Pelvic Floor (Kegel) Exercises

What is the pelvic floor?

The pelvic floor is a complex layer of muscles and ligaments which stretches like a hammock from the pubic bone at the front of your pelvis to the coccyx (or tailbone) at the bottom of your spine. This hammock of muscles supports the bladder, bowel, and uterus. The muscles can become weak as a result of pregnancy, menopause, aging, increases in abdominal pressure (e.g., cough, constipation), lack of exercise, as well as some pelvic surgeries and neurological conditions. The muscles are made of long muscle fibres (required for toning and suppressing leakage) and short muscle fibres (required for emergencies). They can be strengthened like any other muscles by contracting and relaxing them in a workout. Exercising these muscles will help improve bladder and bowel function, strengthen your back, and enrich you sex life. Many people will see improvement after 6 weeks but often takes 3-6 months to see maximum benefit.

How to do the Kegel exercises

It is tricky to find the correct muscles, so here are some tips:

1. Try to stop your urine flow while on the toilet – if you succeed, then you have found the correct muscles and you can go ahead and do the exercises. Do not make a habit of stopping your stream as a way of doing the exercises, as that may lead problems with bladder emptying.
2. Try to prevent gas from escaping from the rectum – a very strong contraction will help you succeed. This may help both bowel and bladder control problems.
3. For women, insert a finger into the vagina – squeezing around the finger will help to identify the correct muscle. It may help to localize the muscles on the right and left separately (think of 3 and 9 o’clock on a clock face). For men, while lying down, observe to see the penis twitch to confirm the correct muscle is being activated.
4. You can use devices like vaginal cones and biofeedback but doing the exercises without such assistance if often effective. There is list of professional pelvic floor physiotherapists on this site as well as links to some apps that can be found on-line.
5. Once you have identified the correct muscles, you are ready to go ahead and start working!
6. You can do them anytime and anywhere, lying down, sitting, or standing.

Planning a Kegel exercise workout

Preparation:

• Make sure your bladder is empty.
• Position: You can do them sitting, standing, or lying down.
• Environment: Initially you may want to find a quiet place so you can concentrate.

Here you go:

1. Contract the pelvic floor muscles – and hold (works the long muscle fibres).
2. Count slowly – 1 and 2 and 3.
3. Relax – count slowly – 1 and 2 and 3.
4. Repeat – usually start with 5 repetitions and increase to 10 repetitions.
5. Add 5 quick contractions – like a pumping action (works on the short muscle fibres).
6. Gradually increase the holding/relaxing to a count of 10.

Use only the pelvic floor muscles – try not to use the abdominal, buttocks, or thigh muscles. Also, do not hold your breath.

Start by doing these 3 times per day, gradually increasing to 5 time per day.

Building strength

1. As you become comfortable and more familiar with the exercising, be creative in your regimen.
2. Increase the holding and relaxing time and vary the length of time you hold and relax.
3. Vary the intensity or strength or the muscle contractions.
   • Picture an elevator going up – contract a little and hold, then contract a little stronger and hold, and contact as strong as you can and hold for as long as you can. Then relax.
   • Now picture the elevator going down – contract the muscle as hard as you can and hold as long as you can, relax just a little and hold, relax a little more and hold, and now relax completely.

Tips