What Are Kegel Exercises?
Let’s talk about Kegels: kee-gels or is it kay-gels? Either is correct, so it doesn’t matter how you say it! This term means a shortening contraction of the pelvic floor muscles, just like a biceps curl is a shortening contraction of the biceps muscle. The name for this exercise comes from gynecologist Arnold Kegel, who published the first paper in 1948 on doing these exercises to improve common symptoms after childbirth.
Performing Kegel exercises is a very common recommendation by healthcare providers for pelvic floor symptoms, however, most people don’t perform the exercises correctly, don’t know how many to do, or how to progress them appropriately. We’ve got you covered with our physical therapist-approved Kegel exercise guideline - everything you ever wanted to know about Kegel exercises and more!
What do Kegel Exercises Do?
Kegels are the strengthening contraction of your pelvic floor muscles. Your pelvic floor muscles are located at the bottom of your pelvis, between your pubic bone and tailbone, and sideways to your sit bones.
What are the Benefits of Kegel Exercises?
The benefits of Kegel exercises are that they help support the pelvic organs and play a vital role in deep core stabilization. Symptoms of weakness in your pelvic floor muscles could be urinary incontinence, prolapse, gas, or bowel incontinence.
Should I be Doing Kegel Exercises?
If you have symptoms of weakness previously mentioned, are pregnant, or have just given birth, it may be a good time to focus on doing Kegels as part of your daily routine or exercise program to help reduce or eliminate these symptoms. You should not focus on doing Kegels if you have been told by a provider that you have a chronically tense or hypertonic pelvic floor. Symptoms of this are painful penetration, like with intercourse, tampon use, or a GYN exam. Sometimes it can also cause constipation and painful bowel movements, as well as urinary urgency, frequency, and even incontinence.
In this case it may be more beneficial to try pelvic floor muscle relaxation prior to strengthening. Every Mother has an Overactive Pelvic Floor Path to help enable you to continue your core strengthening without making pelvic floor tension worse. This path will also teach you to stretch and relax your pelvic floor in order to restore balance. Once you have restored your pelvic floor muscle balance you will likely want to add some Kegel exercises back in with Core Compressions to address deep core strength and synergy. Your PT can advise you as to when the right time to do this is.
How to do Kegel Exercises
Contracting your pelvic floor muscles to perform Kegel exercises can sometimes seem a bit abstract at first. There are a few different cues to think about when learning how to do Kegel exercises. Let’s imagine together for a moment. The classic cue is to imagine you’re in the bathroom, peeing, and imagine trying to stop the flow of urine. (Peeing is not a time to actually perform Kegels, you are just imagining). Another cue is to imagine picking up a blueberry or a marble with your vagina. You can also envision moving the bones of the pelvis closer together, the pubic bone and the tailbone, or bringing the sit bones together.
To ensure you are doing Kegel exercises correctly, you should:
- Feel a subtle tightening around the anus and vagina.
- Feel a lift in your perineum, which is the center of your pelvic floor or you can think of it as the area between your sit bones.
What you should NOT feel:
- A tensing of your glutes (butt cheeks) or any of your other leg muscles.
- A bearing down in your pelvic floor like you are trying to poop.
The easiest body position to perform a pelvic floor contraction is lying down. So, if you are finding it challenging to perform a Kegel while sitting or standing, consider trying it while lying on your back.
How Often Should I do Kegel Exercises?
After you can locate and activate your pelvic floor muscles to perform a Kegel, you can incorporate them into your daily routine or exercise program. You can aim to do isolated Kegel exercises once a day, unless you are doing some other exercise that may cause fatigue of these muscles, such as Core Compressions that also incorporate Kegels. If you haven't done anything to consciously engage your core or pelvic floor, then doing isolated Kegel exercises daily is a good place to start.
How Many Kegel Exercises Should I do?
So, how many Kegel exercises should you be doing? You should be doing enough sets and reps of Kegel exercises to fatigue your pelvic floor muscles, similar to how you might think about strengthening any muscle in your body! A good number of daily Kegel exercises to start with are around 2 to 3 sets. And how many reps of Kegels should you do in each set? That depends on you! A good place to start is 10 reps per set but you should be able to do each rep with equal strength. When you are unable to perform a repetition with equal strength to the previous repetition, then it is time to stop that set and rest the pelvic floor muscles.
If you are wondering about pelvic floor muscle fatigue, it is a similar feeling to other muscle fatigue you have probably felt. In this case, that might be when Kegel exercises get more challenging, you start leaking urine, or you feel pain or soreness between your sit bones or in the vagina.
The good news is, Kegel exercises should not take much time and you can pretty much do them anywhere!
Mastering Kegel Exercises
Once you have made the connection and understanding of how your pelvic floor muscles feel when they are contracted and relaxed, you have mastered Kegel exercises! Isolated Kegels are the most helpful when you aren’t regularly exercising or in the beginning when you are working on reinforcing the connection between your brain and the pelvic floor muscles. This can be most important after surgery, childbirth, or trauma.
When you can perform a few good sets of isolated Kegel exercises while lying down, you can begin to progress your strength in new ways.
