to utilize the services of a pelvic floor physical therapist. A pelvic floor physical therapy session can be a lifesaver for a patient who is having difficulty mastering pelvic floor muscle training. There is compelling evidence that women do better with supervised training regimens than without. I liken the pelvic floor physical therapist to a “personal trainer” for the pelvic floor. The downside of physical therapy is that it is time-consuming and expensive, with variable coverage depending upon the insurance carrier.

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