Kegels 101

Performing exercises on a muscle group that you cannot see and often (at least initially) cannot feel can be frustrating. It often leads people to the conclusion that “Kegel exercises don’t work.” I have had many of my patients tell me that they have done Kegels but stopped because they saw no difference in any of their symptoms.

At this point, I will talk to them about giving it another shot. I tell them to focus on doing the exercises similarly to the way they would exercise any other important group of muscles.

I want to share with you many of the same tips that I share with my patients when I am working one-on-one with them. My hope is that this will help you begin, restart, or continue with a pelvic floor strengthening program. But remember that if you are struggling with “finding those muscles” or just have a sense that you are not doing the exercises correctly, then you may want to request a visit to a specialized pelvic floor PT.

It is also important to remember that before getting started, it's best to talk with your doctor about incorporating Kegels into your exercise routine.

Locating the pelvic floor

First things first: identifying the pelvic floor. This group of muscles runs from your tailbone (coccyx) to the pubic bone. Imagine a bowl of muscles nestled inside your pelvis. Your anal canal (think bowel movement) is one of the areas in this group of muscles. It can help to think of the area that you sit on when you are sitting up straight in a chair.

There are several verbal cues that physical therapists use to help people identify the correct way to perform a contraction, including:

• Pull up as if you are trying to pull your penis inside of you
• Tighten up as if you are trying to stop the flow of urine (but please avoid actually practicing Kegels in this manner)
• Tighten your muscles as if you are trying to hold back ejaculation
• Imagine lifting your testicles up off the chair using your inside muscles.

Some things that you should avoid:

• Holding your breath
• Bearing down – Think “up and in,” not “down and out.”
• Squeezing your outside buttocks muscles or your inner thigh muscles – Nobody should see any movement when you are practicing your Kegels correctly.
• Stopping and starting the flow of urine – It is OK to check periodically because these are the muscles that will stop the flow of urine, but it can be confusing to the bladder and create more problems down the road.
• Holding your pelvic floor in a constant state of contraction – This can create fatigue, soreness, and sometimes a worsening of urinary incontinence.

Let’s get started

Number 1: Find a comfy position. Lying down or reclined sitting are the best options.
Number 2: Relax. Feel your neck, shoulders, back, butt, and legs all let go completely.
Number 3: Focus your brain on your pelvic floor. Where is it? From your anus to your pubic symphysis (pelvic bone).
Number 4: Gently pull up and in from your pelvic floor. You should feel a lifting upwards from the anus through the pelvic floor pulling testicles and penis inward. You may also feel your lower belly (below your belly button) pull in, but the tightening should start with the pelvic floor. Now, let go and feel your muscles relax or lengthen.

How many, how often?

Start with holding for a count of 2 to 5, then release for a count of 4 to 10. How many can you do and still feel the upward pull and the downward release? 10, 15, 20? Then start there and do that twice a day. You do not need to do more than about 25 at a time. Start sitting or lying down.

Next up – the progression of exercises.