What are Kegel exercises?
Let’s talk about Kegels: kee-gels or is it kay-gels? Either is correct, so it doesn’t matter how you say it! This term means a shortening contraction of the pelvic floor muscles, just like a bicep curl is a shortening contraction of the bicep muscle. The name for this exercise comes from gynecologist Arnold Kegel, who published the first paper in 1948 on doing these exercises to improve common symptoms after childbirth. Performing Kegel exercises is a very common recommendation by healthcare providers for pelvic floor symptoms, however most women don’t perform the exercises correctly, or don’t know how many to do, or how to progress them appropriately. A pelvic health PT is the provider to help you through this, but below is a general guide.
Should I be Doing Kegel Exercises?
So, should you be doing Kegels? And if you are doing them, how do you know you are doing them correctly?
Kegels are the strengthening contraction of your pelvic floor muscles. Your pelvic floor muscles are located at the bottom of your pelvis, between your pubic bone and tailbone, and sideways to your sit bones. They help support the pelvic organs and play a vital role in deep core stabilization. If you have symptoms of weakness in these muscles, like urinary incontinence, prolapse, gas or bowel incontinence, are pregnant or have just given birth, it may be a good time to focus on doing Kegels as part of your daily routine or exercise program to help reduce or eliminate these symptoms.
You should not focus on doing Kegels if you have been told by a provider that you have a tight or overactive pelvic floor. Other symptoms of this are painful penetration, like with intercourse, tampon use, or a GYN exam. Sometimes it can also cause constipation and painful bowel movements, as well as urinary urgency, frequency, and even incontinence. If this sounds more like you, get evaluated by a pelvic health physical therapist and see the recommendations a little later in this post about what to do instead of Kegels.
How Do I Know I’m Doing Kegel Exercises Correctly?
- It should feel subtle. Deep in the pelvis you should feel some tightening and lifting like the muscles are pulling up inside of you, toward the spine. It’s ok to feel it both in front, by the urethra, and by the anus.
- You shouldn’t feel your glutes (butt cheeks) or any of your other leg muscles tightening. When you aren’t specifically also doing EM Core Compressions, there should be very little abdominal co-contraction, but you may still feel some activation in the lower abdominals.
- You can look at yourself with a hand mirror to make sure your vaginal opening closes and lifts, or you can feel this tightening with your own finger. Of course wash your hands first, and after, and use lubrication.
- If you see bulging of this area, or the area moving outward, that is not correct. This is called a Reverse Kegel or a Pelvic Drop.
There are a few different cues to think about when learning how to do Kegel exercises. The classic is to imagine you’re in the bathroom, peeing, and imagine trying to stop the flow of urine. (Peeing is not a time to actually perform Kegels, you are just imagining). Another cue is to imagine picking up a blueberry or a marble with your vagina. You can also think about moving the bones of the pelvis closer together, the pubic bone and the tailbone, or bringing the sit bones together.
Once you get the hang of how to turn the pelvic floor muscles on and do a Kegel, it’s important to vary the way you do them and to vary the position you do them in, in order to keep challenging your muscles. The different ways to do isolated Kegels, not with another exercise, could be described like this: quick squeezes, endurance/submaximal holds, and elevators.
- Quick squeezes are just that – quick. Do a Kegel, with maximal effort or power, and then let it go right away and relax completely back to where you started. Then repeat. I recommend doing sets of 10-12 reps.
- Endurance or holding contractions should not be done with maximal effort. Use 50% to 70% effort to activate the muscles, then try to hold steady for several seconds (remember to keep breathing while you’re holding). Relax completely back to where you started and repeat.
- Elevator contractions are a combination of quick squeezes and holds. To do them, activate your muscles by doing a really gentle Kegel, then try to add more effort into it (or “go up another floor,” like in an elevator). I usually recommend people try to complete 3 to 4 “floors.”
How Do I Know if My Kegel Exercises Are Working?
Strengthening the pelvic floor muscles takes time, just like strengthening any other muscle. If you have a consistent practice of doing Kegels and are progressing them appropriately, you should see a reduction in your pelvic floor symptoms sometimes in as little as 2 weeks, but definitely by 6 weeks, with additional benefit happening over a full 12 weeks.
Kegel Tips for the Prenatal & Postpartum Period and Beyond
Kegels During Pregnancy
- Don’t overdo it: 2-3 sets of 10, or however you fit them in, is plenty of isolated strengthening. If you are combining them with other exercises as previously mentioned, there’s no need to do additional isolated exercises.
- Make sure to fully relax between each repetition.
- Add in gentle Reverse Kegels or Pelvic Drops during the final 6 weeks of pregnancy to practice “opening the door” and lengthening your muscles. This is the outward or bulging motion of the muscles and the perineum like what you do to force out gas or have a bowel movement. Just like regular Kegels, practice this on an exhale.
- For more information on Kegels during your pregnancy, read here.
Kegels Early Postpartum
Do them gently, with just your breath or gentle Core Compressions (Every Mother’s Early Postpartum Path walks you through this).
The easiest way to perform Kegels is to tag them with a daily activity or to combine them into your other workout regimen. You only need to do a couple of sets per day (2 sets x 10 reps). I recommend doing them while you brush your teeth, and if you forget a day, no big deal!
When Not to Kegel, and What to Do Instead:
If you know you have pelvic floor tightness or overactivity, you do not want to do lots of Kegels. You may know this if you’ve been told by a PT or other healthcare provider that your muscles are tight or if you have any of the previously mentioned symptoms of an overactive pelvic floor. You may also figure out you have a tight pelvic floor if doing Kegels is painful, or you feel crampy, heaviness, or increased pelvic pressure after performing them.
Instead of doing Kegels, you’ll want to focus on the lengthening contraction of the pelvic floor muscles first, a Reverse Kegel or Pelvic Drop to help restore normal range of motion to the muscles before strengthening. A pelvic health PT will have several additional interventions to help as well.
How Do I Know if I Have an Overactive Pelvic Floor?
Overactive, or hypertonic pelvic floor muscles are a common occurrence. Luckily, it’s fairly easy to do a self-check to see if you may have hypertonic pelvic floor muscles:
- Sit in a chair and do a kegel, do you feel a pulling up sensation?
- Now, relax. Do you feel slightly more pressure on the chair?
- Next, bear down like you would to have a bowel movement or force out gas, do you feel even more pressure against the chair?
If you answered “no” to any of these questions, you may have an overactive/tight pelvic floor. A squatting position naturally relaxes the pelvic floor muscles. So sometimes you’ll be able to feel these different ranges of motion (Kegel, relax, pelvic drop) better if you try it in a squatting position. This could be a deep squat against a wall or door, sitting on a yoga block, or in child’s pose.
I would highly recommend being evaluated by a pelvic floor PT if you suspect you have an overactive pelvic floor or experience any of these symptoms, even with the new Overactive Pelvic Floor Path, because this will allow you an individual assessment of all the pieces to your specific pelvic puzzle. Once you have restored your pelvic muscle balance you will likely want to add some Kegels back in with Core Compressions to address deep core strength and synergy. Your PT can advise you as to when the right time to do this is.
Abby Inman PT, DPT, is a pelvic floor physical therapist based in Milwaukee, WI, and the Pelvic Wellness Educator at Every Mother. Abby is passionate about physical therapists being part of the perinatal and postpartum team and loves supporting moms during this very special time in life. She is also an active member of APTA Wisconsin and the Academy of Pelvic Health Physical Therapy.