Back to the basics… Kegels 102.

I’m calling this post “Kegels 102” because — to be perfectly honest — it’s revised from a post I wrote nearly three years ago. THREE YEARS AGO! Time flies!

This post has some great info, and a dear friend of mine recently reminded me that the pelvic health content offered on this blog is truly priceless for women. My pelvic health posts can be a bit difficult to search for, as they are hidden among layers and layers and LAYERS of posts (nearly 300!).

If you want to know why you should do kegels or how often to do kegels or what other exercises are recommended in addition to kegels, check out my book! If you want to know how to do kegels, keep reading.

Let’s talk about the basics:

Kegels 102

You have probably heard of a “kegel,” the basic technique used for strengthening the pelvic floor based on the research of Dr. Arnold Kegel (an obstetrician/gynecologist circa 1940s). Contracting and relaxing the pelvic floor muscles seems simple, but surprisingly, many women who think they know how to do a kegel are not contracting the appropriate muscles when examined for technique. There are a few steps you need to take to make sure you are doing kegels correctly. If not, your efforts to exercise will be futile and you may even be damaging your pelvic floor.

Try this: Lie down on your back with a pillow under your hips and your knees bent. Place a hand on your belly and breathe normally. Contract your pelvic floor muscles (the muscles that lie at the base of the pelvis and surround the vagina and rectum) by squeezing in and lifting up as if you’re trying to stop the flow of urine. Next, COMPLETELY RELAX the pelvic floor muscles.

Now ask yourself some questions. Did you feel your abdomen move? Did you feel your buttocks clenching? Were you holding your breath? Were you bearing down? If you answered yes to any of these questions, you did not do the kegel correctly. The aim of a kegel is to isolate the pelvic floor muscles which are internal, so there should be no external movement as they contract and relax. NO ONE who is watching from the outside should have any clue that you’re exercising, when in fact, you’re working a vital group of muscles.

Image © Lindsey White, http://www.colorinblackandwhite.com

Take a Look!

To make sure you are performing kegels correctly, use a handheld mirror as you lie in the position described above. This is best done without underwear. As you contract the pelvic floor, the perineum – the area between the vagina and the anus – should move slightly upward and inward (toward your head). If you see the area bulging outward, stop here! You are not doing a kegel correctly. When you relax the pelvic floor, the perineum should return to its normal resting position. If the muscles stay contracted and you’re unable to return the pelvic floor to its normal resting position, stop here. Read on for more information, and then try again.

In addition to taking a look, you can also lightly touch the perineum while you perform the exercise. This can be done with or without underwear. Again, the perineum should move slightly upward and inward as the pelvic floor muscles contract, and return to its normal resting position when the pelvic floor relaxes. If this does not happen, stop here and keep reading for more tips before trying again.

The above techniques – looking and touching – are called “simple biofeedback.” They provide sensory information (visual and tactile) to the brain to help coordinate the command with the movement.

Visualization

If you are not able to perform a kegel correctly, try concentrating on the following visualizations. After you’ve found one that makes sense to you or resonates with you, try the exercise again with one of the simple biofeedback techniques described above.

Visualization One: The Flower. Think of your vagina as a flower that is wide open, like a rose in full bloom. Now visualize the flower closing up tightly and back into the shape it had as a bud, like time lapse photography going backward from summer to spring. Try contracting your pelvic floor (pull in and up) as you visualize the tightly closed bud. Relax the pelvic floor as you visualize the flower in full bloom.

Visualization Two: The Ball. Picture a small, smooth, round ball or marble. Visualize the ball coming into your body as you contract your pelvic floor. Imagine it rolling out as you relax the pelvic floor.

Visualization Three:The Elevator. Imagine your pelvic floor muscles as an elevator that is stopped at the ground floor or the lobby of a building. Contract your pelvic floor muscles as you imagine the elevator doors sliding closed, then lift your pelvic floor muscles upward as you imagine the elevator rising to the second or third floor. Hold briefly at the top of the contraction. Release the contraction as the imaginary elevator lowers and returns to the starting position (the lobby). Fully relax your pelvic floor muscles as you imagine the elevator doors sliding open.

One More Check-In

The following are some cues that you are NOT performing a kegel correctly:
o You can feel or see your abdominals or your buttocks contracting
o You find yourself holding your breath
o You are pushing or bearing down (as if having a bowel movement)
o You cannot see or feel your perineum lift through simple biofeedback

Please do not be discouraged if your form is incorrect and if, after a week or two of training, you still can’t “get the hang” of it. Up to fifty percent of women are unable to complete kegels correctly with verbal or written instruction alone. If you feel that this is the case for you, don’t give up. Seek out a women’s health physical therapist or an urogynecologist. Both disciplines have special training in the treatment of pelvic floor dysfunction including underactive pelvic floor muscles and poor coordination of the pelvic floor. These providers can help you find the pelvic floor muscles and complete a correct contraction. They will prescribe a pelvic floor strengthening program based on your strength level and your needs.


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