Why Kegels Alone Aren’t Enough

We pass out Kegels to women like candy on Halloween.  And pregnant women can feel like they’re on the set of Oprah, “You get some Kegels, and You get some Kegels, Everyone gets Kegels.” Just like too much candy isn’t good for your teeth, well too many Kegels aren’t good for your pelvic floor.  Let’s back up a bit.

History of the Kegel Exercise

The Kegel exercise is named after a gynecologist from the early to mid 20th century, Dr. Arnold Kegel, who published a paper in 1948 using a tool he developed, the perineometer, to measure the intensity of a woman’s pelvic floor contraction.  Now some will debate that pelvic floor muscle training was being used a dozen years before by a chap named Morris, and still, others will go even further back to cultures in ancient China along with Yoga practices that were encouraging the engagement of this important muscle group long before. 

The important point is that the Kegel exercise is a term for an exercise that engages the muscles of the pelvic floor.  Which begs the question, what the heck is the “pelvic floor” anyway?!

What Is The Pelvic Floor?

The pelvic floor muscles are the group of muscles that run from your pubic bone to your tailbone and in between your two sitting bones (ischial tuberosities).  This means if you own these bones, you have a pelvic floor. 

Here’s looking at you, our male-bodied friends! 

In female-bodied people, these muscles have 3 main layers: superficial which you can touch externally, a middle layer which forms more ligamentous attachments to the urethra, and a deep layer that extends almost to the level of the Fallopian tubes. 

Approximately 70% of the muscle fibers in the pelvic floor are slow-twitch fibers which means there is an endurance component to the contraction that needs to be utilized in order to train these fibers.  The remaining 30% of the muscles are fast twitch fibers and are better engaged with a more rapid pumping-type contraction. 

These details are important because there is NOT just one generic Kegel exercise that will get to all the layers and muscle fiber types, rather there are over 10 different types of Kegels you need to know about.

Most people know Kegels, as the muscles, you would use if you were to try to stop the flow of urine.  And while the pelvic floor muscles are engaged when attempting to stop the flow of urine, these are primarily just the superficial pelvic floor muscles and are often accompanied by a contraction from the gluteals and abdominals. 

And for the record, you shouldn’t be exercising these muscles while you are actually urinating. 

There are delicate reflex loops that can get muddled when you’re constantly stopping and starting the flow of urine, so when your cheeks hit the seat, exercise shouldn’t compete.  Just relax and breathe and be sure to fully empty your bladder without rushing or straining.  

Breathing Techniques During Pelvic Floor Contraction or Relaxation

Here’s the other major obstacle when attempting to isolate this important group of muscles:  breathing coordination.  As a Women’s Health Physical Therapist, I teach just about every client I see some level of pelvic floor contraction or relaxation (more on that in a minute) and 99% of my clients are breathing backwards. 

There is a unique relationship between your respiratory diaphragm and the pelvic floor muscles that goes beyond the scope of this blog, but suffice it to say that we need these two muscle groups to move in unison, like a piston, in order to manage the pressure in your abdomen and prevent things like abdominal separation (DRA) and pelvic organ prolapse. 

It’s imperative that you learn to exhale as you contract the muscles and inhale to allow them to soften and melt.  Let’s practice!

