Pelvic floor health is getting lots of attention lately, and so is the number one tip for down-there fitness: kegel exercises. Read on for your complete guide to these seemingly simple squeezes.
This bowl-shaped group of muscles supports the organs in the pelvis, including the uterus and bladder. The pelvic floor controls the openings of the vagina, urethra and rectum and works to stabilize the pelvic region, supporting the spine and hip joints. “It actually has a lot of functions,” says Michiko Caringal, a pelvic health physiotherapist for Happy Down There in Toronto. “It’s so important.”
Kegels (named after Arnold Henry Kegel, an American OB/GYN who invented the exercise in the 1940s) are contractions of the pelvic floor muscles that are meant to tone and strengthen the area. Pregnancy and delivery, abdominal surgery, respiratory issues that involve a lot of coughing (such as asthma) and aging can strain pelvic floor muscles, causing weakness over time. Doing Kegel exercises can make sex more pleasurable (during and after pregnancy) by helping to relax your vaginal muscles and improve your blood circulation down there. Kegel exercises are also a way to treat and prevent incontinence and may assist with childbirth by helping you learn how to relax.
But there are some caveats. Kegel exercises aren’t for everybody, says Caringal. There’s a significant number of women who experience hypertonicity (pelvic floor muscles that are actually too tight) and would benefit more from different exercises to relax the area, she says.
You may hear women say they do Kegel exercises while sitting in traffic or a ho-hum work meeting. It’s true, you can do them anytime, anywhere. However, Caringal recommends taking a quiet moment to lie down and do them so that you are not working against gravity and can focus on the exercise, at least until you master the movement.
Begin by lying on your back on a flat surface, ideally with your knees bent and your feet planted. Now imagine lifting something like a blueberry or ping-pong ball inside your vagina toward your head.
“The cue to lifting up is more important than just squeezing,” says Caringal. Hint: You want to think of gently picking it up and putting it down again. You don’t want to crush it, and you don’t need to squeeze—it’s a blueberry, not a piano. You can target different areas of the pelvic floor with different imagery, she says. There are three main areas of the pelvic floor—front, middle and back—that you can target through visualization (think squeezing at the front to stop the flow of urine, in the middle as if squeezing a tampon up higher in the vagina and at the back as if trying to stop passing gas).
You may have read that the feeling you’re going for is what you experience when you stop urinating in the middle of emptying your bladder, but that doesn’t capture the full sensation, says Caringal. (Plus, you shouldn’t actually practice Kegel exercises while urinating because this can cause elimination dysfunction over time.)
How long you should hold a contraction and how often you do Kegel exercises depends on the person and the problem. A woman with low strength and endurance may only hold them for five seconds before releasing, says Caringal. For some, that isn’t possible and has to be built up over time. You should aim for 10 seconds for a general strengthening routine and then repeat it five to 10 times, three times a day, for a few weeks. Speak with your physician or physiotherapist to decide how long you should continue the routine.
There are devices like Elvie, Kegel balls and other biofeedback trainers (there are a variety of devices that produce stimulation through sound, sensation and even feedback via phone app) that can help make sure you’re targeting the right muscles, as well as vaginal fitness apps to remind you to do your “workout.” Some people find them very helpful, so ask your healthcare practitioner if they think a device might be useful for you.
As your baby and belly grow, there’s more and more weight on your pelvic floor and your muscles may struggle to support it. That’s why, as pregnancy progresses, some moms notice urine leaks when they sneeze or cough. During delivery, the pelvic floor muscles are stretched out even more to make room for baby to enter the world. As a result, nearly 40 percent of women experience some loss of bladder control postpartum. (Postpartum fecal incontinence is also possible for those who have had severe vaginal tearing or major episiotomies during delivery.)
Luckily, experts agree that doing pelvic floor training during pregnancy can result in a shorter labour (a 2004 study published in the British Medical Journal showed that it could prevent a prolonged second stage of labour), as well as reduce the odds of postpartum issues. Norwegian research published in 2017 even found that pelvic floor training during the second half of pregnancy prevented postpartum urinary incontinence in their test subjects.
Before you start working out your pelvic floor, talk to an OB/GYN, a midwife or a pelvic floor physiotherapist to assess the tone of your pelvic floor with an internal exam. “Kegels are not one size fits all,” says Caringal. “You need to know the state of your muscles or you can’t train them properly.”
Some people have trouble identifying and isolating their pelvic floor muscles, while others experience discomfort when they attempt Kegel exercises (in which case the exercises should be discontinued until discussed with a healthcare practitioner) or aren’t sure if Kegels are right for them. An expert in pelvic health can create a personalized plan to help you work on tone, strength, coordination and endurance, according to your body’s needs. “That empowers you, which is most important of all,” says Caringal.
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