The Kegel exercise is the cornerstone of pelvic floor (PF) rehabilitation for incontinence and prolapse. Some have called Kegels a worthless activity or a waste of time. Nothing could be further from the truth. Kegel exercises are highly effective if performed correctly and that is where women need more direct instruction. Today, I will give you that direct instruction.
Let me begin by telling you a proper Kegel or PF contraction is a two-step process. The first step is to squeeze your PF muscles as if to stop the flow of urine or the passing of gas. Usually, this step is the only one women are instructed in and the second most important step is left out. That critical second step is to draw your PF up into your pelvic outlet, as if there is a string attached from your belly button to you PF and you are attempting to pull it up into your abdomen. This elevation takes your pelvic floor from a bowl shape to a flattened, tighter position within your pelvic outlet.
You can confirm that you are doing the first part of the Kegel correctly by inserting your finger tip into your vaginal opening. You will feel a light squeeze on your finger when contracting your PF. The second part – the PF elevation - cannot be felt with palpation since the muscles that are working are internal. You can, however, feel your belly button draw in as you work to elevate your PF. The movement you are feeling is the contraction of your TA (Transversus Abdominis) muscle which cinches up your midsection and works in a coordinated fashion with your PF. One final cue is to remember to keep breathing as you elevate you PF. If you are holding your breath to draw your belly button in, you are using the wrong muscles. Therefore, focusing on continuing a steady breathing pattern is important.
It’s important to note that PF elevation is not easy as you first begin. It requires concentration and visualization because this is a contraction that you cannot see, but can only feel. Initially you should perform this exercise lying on your back with your knees bent. Work to hold your PF elevation for 8-10 seconds (remember to keep breathing normally!) before releasing and allowing your PF to completely relax.
On our Hab-It: Pelvic Floor DVD, I then instruct patients to follow this long hold with four “quick flicks” which are actually quick contractions of your PF or simply part one, outlined above, of a Kegel contraction. These don’t require a longer hold. Rather, they are performed to a rhythm of “contract-relax-contract-relax…” and so on. You can visualize these quick contractions being important for strong and fast reactions of your pelvic floor as you cough, laugh, or sneeze. The elevation of your PF that is the second part of the Kegel contraction works the muscles of your pelvic floor that have endurance roles. This includes supporting your bowel, bladder, and uterus, and giving effective compression to the pathway extending from your bladder to your urethral opening. It is this compression that will help to completely resolve your incontinence symptoms.
Simply performing the first part of the Kegel and just tightening the muscles around the three openings of your pelvic floor will NOT help with prolapse issues and usually will not completely resolve incontinence. It is this incomplete exercise instruction that is giving the Kegel a bad rap. Many women blog that they performed 40 + Kegel exercises per day for weeks and saw no results. My message is to try it again, focusing on a 2-step process and let us know the changes you experience after four weeks.
So, back to our initial question…”To Kegel or Not To Kegel?” I give an emphatic “YES”, you must Kegel but you also must do it right!