The Kegel is a simple exercise that has gained a lot of attention over the past 15 years. Magazines write about how important it is for all women to do their Kegels, and talk shows offer Kegels as a solution to accidental urine leakage. Our media outlets have done a good job of increasing awareness, but they are failing to give both accurate and complete instruction on how to perform a Kegel.
The proper instruction for pelvic floor strengthening with a Kegel exercise includes two distinct actions. The 1st action, as many have been instructed, is to tighten up your pelvic floor muscles as if to stop the flow of urine or the passing of gas. This contraction activates both the urovaginal sphincter as well as the anal sphincter. These sphincter muscles are relatively superficial muscles and you are able to feel them activate as a light squeeze on your fingertip within your vaginal canal. The quick contraction of your sphincter muscles can be performed to a rhythm of contract-relax-contract-relax with no prolonged hold.
It is the second action of your pelvic floor muscles that is often left out of Kegel instruction. Your pelvic floor is not only made up of superficial sphincter muscles, but also of deeper layers of muscles that actually elevate the pelvic floor. This elevation takes your relaxed pelvic floor muscles from a position shaped like a "bowl" to a flattened, tighter position with more tension in the muscle fibers. The elevation and increased tension acts to squeeze on the ureter traveling from your bladder to your urethral opening, helping to prevent involuntary urine leakage, as well as to give better support to our abdominal organs (bowel, bladder, and uterus), keeping them stabilized within our pelvis.
My best instruction for elevating your pelvic floor muscles is to picture a string attached from your belly button down to your pelvic floor and you are attempting to draw the muscles of your pelvic floor up into your pelvic outlet. You keep pulling up on that string, trying to get your pelvic floor up towards your belly button for a full 8 second count. At the end of an 8 second count, you allow your pelvic floor to completely relax before tightening up your pelvic floor and elevating once again. The advice I give my patients is to keep your Kegel elevation repetitions to 8-10 longer holds per day to prevent fatiguing the muscles and increasing your symptoms.
Hopefully this information will help to clarify the advice that many women are given throughout their lives as many things, including childbirth, pelvic/abdominal surgery, and menopause can lead to pelvic floor weakness and symptoms of incontinence. "Do your Kegels" means more than performing as many mindless squeezes as you can throughout your day. If you perform your quick contractions as well as longer holds with elevation as part of a daily routine and you do them with a purpose in mind, you will benefit so much more.
Published On: October 28, 2009