“Do 400 Kegels per day.”
“When you’re pregnant, you don’t want to get too tight, or the baby won’t come out.
“Everyone should do 30 minutes of Kegels a day.”
As a pelvic floor physical therapist, I’ve seen all of these on the internet. But what is the truth?
“Just do your Kegels” is what many pregnant people hear from providers. The internet is full of advice on what to do and not to do during pregnancy. Let’s dive into the truths and myths surrounding the Kegel.
What is a Kegel?
A Kegel is the name for the voluntary contraction you can do with your pelvic floor muscles (PFM). This contraction involves both a circumferential tightening and lift of your pelvic floor muscles. If performed correctly, over time your pelvic floor muscles can become stronger.
What are the PFMs?
The pelvic floor is made up of muscles, organs, and connective tissue. The PFMs are a hammock of muscles that sit at the bottom of your pelvis. They perform four main functions:
- Continence: these muscles allow you to hold back your bladder and bowels until you decide it’s the right time to go – not in the middle of a run or exercise class.
- Organ support: the muscles help keep your colon, uterus, and bladder elevated.
- Posture: the muscles work in concert with your abdominals as part of your core support and postural control.
- Sexual Pleasure: the PFM help improve your ability to have, and enhance the strength of, your orgasms.
Of course, you want all of these, so let’s get going.
Before I teach you how to perform Kegels, I think it’s worth knowing a bit more about these muscles. First, you have fast and slow-twitch muscles. We’ll refer to these as your “sprinter” versus your “marathon” muscles. The sprinter muscles help quickly close and lift, and keep your pants dry, when you laugh, cough, or sneeze. The “marathon” muscles are always a little bit active and help keep your uterus, bladder, and bowels up where they should be through your whole day.
Why perform Kegels?
Strong pelvic floor muscles help reduce your likelihood of having pelvic floor dysfunction such as pelvic organ prolapse and leaking urine. Pelvic floor dysfunction occurs when the muscles aren’t working properly to help with the four functions above, and can result in leaking pee when you get to your front door, losing urine with laughing, coughing, or sneezing, pain with sex, constipation, and your organs descending downward.
There are different kinds of pelvic floor dysfunction: underactive or “weak” and overactive or “tight.” People with weak PFM experience leaking urine or stool with laughing, coughing, sneezing, or exercise or at the front door. Weak muscles might also feel like pelvic floor heaviness. Symptoms of overactive pelvic floor muscles include constipation, pain with sex, tailbone pain, pain with sitting. If you think to yourself, “Well, I’m leaking, so I must have a weak pelvic floor,” know that you can simultaneously have a “weak” and “tight” pelvic floor. If you suspect pelvic floor tightness, see a pelvic floor PT.
A few factors that can contribute to pelvic floor dysfunction include your pelvic floor muscle strength and coordination, whether or not you’ve had children, if your job involves lots of lifting, constipation, aging, and how strong your connective tissue is. We can’t change how old we are, but we can change the strength and coordination of our muscles.
There are significant downsides to having weak pelvic floor muscles. Leaking urine is one type of pelvic floor dysfunction which can make people less likely to be active. Yet we know that physical activity is important for our health. Staying active can help by reducing depression and anxiety, controlling and reducing diabetes, reducing our chances of getting osteoporosis, lowering high blood pressure, reducing the effects of obesity, and lowering the risk for breast & colon cancer, and reducing coronary artery disease.
Urinary incontinence occurs in up to 46% of women in the US, and up to 50% of women show some degree of pelvic organ prolapse during a vaginal exam. Kegels or PFM exercises have been shown to reduce stress urinary incontinence or leaking with physical exertion or downward pressure like coughing, sneezing, laughing in many women.
When NOT to do Kegels!
Despite the clear evidence that Kegels can help reduce pelvic floor dysfunction, there are times when Kegels are the wrong thing to do. If you fall into the category of overactive pelvic floor muscles, Kegels will likely only exacerbate the problem. If you suffer from painful sex, trouble emptying your bowels or bladder, or pelvic pain, consult with a pelvic floor PT and don’t do Kegels. Imagine this: if you squeeze your biceps so much that you couldn’t fully straighten your arm muscles, you wouldn’t start squeezing your arm more, you would get therapy to help relax those muscles first. Eventually, you might be appropriate for strengthening. In pelvic PT, we say “lengthen before you strengthen.”
Another time to NOT do Kegels is on the toilet. When you’re on the toilet, we want you to empty your bladder, and Kegels stop the stream of pee. Please try Kegels at a time when your pelvic floor should be squeezing.
If you perform Kegels and your symptoms get worse, stop and consult with a pelvic floor physical therapist or your care team. Symptoms like leaking urine can happen because of a combination of overactive or tight and underactive muscles.
When do I start Kegels?
Ideally, start performing Kegels when you are pregnant. However, any time is a good time to start. A stronger pelvic floor is associated with less preterm labor. If you are postpartum, you can start a few days after birth as long as you don’t have a catheter and your team thinks it’s okay. I have people start gently using their core muscles, including their pelvic floor, within the first few weeks after birth. The key is to use them gently at first. The marathon muscles are always working to help stabilize your posture, so starting gentle awareness and activation after birth is usually okay.
How to Do a Kegel
If you’re early on in your journey, know that these muscles move very little and you may not feel a significant lift and squeeze, but you will eventually.
I’m always saying “less is more.” To get a good idea if you are performing them correctly, whip out a mirror, check yourself (yes, I do mean that–wash your hands and/or use gloves and lubricant to make yourself more comfortable), or see a pelvic floor physical therapist.
- Start out lying down when you can fully relax and pay attention to your body. Take a breath in, and as you start to exhale, imagine like you are gently “holding back gas.” The cues, “hold back gas” or “tighten and lift your anus” are very helpful when teaching women to contract their pelvic floors. If you like a bit of humor, think about “sucking a smoothie up through a straw into your vagina.”
- After performing this squeeze, give yourself five to 10 seconds to fully let go.
- Now I want you to put one hand on your belly and one hand on your inner thigh. Inhale, and as you breathe out, “hold back gas” and check that your abdominals and thigh muscles are staying relaxed. If, like most people, you feel those muscles contracting, start over. Fully release your muscles. During your next attempt at a “Kegel,” try a smaller squeeze.
- Next, try a pelvic floor contraction or kegel and see if you are breathing or holding your breath.
- During an ideal Kegel, you can breathe in and out normally and you are only using those muscles at the bottom of your pelvis.
- Try a few long holds and quick squeezes. After each little quick contraction, fully let go before you try the next one. Releasing your pelvic floor muscles is often harder than squeezing them. You may need to wait 10 seconds as your pelvic floor muscles release down after a long squeeze.
How many Kegels?
It’s best if you see a pelvic floor physical therapist to check how long you can hold those muscles. Ideally, try to perform squeezes for up to 10 seconds. Perform 10 Kegels in a row, three times a day. However, every individual is different. You may need to start with five squeezes for a 3-second hold if you are weaker and work your way up to 10 seconds. You may also have different needs. A crossfitter will need a stronger pelvic floor than someone whose main exercise is swimming.
Note: Kegels aren’t the be-all-end-all. Many other factors contribute to pelvic floor dysfunction like posture, breathing, and your use of other muscles. If you have significant leaking, prolapse, or pain, see a pelvic floor specialist.
Here is How to Find a Pelvic Floor Physical Therapist