How to Do Kegel Exercises

What is a Kegel?

One of the most common questions I hear as a pelvic health physical therapist is, “should I do Kegel exercises?” These movements are designed to support bladder function and therefore are a great treatment option for managing bladder leaks.

These exercises are isolated muscle contractions that are only performed by the Pelvic floor muscles. The method was named after gynecologist Arnold Henry Kegel, who was the first to define pelvic floor exercises. Let’s dive deeper to understand how they can be beneficial for women experiencing bladder leaks, and how to perform them.

Let’s dive deeper to understand how they can be beneficial for women experiencing bladder leaks, and how to perform them.

There are several benefits of Kegel exercises for women including:

  • Aid in postural support, which helps reduce low back pain
  • Assist with sphincteric control (muscles that contract to maintain continence)
  • Improve sexual function
  • Aid in lymphatic and blood flow

Last, but certainly not least, they can help improve pelvic floor muscle strength and endurance, which helps control and support the bladder. This is because strengthened pelvic floor muscles keep the bladder, uterus, and rectum in place. Strengthening ultimately helps improve coordination of the sphincter muscle and control the opening/closing of the urethra, which can minimize or prevent accidental leaks.

Proper Form

It’s important to know how to do Kegels to ensure you activate the right muscles supporting the bladder. It’s also vital to know proper movements to avoid injury or over-working the pelvic floor muscles.

First, you should empty your bladder. This ensures that you have no discomfort during the exercise and can focus on the contraction as well as the relaxation.

To begin the exercise, imagine you are squeezing your muscles to stop a urine stream. You should first contract from the anus then towards the vaginal opening. Another way to think of this is contracting “from back to front.”. Note you should not practice while you are urinating, as this disrupts the natural reflex your pelvic floor needs to relax during voiding.

You should feel your abdominals gently draw in, but you should not feel your buttocks squeeze or your legs tighten together. Think of this as a “secret” exercise – anyone sitting next to you would not be able to tell you are doing anything at all.

Different Ways to Perform Kegels

There are different ways you can perform Kegels to support bladder function, so you should work with a pelvic health physical therapist to define your goals so you can train your muscles properly.

To Reduce Reactive Leaks

If your goal is to manage bladder leaks that result from coughing or sneezing, you will need to control the reactive nature of your pelvic contractions. For this type of incontinence, I recommend “Quick Flicks”:

  • Perform a quick pelvic floor muscle contraction, a.k.a. hold for 1 second
  • Release the contraction
  • Repeat the contraction for 10 repetitions, aiming to work up to 30 quick contractions
  • Perform the set daily

To Improve Endurance

If your goal is to improve endurance of your pelvic floor to better support your bladder, it’s best to hold the pelvic floor muscle contraction for a longer amount of time. To build endurance, try the following:

  • Contract your pelvic floor and hold for 3 to 5 seconds, aiming to work up to a 10-second hold
  • Perform 7-10 repetitions, aiming to work up to 15-20 repetitions without a break
  • Perform the set 3 times per week

Advanced Kegels

Once you have achieved the “long hold” type of endurance mentioned above, you can try a more advanced type called “Descending Elevators.” Please note that these advanced exercises require the help of a physical therapist.

To perform Descending Elevators, follow the process below:

  • Stage 1:
    • At the “100th Floor,” perform a pelvic muscle contraction at 100% effort. To confirm you’re contracting at 100% effort, use pelvic floor muscle biofeedback by working directly with a pelvic health physical therapist.
    • Then, go to the “50th Floor” and hold a contraction at 50% effort for 3 seconds.
    • Rest.
    • Repeat the sequence 5 times.
    • Perform daily for 2-4 weeks, then progress to Stage 2.
  • Stage 2:
    • Hold 100% of a pelvic muscle contraction for 3 seconds.
    • Then hold contractions as you descend the levels: 75%, then 50%, then 25%.
    • Repeat the sequence 5 times.
    • Perform daily for 2-4 weeks. Then, perform 3 times per week for maintenance.
  • Optional:
    • You can also progress the exercises by adding Ascending to Descending Elevators. Start at a 25% pelvic muscle contraction, then 50%, 75%, 100%. Once you get to 100%, descend back to 75%, 50% and 25%. Hold for 2-3 seconds at each level.

    Working With a Pelvic Health Physical Therapist

    Since Kegel exercises can improve bladder function, many of my patients experiencing bladder leaks are anxious to get started right away. However, I always make sure we first cover how to properly do a Kegel.

    Research has shown that 16-31% of women with pelvic floor dysfunction do not perform Kegels correctly when only given verbal instruction. This explains why new patients sometimes tell me they’ve tried these movements on their own but didn’t see any improvement in bladder leakage. To achieve real results (like minimizing or stopping bladder leaks), I recommend working with pelvic health physical therapists who can help with:

    • Understanding how to perform Kegels correctly and walking you through the movements 1:1
    • Providing a detailed evaluation to determine your health needs and goals
    • Designing a program to restore strength, endurance, and coordination
    • Determining if other muscle weakness or incoordination is contributing to bladder leakage
    • Giving you a customized program to do at home
    • Recommending other solutions like products to manage leaks like Poise© Ultra Thin pads

    Now that you know how to Kegel properly, and the variations for different goals, talk to a pelvic health physical therapist to identify the best exercises for your specific needs.

    Pelvic health physical therapists are trained to help you manage conditions like bladder leaks and pelvic floor dysfunction with non-invasive treatment options – so don’t be afraid to ask!

    # # #

    Author Summary: Dr. Heather Jeffcoat, DPT, Pelvic Health Physical Therapist is the founder of Fusion Wellness & Femina Physical Therapy (FeminaPT.com). Her work focuses on pelvic and sexual health education for all, and she lectures internationally on Female Sexual Dysfunction and chronic pelvic pain. She is also the author of Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve.

    Sources:

    • A 10-minute online survey was fielded on February 1, 2021 through February 8, 2021, in the United States among a nationally representative sample of 1,173 women 25+, including an additional oversample of 202 new moms**, at the 95% confidence level and with a margin of error of ±/-3%.
    • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551249/
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