How To Do Kegels

Pelvic floor exercises, which include kegel exercises, are extremely useful in decreasing pain and improving lumbar spine function – especially to women post-partum.  After 9 months of carrying a baby in utero, women’s abdominals stretch and are rendered less effective in keeping the lumbar spine stable. Additionally, the extra weight carried in the front of their bodies increase strain on the lumbar spine and pelvis. During birth, episiotomies may happen, tearing and stretching and ligaments of the pelvic floor may happen, and C-sections (a complete surgical rupture of the abdominal fascia) can also happen, further jeopardizing the mother’s post-partum spine and pelvic function.

Some common symptoms we see in the clinic is dyspareunia (pain with intercourse), incontinence (leaking when laughing or exercising), and pelvic prolapse. One of the ways we can treat for these issues is from introducing Kegel exercises. Not all women are clear what they are or how to do them, so here is a Q&A about Kegels:

What are Kegel exercises?

Simply put, they are exercises that contract and strengthen the pelvic floor muscles. This is similar to how bicep curls may strengthen bicep muscles. While most women have heard about Kegel exercises, research indicates only 30-50% of people perform them correctly.

hy does correctly contracting the pelvic floor muscles matter?

Correct activation strengthens the desired muscles. This can help with decreasing leaks/incontinence, healing after giving birth, stabilizing pelvic prolapse symptoms, healing after trauma including falls on the buttocks, and enhance pleasure for both partners during intercourse.

What’s the harm in doing this incorrectly?

If done incorrectly, they can increase leaks, prolapse symptoms, and further weaken already compromised muscles.

It is important to “draw the pelvic floor up and in” and avoid forceful bearing down, as well as avoid breath-holding.

How do I do Kegels on my own?

1. Lie on your back to start, knees bent and opened. Check that your stomach and bottom muscles are relaxed – make sure you’re not holding your breath. Use a hand mirror to observe your pelvic floor muscle (“PFM”) area = the muscles around your vagina. When you perform a Kegel, you should see the perineum (area between vagina and rectum) draw up and into your body.
2. Squeeze and lift your pelvic floor muscles as strongly as you can. (You may only feel a subtle movement, to begin with). Tighten your pelvic floor muscles and not the muscles of your thigh or buttocks. Feel your pelvic muscles pulling up and inward into your abdominal cavity with each contraction.  You can feel the contractions with your fingers – make sure you are not pushing down and out (this is the opposite of a Kegel!)
3. Try and hold the squeeze for 3 – 5 seconds (you may like to begin with just 3 seconds).
4. Rest for 5 – 10 seconds and then repeat the ‘squeeze and lift’ 5 – 10 times. This is one set.
5. The most important part of doing a Kegel is relaxing after the contracting. Full relaxation is key!! Fully letting go your pelvic floor is critical for getting a great contraction. If you hold a low level of contraction all the time, you get weaker and can never fully contract your pelvic floor. This is what causes leaks. Focus on both the contraction phase and the releasing phase. When you first start out your muscles might be weak, however, it’s important that you don’t ‘cheat’ by holding your breath or squeezing your inner thighs/ bottom. Try to work up to three sets each day.
6. Once you’ve got the hang of the exercises you might like to link your exercises to other regular daily activities as a reminder. Try them out when brushing your teeth, having a shower or after toileting. The most important part of doing a Kegel is relaxing after the contracting. A pelvic floor physical therapist can help guide you on how to properly perform Kegels if you are unsure or cannot fully feel muscle activation. For better guidance, Stride Strong Physical Therapy’s women’s health physical therapists can help guide you through this process, especially if you have concurrent pain or you feel you’re not sure about this exercise.

If you would like to come and visit a women's health physical therapist, we have private treatment rooms at our Hillsboro clinic for patients who want to discuss their concerns with a specialized pelvic floor physical therapist in a private and quiet setting. To read more about our Pelvic Floor Physical Therapist, click here.

Sources:

1. Eldeeb et al. Effect of segmental stavilizaing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2019 Jan 4. doi: 10.3233/BMR-181258.
2. Nilsen et al. Mechanical oscillations superimposed on the pelvic floor muscles during Kegel exercises reduce leakage in women suffering from stress urinary incontinence: A prospective cohort study with a 2-year follow up. Acta Obstet Gynecol Scand. 2018 Oct;97(10):1185-1191. doi: 10.1111/aogs.13412.