Do you know how to do a Kegel correctly? Most people don’t! Yet kegel exercises are the most popular piece of advice given for any condition in the pelvic area, regardless of their symptoms. Leak with urine? You should kegel. Painful intimacy? Try kegeling.
Our bodies are more nuanced than that! There is not a one size fits all solution to these problems. The kegel was named from Dr. Arnold Kegel, who in the 1940s developed an “exercise” for women with leaks and other pelvic floor dysfunction. His exercises were more nuanced than the spastic clenching that most people think of today. Unfortunately, squeezing 100’s of times a day while sitting at a traffic light is what’s become synonymous with pelvic floor exercise today.
Since 25% of women have some form of pelvic floor dysfunction, understanding how to do and more importantly if you should do it, is critical. Let me explain the correct way to contract these muscles first.
The pelvic floor is a set of muscles that extend from our pubic bone back to our tailbone and sit in a bowl shape at the bottom of our pelvis. The pelvic floor actually has 3 main functions:
1) The Elimination of Waste (controlling the closure and opening of bowel and bladder),
2) Organ Support, (holding up all the essential organs like an awesome support base)
3) Sexual Appreciation
Let’s talk a bit more about that last one! By sexual appreciation, I am referring to orgasm here! It’s basically a kegel - a series of little contractions. But the other reason I say sexual appreciation is because these muscles are sphincters -- they need to both contract and relax, just like any other muscle in the body. So in order to be able to enjoy intercourse and a robust orgasm, we need those muscles to be able to relax and open and then contract. The more robust movement we have (the more our muscles and contract and relax), the more sensation we will have.
To figure out where these muscles are, let’s find the bony landmarks that connect to the pelvic floor muscles. First, put your hands on your hips, as if you are being “sassy.” (It’s totally optional to wiggle your hips!). This is the top of your pelvis. Let’s now take one hand and place the palm on your belly button. Where your fingertips land is your pubic bone. This is one attachment point of your pelvic floor. Take that same hand and place it on the top of your pants. Where your fingertips touch is likely your tailbone. This is the second attachment point of your pelvic floor. There are two more to go. Take both hands and simply sit on your palms. Rock your pelvis back and forth. These are your sitz bones, the last two bony landmarks or places your pelvic floor attaches. These 4 points create a diamond shape.
To contract your pelvic floor muscles, think about pulling your pelvic floor muscles up and inside your pelvis while bringing all four of those boney landmarks together.
If you are doing a kegel correctly you should not have any muscles on the outside of your body visibly contracting. Nobody should know you are doing a kegel. If your pelvic floor muscles are weak or you don’t know how to activate them correctly, your butt, leg and abdominal muscles kick in to try and help out.
Don’t forget to check-in with the relaxation – this is the other half of the kegel story. To relax your pelvic floor muscles, they should move in the opposite direction – instead of the muscles moving together and up inside your pelvis, they should move down and away, towards your feet. Feeling both contraction and relaxation is the full definition of a kegel.
When should I do kegels? How do I know if they are not for me?
There are some obvious signs such as if you feel pain when you do them or are experiencing painful sex. Unfortunately, there is not a black and white answer to this. Most people cannot tell you whether you should be doing kegels by simply hearing your symptoms. The best thing to do is get checked by a pelvic floor therapist. They can provide a through exam and will give you a specialized exercise program that will best fit your recovery.
It’s time to start talking about how to properly do kegels! And to realize that they are not the solution to a healthy pelvic floor.
About Lindsey Vestal
Lindsey Vestal owns The Functional Pelvis, a private practice specializing in pelvic floor therapy “house calls” for pre and postnatal women. She graduated from NYU with a Master’s of Science in Occupational Therapy. She has dedicated her career to empowering women to find relief from conditions such as bowel and urinary incontinence, constipation, dyspareunia, pelvic pain, prolapse and pre and postnatal complications. She has trained with Herman & Wallace Institute, Marquette University, Diane Lee's Integrated Systems Model, Maitland as well as specialized biofeedback training for the pelvic floor. She is a certified Restore Your Core™ (RYC™) teacher. Lindsey teaches pelvic anatomy and pelvic floor health for the Maha Mama pre- and postnatal yoga teacher training in NYC. She is an ongoing contributor to Well Rounded NY and Motherly. She has published in the NY Times, Family Circle, Romper, NY Mag, Harper’s Bizarre, US News + World Report.
As an OT, she is a passionate promoter of bridging pelvic floor rehabilitation with lifestyle modifications while addressing the psychological impact that pelvic floor issues have on our everyday lives.
She also offers online training courses for occupational therapists interested in pursuing the pelvic health specialty. Her flagship course is titled, “OT Pioneers: Introduction to Pelvic Floor Therapy for Occupational Therapists.” (https://functionalpelvis.lpages.co/pelvic-soma-hour/)
Lindsey lives in Manhattan with her husband and two children Avery and Liam.