Kegels & The Important Muscles You Might Not Be Exercising

Know the feeling when you’re bee-bopping along and all of a sudden you really gotta go – and then maybe you do, just a little. Or how about when you’re doing your best to follow through on that promise to yourself that this time you WILL finish (or start!) that workout, but the idea of a little sprinkle (and I don’t mean rain) keeps you from doing what you’d really like.

Sounds like someone’s dealing with some good ol’ fashioned urinary incontinence.

Huh?

But you may or may not have this “magical” term in your vocabulary, so you take to google trying to figure out what to search that won’t cause you to blush too much (how to stop peeing pants, peeing with running and/or lifting, peeing while laughing).

Finally, your search results arrive and you stumble upon the Kegels, the exercise designed to strengthen those beautiful pelvic floor muscles (PFM).

Pelvic Floor Muscles

If you’re like many of my clients, right now you’re thinking, “What the what? Muscles where?” That’s right ladies (and gents), you have a fabulous set of muscles right under your nose – well, a little further south – that help you keep your bladder (and some other organs) trucking along and clothes dry.

To keep things simple (which the human body is definitely not), let’s suffice to say there are 3 layers of the pelvic floor (PF). They work to hold back our body’s waste products until we’d like to visit the porcelain throne, as well as to support and stabilize your pelvic organs among other things. (To read more about this and how to avoid a prolapse of the pelvic organs, be sure to check out this post.)

At least that’s what they’re supposed to do. Because let’s be honest, if they were working alright, alright, alright, (anyone else just read that in Matthew McConaughey’s voice?) you probably wouldn’t be at this page reading these words. But here you are so…back to the kegel.

How to Kegel

So how does one do this blessed kegel exercise? (especially as some research says that 50% of women don’t do them correctly (https://www.ncbi.nlm.nih.gov/pubmed/1872333). Many websites will tell you, “Just stop the flow of urine while you’re peeing!”

Unfortunately, for the majority of women I work with, this doesn’t cut it, because:

Many women with incontinence can’t stop the flow of urine to find these muscles, and
Doing this over and over again can actually make things worse by interrupting our normal bladder habits (<- awesome post by Tracy Sher, PT on this)

Urinary incontinence comes in different forms, but one of the most common is stress-related (and no, I don’t mean the kind of stress that make you want to chew off all those perfect nails you just had manicured).

Stress Urinary Incontinence

Stress urinary incontinence (SUI) comes to rain on your parade when extra pressure gets put on the pelvic floor when it’s not ready for it (coughing, sneezing, laughing, lifting, jumping, to name a few common culprits). This affects A LOT of women (almost 50% in one study: https://www.ncbi.nlm.nih.gov/pubmed/2325968) – particularly after childbirth, but it doesn’t have to!

Lucky for us, women (or men) with stress incontinence benefit most frequently from Kegels. The best way to tell whether you’re doing Kegels correctly and if they’re actually something that would benefit you is to visit your friendly, neighborhood pelvic floor physical therapist. But seeing as how some of us don’t have that option readily available, let’s see if we can figure this thing out together.

Kegels Step-by-step

Start by sitting or standing with feet about hip-width apart and weight evenly distributed through your right and left.
Keeping good alignment (<- link to a video of a pregnant Katy Bowman explaining this) (ribs in line with pelvis, collarbones gently lifted, head over shoulders), lean forward slightly (If standing, you’re putting slightly more weight on the balls of your feet but not going up on tiptoes) – a tip from Julie Wiebe, PT, this will allow the front of your PF that helps with bladder control to engage more easily
- side note – you don’t want to stand like this all the time. You want to stand normally with more weight through the heels! But for engaging the urogenital triangle of the pelvic floor (the part that helps hold in urine), it’s often easier to connect with your weight through your toes when you’re first starting.
Take a few good breaths in, focusing on expanding your lower rib cage (all the way around from the front, sides, and back of the body) and sending happy thoughts to your nether regions.
On your next exhale, try to lift your pelvic floor by using one of these cues:
1. Pull up and in like you’re trying to hold back gas but you don’t want anyone to know
2. Pull your underwear up
3. Bring your tailbone towards the front of your pelvis
4. Pretend you’re lifting an elevator
Hold this contraction for up to 10s without holding your breath

Congrats! You just did a kegel!…or did you? Typically, this is when my patients tell me they’re not sure whether they’re actually doing it right. Or they use every muscle around the pelvic floor, except the PFM themselves.