  1. In sitting, imagine your pubic bone, tailbone, and sitting bones to be aligned in a diamond formation, almost like you were sitting on a napkin turned diagonally so each bone rested on each point of the diamond or napkin.  Keeping your muscles heavy into the napkin, EXHALE and imagine drawing just your pubic bone and tailbone together, almost like you were bringing the top and bottom of the napkin points towards the center. Remember to keep your tummy and your booty muscles quiet.  Now INHALE and allow your muscles to bring these two areas back to their resting state.  Now keeping your muscles heavy into the napkin, try to EXHALE and bring just your two sitting bones towards the center like you were drawing in those two ends of the napkin.  Remember to tell your abdominals and gluteals they shouldn’t be helping!  Now INHALE and allow your muscles to bring these two areas back to their resting state.  This is a great exercise to get the superficial muscles working!!!
  2. But what about those deep muscles?  Remember that the 3rd layer of your pelvic floor extends all the way up towards your fallopian tubes.  Let’s practice finding those!  Imagine you are sitting over a blueberry.  The blueberry is right at the entrance to your vaginal opening.  Start by EXHALING and using your muscles to pick the blueberry up and lift it 2-3 inches into the vaginal opening.  Remember, it’s a blueberry, not a refrigerator, so this is NOT the strongest contraction of your life but instead a controlled lift where you don’t squash the blueberry.  Tell your stomach and butt muscles to not help!  And now inhale to lower the blueberry all the way down and imagine it dropping out and rolling away on the floor.
  3. Once you’ve got the hang of finding the superficial and deep muscles, you can start experimenting with how long you hold the contraction.  For example, try lifting your blueberry and keeping it up there for 10 seconds (if it starts to fall out around 4 seconds, gently pull it back up again without smushing it).  Train yourself to not hold your breath but to continue to inhale and exhale which keeps your pelvic floor muscles engaged.  Check-in with your tummy and bottom to make sure those muscles aren’t hogging all the work!  Next, you can practice quickly lifting and lowering your blueberry in 2-second pumps.
  4. Now that you’ve mastered the different layers of muscles and the different muscle fibers types, we can have a little fun while we practice working the muscles concentrically and eccentrically.  Picture a 3 step staircase inside your vaginal opening.  Replace your blueberry with a marble and practice lifting your marble up 25% of your effort just onto the first imaginary stair. Now 50% of your effort, pull it up a little higher.  Now 100% of your effort, holding the marble at the deepest layer of your pelvic floor.  Here’s the hard part.  Lower the marble just a little bit onto the 2nd stair.  Now lower it just a little more onto the first stair.  Now allow your muscles to completely relax and let your marble drop all the way out.  Hard isn’t it?  On first attempts, most people will say their marble just slid out when they tried to lower it, but practice will help!

Common Mistakes When Learning Kegels

There are some common mistakes that most people make when learning Kegels.  I’ve already mentioned two pitfalls:  allowing the abdominals/gluteals to help and not properly coordinating the breathing so that you EXHALE to contract and INHALE to relax. 

The other big obstacle is forgetting that the relaxation phase is just as important as the contraction phase.  If we all followed the mainstream advice and did Kegels hundreds of times a day, we’d all most likely have tight, angry pelvic floor muscles. 

Yes, we need functional muscles that need to know how to contract to help close our sphincters and support our organs and stabilize our pelvis (especially when a baby is living there).  But we also need pelvic floor muscles that know how to relax so we don’t have to strain to urinate or defecate, so we can support our organs without squeezing them, and so we can eventually slide our babies out. 

If you have bladder issues such as an overactive bladder or pain with vaginal penetration, you could have hypertonic (too much tone, stiff, difficult to lengthen) pelvic floor muscles which need to first learn how to relax before they can learn to generate strength.

How To Relax Your Pelvic Floor Muscles

When attempting to get a client to relax her pelvic floor muscles, lots of cues can be used, but my favorites are:

  1. Allow your muscles to melt like melted butter underneath you
  2. Imagine a super-ripe strawberry underneath your vaginal opening and allow your muscles to smash the strawberry (not a bearing down but rather an intentional heaviness)
  3. Pretend you are going to secretly expel a small amount of gas in public
  4. Allow your muscle to open like the petals of a rose in bloom

Here’s the thing... Kegels are failing millions of women all over the world because they really just teach us how to clench.  The beauty of the Kegel can be its very curse.  Because doing a Kegel is entirely invisible to the casual observer; this widely popular women’s health exercise can be done while you’re sitting on the train or in a meeting without anyone noticing. 

But, doing it when you are still does not make it a very functional exercise nor does it have great crossover to other activities of daily living that are desperate for you to bring your pelvic floor into awareness such as going from sit to stand, lifting that heavy crockpot from the bottom cabinet, carrying an infant or child, and even with routine exercises. 

Once you’ve learned to contract (and RELAX) all the layers of the muscles, concentrically and eccentrically, focusing on the fast-twitch and slow-twitch fibers, it’s time to pull these muscles into your regular daily movement and exercises.  And that, my friends, is a well-balanced pelvic floor, capable of doing life with you!

Disclaimer: If your head is swimming with the contract and relax and the breathing or if you’re not sure you’re even in the ballpark, a Women’s Health Physical Therapist is your best friend.  Not only will they use visual and tactile biofeedback, but some can use biofeedback devices to help determine what’s going on down there.  Find one in your area!  Think you’ve got it mostly figured out but want to take it to the next level and learn exercise programs specifically designed to target this area, I’m your gal.  

Check out the online Core Restore Online Program developed just for women like you!

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