Pelvic floor

Kegel exercises

How to find your pelvic floor muscles, how to do Kegels correctly, and what to do if you have trouble.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

What are the consequences of a weak pelvic floor?

As a woman ages, the pelvic floor muscles may begin to sag and weaken from the stress placed on them. Many conditions can stress the pelvic floor, including:

• Pregnancy-related changes in the body
• Heavy straining during childbirth
• Damage to the pelvic floor sustained during childbirth
• Repeated straining, such as during bowel movements or with chronic cough
• Repetitive heavy lifting

As a woman goes through menopause, estrogen levels fall, which leads to weakening of the pelvic floor muscles. Weak pelvic floor muscles can result in pelvic organ prolapse, when one of your pelvic organs falls out of place. Prolapse can occur to the bladder, urethra, uterus, rectum, intestine, and vagina. Other consequences include involuntary leakage of urine or stool (urinary and fecal incontinence).

What are the benefits of strengthening the pelvic floor?

• Maintaining the strength, tone, and elasticity of the pelvic floor muscles, which helps support the abdominal and pelvic contents against gravity
• Helping with bladder and bowel control
• Improving sexual response for you and your partner

How do I recognize the muscles?

It can be difficult to learn to contract your pelvic floor muscles correctly. There are several ways to check that you are using the right ones:

• Sit on the toilet. Empty a small amount of urine and try to stop the flow. Then relax completely and let your bladder empty. If you cannot stop the flow, it is a sign of pelvic floor muscle weakness. If you can, you have the basic technique.
• Insert one finger into the vagina and tighten your pelvic floor by squeezing around your finger. You should feel the vagina tighten around your finger and the pelvic floor move up slightly. Relax and you will feel the pelvic floor lower.
• During intercourse, tighten your pelvic floor muscles around your partner’s penis. Your partner can help you evaluate their strength.

What if I still have trouble finding the muscles?

If you cannot stop the flow of urine or feel any squeezing around your finger, mental imagery can help. Try one of these:

• Imagine gently lifting your entire perineum, from your pubic bone back to your tailbone, upward
• Imagine lifting the clitoral area into your body
• Imagine pressure running up the inside of your thighs and into your vagina
• Imagine drawing the edges of your vagina inward
• Imagine lifting a tampon

Be sure you do not put too much effort into the contraction. Too much effort can lead to the wrong kind of contraction, called a valsalva maneuver, which is a bearing-down technique similar to having a bowel movement. If you are having difficulty, put only 50 to 60 percent effort into each contraction and go slowly and gently. You are much more likely to get the correct contraction this way.

How do I start?

When learning Kegels, start in a position that lets you isolate the pelvic floor muscles: sitting on a hard surface, lying on your back with your knees bent, or lying on your side.

1. ContractContract your pelvic floor in the same manner as when you identified the muscles above.
2. HoldHold the contraction for one to two seconds.
3. RelaxRelax all the way for 2 seconds.

Repeat this sequence 10 times, and try to do it 3 to 5 times a day. Once you can hold for 2 seconds, increase the hold to 3 seconds, alternating with a 3 second rest. Keep increasing the hold time until you can hold for 10 seconds, always resting for the same length as the hold.

Getting the most out of your exercises

• Use only the pelvic floor muscles, not your buttocks or thigh muscles. If you are doing them correctly, no muscle movement will be seen.
• Do not hold your breath. Breathe normally and focus on the pelvic floor muscles tightening and relaxing.
• Make sure the muscles around the vagina and rectum contract equally. If you feel more tightening around the rectum, place your hand near your pubic bone for tactile cueing. The goal is to feel the muscles around the vagina and rectum tighten strongly and evenly.
• At first the muscles may not want to stay tightened for long. When you feel them let go, tighten them again. In a week or two you will notice the control improve.

How do I progress?

Start lying down or reclined. Once you can do the exercises well there, try sitting, then standing. Work them into your daily routine so doing them becomes a habit, for example while:

• Washing your hands
• Watching television
• At stop lights
• Waiting in long lines
• Checking your email
• Brushing your teeth

What if I still have problems?

If you still cannot get a proper activation of the muscles, physical therapy can help. Techniques commonly used include:

Biofeedback

Special computer equipment measures muscle activity so you can use the feedback while exercising to learn to contract and relax your pelvic floor muscles properly. Methods include a vaginal or rectal sensor, electrodes placed near the vaginal or rectal areas, and ultrasound imaging.

Electrical stimulation

A small electrical current is passed through the pelvic floor muscles using a vaginal probe. This makes the muscles contract and helps you learn to contract them. It does not hurt, but you will feel a tingling sensation through the pelvic floor.