Kegel Exercises: What to Know About Pelvic Floor Exercises

We know that we tend to lose muscle as we age, and not just the ones that move our bodies. The pelvic floor muscles that control our internal organs, including the bladder, also can become weaker as we get older, or after pregnancy or childbirth. When these muscles do not function correctly, people often experience symptoms and may think that the muscles need to be strengthened. But that may not always be the case.

What are the pelvic floor muscles?

The pelvic floor muscles sit at the bottom of our pelvis like a hammock, or a bowl with the muscles forming the bottom. There are openings in these muscles that allow us to urinate, defecate, and for those with a vagina, have penetration or menstruate. 

These muscles have several functions:

• support: for the pelvic organs—urethra, bladder, uterus, ovaries, rectum, prostate
• stabilize: hold the pelvis together from the bottom and provide stability to the hips, tailbone, and lower spine
• sexual: orgasm, erection, ejaculation, and penetration for intercourse
• sphincter: to provide a valve for holding back urine, feces, and gas, and to relax adequately to assist with voiding of urine and bowels

Problems with these muscles can occur at any time during a person's lifespan. Pelvic floor dysfunction can result from trauma, childbirth, hip or spine injuries, cancer (prostate, bladder, uterine, cervical, rectal, etc.), surgery, radiation, and menopause. 

What are Kegel exercises? 

Kegel is a name for a type of exercise used to isolate, strengthen, and control the muscles of the pelvic floor. The name comes from Dr. Arnold Kegel, a physician who developed a program to strengthen these muscles.

Can Kegel exercises help improve pelvic floor function and bladder control?

Yes and no. Many believe that an involuntary loss of urine must be due to a loss of strength in these muscles—and this is certainly true for some people. However, it is often more complex than that.

The trick with pelvic floor exercises, including Kegels, is that muscles not only have to contract to work properly, they also have to relax completely in order to function properly. If you have a tight pelvic floor, and you contract that muscle, you risk increasing the tension of that muscle and may still be unable to control urine. Having a tight muscle is not the same thing as having a toned muscle. 

What do I need to know about Kegels?

While Kegel exercises can certainly be effective for help with bladder control, it is important to understand three things before beginning a program.

1. To do Kegels correctly, they must be done in isolation. This means that using other muscles like the buttocks, inner thighs, and abdominals (and holding your breath) should not happen when you are doing a proper Kegel, or they will not be effective.
2. Kegel exercises are most effective when dealing with stress urinary incontinence (loss of urine with a cough, laugh, lift or sneeze) versus urge urinary incontinence (losing urine following a strong, sudden urge or trying to get to the bathroom).
3. Kegels can often make pelvic pain worse, and it is never recommended to begin a Kegel exercise program without consulting a medical expert in pelvic pain.

How to do Kegel exercises 

While Kegel exercises will not help everyone, they are an easy way to attempt to improve bladder control at home. It is essential to do them correctly to truly be able to assess whether these exercises are effective for you.

First, always do Kegel exercises with an empty bladder, and never on the toilet while stopping the natural flow of urine. This can lead to other health concerns, including urinary tract infections.

It is best to begin doing these exercises when laying down, and then progress to standing when you feel you can isolate them properly. When you do a Kegel properly, you should feel upward movement in your perineum (the area between the vagina or scrotum and the anus). Perhaps the simplest way to perform the exercise is to make sure your buttocks, legs, and abdomen are relaxed, and then imagine gently attempting to pick up a "blueberry" with your anus or vagina. You do not need to squeeze the muscle hard for this to be effective. In fact, if you are doing a Kegel perfectly, no one should know you are doing one. The only thing that moves during a Kegel is the pelvic floor itself.

Once you find the muscle group, you can gently squeeze and hold for three to five seconds, and then relax the muscle completely for three to five seconds. Do this five to ten times for two to three sets, one to two times per day. Once you get better at them, you can work on holding them for longer, up to ten seconds with equal amounts of rest between reps. Work your way up to ten repetitions for three sets, two times per day. Remember that more is not always better. We do not want these muscles to fatigue.

What do I do if Kegels do not help my problem?

The good news is that there are many experts who can help you stop your incontinence once and for all. Any involuntary loss of urine (no matter how small) is not normal at any time and can be fixed. Pelvic physical therapists are specially trained professionals who can use a variety of interventions to help restore proper pelvic floor function. 

Additionally, seeing a urologist may be helpful to assess if there are any underlying issues with your kidneys or bladder that are contributing to your symptoms. If you are unsure if a Kegel program is right for you, ask your primary care provider for a referral to a specialist who can help.