Kegel Exercise Variations
Once you’ve learned how to turn the pelvic floor muscles on and off to perform a Kegel, the next step is to vary the position you do them and the way you do them to keep challenging your muscles. The easiest position to perform a Kegel exercise in is while you are lying down. After trying that, you could progress to doing them seated or standing, which adds the load of your pelvic organs onto the pelvic floor. You could also vary ways you do isolated Kegels, which could be described like this: quick squeezes, endurance/submaximal holds, and elevators.
Isolated Kegel variations:
- Quick squeezes (spring Kegels) are just that - quick. Do a Kegel, with maximal effort or power, and then let it go right away and relax completely back to where you started. Then repeat. I recommend doing sets of 10-12 reps.
- Endurance or holding contractions with submaximal effort. These should not be done using maximum effort! Use 50% to 70% effort to activate the muscles, then try to hold steady for several seconds (remember to keep breathing while you’re holding). Relax completely back to where you started and repeat.
- Elevator contractions are a combination of quick squeezes and holds. To do them, activate your muscles by doing a really gentle Kegel, then try to add more effort into it (or “go up another floor,” like in an elevator). Try to reach the floor you can get to easily and then challenge yourself one floor at a time for maybe 3 to 4 “floors.”
Kegel Exercises Progression
After isolated Kegels, you will want to progress to coordinating a Kegel with other movements or exercises so that the pelvic floor muscles learn to function as part of your core system and work with your abdominals and glutes. For example, doing a Kegel while lifting something will add more resistance and can help you learn to use your pelvic floor muscles at the right time.
To do this, let's go back to the image mentioned earlier with the blueberry or marble that we used to help us cue pelvic floor muscle activation. On an exhale you will perform the Kegel - squeezing and lifting the pelvic floor up, imagining you are picking up that blueberry or marble with your vagina, while simultaneously performing the work, such as lifting something. Doing movement in this way coordinates with the deep core, so it can help to also consciously draw your belly button towards your spine, activating your abdominals, as you are doing the Kegel. You can do this as a Core Compression incorporated into any resistance exercise.
Here is an example of doing a Kegel exercise during a common strength training exercise, a biceps curl. Inhale and relax or soften your abdominals and pelvic floor muscles as you open your arms to prepare to do that biceps curl. Then, as you exahle, simultaneously perform the Kegel, pull your belly button towards your spine, and perform the bicep curl. This is the kind of coordinated movement you want to practice so you can train your pelvic floor muscles to activate at the right time!
Should I be Using Kegel Exercises Tools?
There are numerous tools on the market that were developed to help enhance pelvic floor exercises. Unfortunately none of these tools have been proven to help improve muscle function. If, however, the use of a tool would enhance your compliance with an exercise program, then any of the following tools could be useful.
Kegel Weights or Kegel Balls:
Kegel weights or Kegel balls are small round or conical structures that are made to put inside the vagina when you are performing pelvic floor muscle exercises. These tools can have several benefits. They help by giving you something to squeeze, increasing the sensation of the muscle contraction. They also give a little bit of resistance to lift, especially if you are doing the pelvic floor exercises while standing.
Bluetooth enabled pelvic exercise trainers:
There are several bluetooth pelvic floor trainers on the market. These devices use a pressure sensor to give you visible feedback about how much you are squeezing and how long you can hold the contraction. They can also guide you through a workout program, and can tell you if you are doing the exercise correctly. The downside of these trainers is that there is no “normal” when it comes to pressure created in the vagina from a pelvic floor contraction, so it isn’t actually giving you any feedback in regards to true “strength” of your pelvic floor.
Kegel Tips for the Prenatal & Postpartum Period
Kegel exercise recommendations can be different if you are pregnant or in the early postpartum period. See the nuances below if it’s applicable to you.
Kegels During Pregnancy
- Don’t overdo it: 2-3 sets of 10 most days, or however you fit them in, is plenty of isolated strengthening. If you are combining them with other exercises, such as your Core Compressions, there’s no need to do additional isolated exercises. Remember, these muscles, just like leg muscles, can get tired and sore so be cautious not to do too much. On days when you incorporate Kegels into other exercises, skip isolated Kegels.
- Make sure to fully relax between each repetition.
- Add in gentle Reverse Kegels or pelvic lengthening/relaxation during the final six weeks of pregnancy to practice “opening the door” and lengthening your muscles.
- For more information on Kegels during your pregnancy, read here.
Kegels Early Postpartum
Do isolated Kegel exercises gently, with just your breath or gentle Core Compressions (Every Mother’s Early Postpartum Path walks you through this).
Kegel Exercises for Pelvic Floor Health
Kegel exercises are a tool to help each of us restore and maintain healthy pelvic floor muscle tone, strength and function. If function is good, and strength plus the ability to relax is good, then you have the balanced tone necessary for good pelvic floor health! For a more guided experience to achieve core and pelvic floor health you can join an Every Mother path that is customized to meet your needs.
Last Reviewed by Whitney Rogers PT, DPT in September 2022
Source:
- Kegel, A. H. (1948). Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology, 56(2), 238–248. https://doi.org/10.1016/0002-9378(48)90266-x.
