You might have heard of a kegel exercise before. They are often discussed as an exercise that helps with incontinence or pelvic organ prolapse. A ‘kegel’ or more formally, a pelvic floor muscle contraction, is a squeeze of the pelvic floor muscles. The pelvic floor muscles are those muscles that run from the pubic bone in the front, between your legs – much like a hammock, and attach to the tailbone in the back. They are responsible for holding up your pelvic organs (bladder, uterus, rectum) and for helping to control urine and feces elimination. They also do many other exciting things, but let’s stick to the most basic information for now.
It’s been estimated that roughly half of all women contract their pelvic floors improperly. Go ahead, give it a try. Imagine that you are trying to stop the flow of urine. Did you try? If you held your breath, tensed your abdominals, squeezed your bum muscles or your inner thighs, then your kegel could use some work.
So how do you kegel properly? Firstly, a kegel is only the contraction of the pelvic floor. It does not include help from the buttocks, inner thighs or abdominals. Secondly, you should not be holding your breath. I initially teach kegels done on an exhale. This helps to prevent breath-holding, and we have some evidence to suggest that the pelvic floor works best with its surrounding muscles during a breath out. So it goes much like this; “Deep belly breath-in, then exhale through the mouth and kegel”. I usually get someone to learn while lying on their back, and then progress to a standing position. Standing is slightly more difficult, as the weight of the internal organs in now resting on the pelvic floor. Furthermore, people tend to be prone to leaking while standing up.
There are two other errors that I commonly find when teaching a pelvic floor contraction. I often see that people will give me a very “sphincter-like” squeeze. Sometimes they only try to close around the urethral/vaginal/rectal opening. When doing this, they often miss the lift that we need to see. I need the pelvic floor to squeeze and then I need to see it be drawn upwards towards the belly button. The other error that I find women, in particular, make is to ignore the rectal component of the kegel muscle. As I mentioned earlier, the pelvic floor muscles run from the front of the pelvis all the way to the tailbone. They offer support to the rectum and help maintain fecal continence. Many women get so focused on the vaginal component of the kegel, or perhaps they are trying to avoid squeezing their buttocks, that they don’t engage the back half of their kegel muscle. Not only must you use your muscles to help “close the vaginal opening” or “stop the flow of urine”, but at the same time you should also be trying to close the rectal opening, or “preventing gas from escaping”.
The whole sequence of the exercise should look like this: “Inhale into the belly while keeping the pelvic floor relaxed, exhale out the mouth and kegel (squeeze AND lift the front AND back portions of the pelvic floor). Hold the kegel for the duration of the exhalation. Repeat with the following breath. Inhale and relax, exhale and kegel. That is A LOT to think about. The muscles can get confused after a couple of breaths like this. Often times you must restart this breathing sequence over and over, before perfecting the technique.
Most of my patients looking to develop strength in their pelvic floor muscles will aim to perform this sequence of breathing and muscle contraction for 30 seconds, and gradually build to 2 minutes. Some people are so unaccustomed to breathing this deeply for so many consecutive breaths that they get dizzy after a couple of cycles. I remind patients to take some normal breaths in between if needed.
Kegel exercises are only a small piece of the puzzle in solving incontinence or pelvic organ prolapse. Having good pelvic floor strength is important but there are other factors at play. If I wanted to learn to throw a ball, I couldn’t just do bicep curls and expect to have a great throwing arm. There are supporting muscles, sequences of movement, endurance, posture and coordination to consider. Sometimes all of these factors need to be addressed. Others times, only a few need work.
One last word of caution; there are a number of people for whom kegel type exercises could make things worse! Some people have problems with pelvic floor muscles that are too tight. Symptoms of this can be pelvic pain conditions, urinary urgency and painful sexual intercourse. If you suspect that your pelvic floor muscles are too tight, kegels might be a poor exercise choice for you.
As always, if you suspect that you have a pelvic floor muscle condition, speak to your family doctor or healthcare provider about finding a well trained pelvic floor physiotherapist that can develop a treatment plan designed just for you.
BSc., MSc. PT