Have you ever been told to do your kegels? 

Are kegels the answer to all my problems?

 

How do you even say kegel? 

 

A kegel (technically pronounced “kay-gel”) is a contraction of the muscles of the pelvic floor. See image below.

 

Keep  reading on for the answers to these questions and so much more.

 

As pelvic floor specialists, we’ve encountered plenty of individuals who have said some variation of the following “I’ve done my kegels, but they didn’t make a difference.” 

 

Many people who’ve heard of pelvic PT believe all we do is prescribe kegels. We do so, so much more than just kegels, but working on kegel-ing is a big part of our speciality and training.

 

So why should I even see a pelvic PT? I can kegel on my own.

 

In the US, we receive minimal information on kegels. In a 2005 study of 232 postpartum women, 46% of the women reported receiving no information on kegels at all (McLennan et. al, 2005).

 

And if you were given information on kegels, you likely got this information on a handout from a healthcare provider’s office or the pages of Cosmo. 

 

Verbal/ written instructions are not enough 

 

In one study, researchers provided 47 participants with verbal instructions on how to kegel and then measured their strength. Only 49% of participants performed the kegel correctly. In fact, 25% of the participants performed a movement that would actually make leakage worse (Bump et. al, 1991).

 

A correct kegel involves not only a pelvic floor muscle contraction, but also complete relaxation, coordination with the breath, and co-activation with the deep abdominal muscles. 

Try this at home

 

Lie on your back with your knees bent and supported.

 

Take a gentle inhale and as you EXHALE kegel.

 

If you have female genitalia, you will close both openings, vagina and anus, and imagine that you are lifting both openings up to your abdomen.

 

If you have male genitalia, close and lift at the anus and think about lifting the scrotum up toward the body. 

 

If that cue doesn’t work for you, try these:

• Bring the pubic bone toward the tailbone
• Imagine that you’re stopping your flow of urine 
• Imagine you’re in a crowded room and you wanted to stop gas from escaping
• Your pelvic floor muscles are an elevator, close the doors and go up to the first floor

 

Hold the contraction for 5-10 seconds.

 

Are you holding your breath? Make sure that you’re still breathing.

 

Inhale and release the contraction. 

 

A bit more complicated than just squeezing some muscles, right?

 

A trained pelvic health specialist will take a look at all these details and get you kegel-ing like a pro.

 

Why should I do kegels?  

 

Your pelvic floor muscles support your organs, stabilize your body, aide in sexual function, help maintain continence, lengthen to void and defecate etc. All very important things!

 

Strengthening your pelvic floor is the first line of defense and prevention for serious quality of life issues like bladder or bowel incontinence and pelvic organ prolapse.

 

Because the pelvic floor stabilizes, low back pain can be related to pelvic floor muscle dysfunction.

 

A traditional kegel may not solve all your problems

 

The relaxation component of a kegel is just as important as the contraction component. 

 

Problems like pelvic pain, pain with sex, as well as incontinence and prolapse can be made worse if the pelvic floor is not able to lengthen and let go. A short and overactive pelvic floor muscle is not a strong muscle. Like any muscle in the body, you want both strength and mobility.

 

How do we train for pelvic floor lengthening?

The reverse kegel

 

To reverse kegel, start by taking some deep breaths.

 

As you inhale, your pelvic floor naturally drops and with and exhale, your pelvic floor lifts. The pelvic floor and diaphragm should work together like this. See if you can tune in and feel that relaxation on the inhale.

 

Take it a step further now by visualizing spreading your tailbone and pubic bone away from each other with the inhale. This should be a very gentle movement. 

 

Feel the gentle recoil of the pelvic floor on the exhale. 

 

Confused? Kegels are quite a bit more complicated than a “squeeze”. It may be time to see a trained specialist.

 

-Megan Fosko PT, DPT

 

Bump RC, Hurt WG, Fantl JA, et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991;165:322-329.

 

McLennan, M. T., Alten, B., Melick, C., Hoehn, M., & Young, J. (2005). Patients’ satisfaction with and attitudes toward vaginal delivery. Journal of Reproductive Medicine, 50(10), 740–744.