Tips for knowing whether you’re doing a kegel correctly:

Place your hands on your glutes while you perform. Is your cutie patootie squeezing for all it’s worth? When you do a kegel correctly, your rear-end shouldn’t be moving much (remember you’re holding back gas and you DON’T want anyone to know)
Place your hands on your belly. Is it pushing out into your hands? We definitely don’t want this. You’re probably bearing down (like too many of us when we’re constipated) and could be performing a Valsalva (not a Latin dance move), which could potentially worsen things over time.
Place your hands on the inside of your thighs and notice whether your legs are clenching in tight. These adductor muscles should also not be the primary drivers of the contraction
Place a hand over the front of the pubic bone with pads of your fingers between your legs on your perineum (like a little girl who has to go REALLY BAD and doesn’t care who knows). When you kegel, you should feel a lift in this area. [If you don’t know what your perineum is, and, let’s be honest, so few among us has a great grasp on that anatomy – I serve up what you need to know in this article]
If you really want to know, grab a hand mirror and look! While performing a kegel you should see your rectum pucker and your perineum (the space below the vagina but above the rectum) lift up. If the perineum is moving down toward the mirror, you’re bearing down and performing a Valsalva.

When you’re still not sure

If you’re still not sure, there are some handy-dandy tools out there that might be of service – but they’re also a little more intimate. And some are cheaper and/or easier to get than others.

Tampons – insert one and then hold onto the string. When kegeling, you should feel a slight pull up. You can also practice pulling down on the string a little while trying to resist it. Obviously, this may be a little uncomfortable to get in/out depending on the amount of -ahem- moisture available. Also, make sure you’re not leaving a tampon in when not menstruating as it could lead to some serious health issues. (While we’re on the subject of tampons, you might also think about trying a more natural version if you’re concerned about chemicals and/or irritation)
Baby calf nipple – this is almost the same idea as the tampon, but easier to slide in and out. This is also a cheap option and can be purchased online or at your local farm supply store. Make sure you clean with unscented soap before using it.
Condom with marbles, carrot, or another hard object – this will give you something to squeeze around and most people have easy access to (but please don’t stick something foreign into your vagina on its own, particularly without a way to get it out. Remember stories of kids sticking peas, marbles, coins, etc, into their noses and then having an exciting trip to the ER to remove?)
The pelvic floor educator – more pricey than the above-listed options, but also provides better feedback on whether you’re performing a kegel. The wand moves up toward you if you’re performing a PF contraction
Weights and/or exercisers – much more expensive than the other options but may give you better feedback. Not required by any means, but some women are more likely to do their exercises when they’ve doled out a little dough (hello gym membership!)

Have at it!

However you choose to kegel, I hope you feel more comfortable connecting to your pelvic floor. Because this connection is really what it’s all about – not strengthening your pelvic floor into oblivion. In fact, Kegels will not solve the problems surround incontinence for the long haul on their own. We need a bigger view of the body and all its parts! A great way to start this journey is to check out my guide on how to incorporate this knowledge into more of your day to day because if you’re like me, another thing to add to the to-do list does not a happy lady make.

P.S. If you have pelvic pain (including with sex), don’t do Kegels until you’ve addressed this with a health care provider. At times women’s PFM are actually shortened and too tight, and this can cause bladder leakage. If you do Kegels, you’re exacerbating the issue. Any questions or concerns about whether you should do Kegels or not? Go see your primary care provider, OB-GYN, or pelvic health PT. You can see a PT without a referral in many cases and she/he can set you on the right path.