Not All Kegels Are Created Equal

How to Optimize Your Pelvic Floor Exercises

Are Kegels Right For You?

By this point, you’ve hopefully heard the word on the street: kegels are not for everyone. It’s true... but it’s also not true. It’s true because we should never be strengthening until we have full range of motion and the ability to relax. It’s not true, because everyone can be working on their pelvic floor to optimize its function and work towards strengthening. Let me help you figure out what the perfect recipe is for your pelvic floor with these three components of the perfect kegel!

1) Full Range of Motion — Relax First!
The Pelvic floor is a bowl of muscles at the base of the pelvis responsible for support of the pelvis itself and the pelvic organs (bladder, uterus, rectum) as well as bowel, bladder and sexual function. It should be able to contract fully up and in (a kegel) and relax fully (lengthening/reverse kegel/bulge).

You wouldn’t dream of doing bicep curls if you couldn’t even straighten your elbow fully. You wouldn’t strengthen your upper traps if they were so tense they practically touch your ears. This would only lead to more pain and dysfunction and the same goes for the pelvic floor! We must relax completely before we start strengthening.   

Some potential signs and symptoms that you might not be relaxing completely are urinary leakage, urinary urgency or  burning, incompete emptying, weak urinary stream, constipation, pain with sex or gynecological exams, difficulty with tampon insertion, pelvic or abdominal pain. 

Try these cues to see if you can feel the lengthening/ relaxing: 

• “Take a deep breath in and feel the air expand down into your pelvic bowl, like you are blowing up a balloon down into your pelvis.” 

• “Take a deep breath in, and send it down to your pelvis imagining the muscles are melting like warm butter on a hot skillet.” 

• “Try doing 1/8th of a kegel and then let it go. Can you feel the muscles drop down? If not, try exhaling while you contract and inhaling while you relax. Use the diaphragm’s relationship to the pelvic floor to our advantage.”

• “Try a different position. Child’s pose is one of my favorites! Take a deep breath in and try to feel your tailbone expand back and sit bones (the bones in your butt that you sit on) come apart from each other.”

If you are still not feeling the muscles relax, reach out to a pelvic floor physical therapist! It is our job to help you find these muscles and figure out the reason why they aren't functioning properly. The reason could be anything from your neck to your big toe affecting the pelvic floor.

2) Find the Right Muscles — All Three Layers
There are more than 20 individual muscles of the pelvic floor! They are organized into three layers. In my practice, I find that most people only use some of the muscles of the pelvic floor, and they leave so much amazing support and function on the table.  Let’s see if you can find them all! Here are some cues to try to feel each layer engage: Don’t forget to relax after each contraction!:

First layer (most superficial muscles at the surface): 

• “Imagine like you are trying to PINCH your labia towards each other.” 

• “Imagine you are trying to pick up a pearl with your labia.” 

Second layer (still superficial, right around the urethra): 

• “SQUEEZE like you are trying to stop the flow of urine.” 

Third layer (the deeper bowl): “Bring your clitoris towards the anus and LIFT up and in.” 

• “Imagine you are trying to hold back a big bowel movement/ gas from escaping.” 

• “Lift the perineum up and in.” 

• “Bring the pubic bone toward the tailbone and lift up and in.”

3) Isolation of the Pelvic Floor — Stop Using Your Butt! and Breathe!
Once you have full range of motion and are able to find all of the muscles, it’s time to make sure you aren’t compensating with other areas of your body! The body is incredible and will find a way to utilize other body parts to help the pelvic floor. However, we want the pelvic floor to be able to function independently! 

3 Most common compensators: 

1. Butt muscles: When you do your kegel, are your glutes helping? Put your hands there, feel if your butt is moving.  If so, really try to focus on just using the pelvic floor. 

• 2. Abdominal muscles- The lowest part of your belly will engage a little with the pelvic floor. That’s normal, but if you feel your whole 6-pack ab muscle or obliques engage, you’re doing too much. 

3. Holding breath- Especially when you are working on endurance for the pelvic floor (longer holds), holding your breath is very common. However, it’s not functional! You need your pelvic floor to be strong while you are breathing and moving throughout your day. If you can’t do a kegel while you breathe, how do you think your pelvic floor is working while you run?

Still not sure if you are doing it right? Reach out to a pelvic floor PT! It is our job to give you feedback, and let you know exactly which pieces might be missing for you. 

Extra Credit: Quick Twitch and Endurance Training
Once you have full range of motion, you’re relaxing completely, you’re contracting the correct muscles, you are isolating and breathing properly…. Whew!! Gold star for you!! Let’s start to train the muscles specifically for your daily activities. 

There are two types of muscle fibers in every muscle of the body:

 1) Quick twitch muscle fibers (turn on with fast activities such as coughing, sneezing, laughing, lifting, jumping)

2) Endurance/ slow twitch muscle fibers (are on for longer periods such as when we are walking around or standing) We want to make sure that we are training both! 

Quick- Contract the pelvic floor completely. Relax the pelvic floor completely. Repeat trying to make it faster, without losing the quality (ie full range of motion, isolation, proper breathing!) 

Endurance- Contract pelvic floor and hold- can you keep the muscles engaged while you breathe? Isolating from glutes, legs and abs? Are all three layers engaged? Or does it start to let go after a few seconds? Now relax completely!  See if you can work up to 10 second holds, and repeat 10 times.

If you are still having pain, bowel/ bladder leakage, queefing, difficulty controlling gas with certain activities, make sure that you reach out to a pelvic floor physical therapist so that we can tailor muscle training specifically to the activity you need.