Do Your Kegels!

Do Your Kegels

What is a kegel?

A pelvic floor muscle exercise, commonly known as a “kegel” is a contraction of the muscles that support the lower abdominal organs (uterus, bladder, and rectum).  These exercises were first described by Dr Arnold Kegel in the 1940s while he was researching female urinary incontinence and poor pelvic muscle function. He used rudimentary methods such as a tire pressure gauge system to measure pelvic floor contractions, which allowed the women to visualize the strength (or weakness) of their muscles.  Since then, women have been told to practice “kegels” but have not been given clear instructions on how to properly perform them.          

What is a kegel NOT?

Training the pelvic floor muscles should NOT involve accessory muscles, this means that the abdominal muscles and gluteal muscles should not be contracted (squeezed).  To truly benefit the pelvic floor, it is important to isolate these muscles. Isolating muscle groups is a common practice in most exercises, for example, if you are trying to work the biceps through curls, and you use shoulder or back muscles to help raise the weight, you do not receive the full benefit specifically to the bicep.  Also, a kegel is NOT the stoppage of urination or urine flow (as this may dysfunctionally train the bladder). Finally, a kegel is NOT a glute bridge or squat (or any other big muscle movement). While pelvic floor contractions and holds can certainly be incorporated into these movements, a glute bridge in itself will not isolate the pelvic floor.  Keep in mind that if performed correctly, no one should know that you are doing a kegel.       

How to properly “kegel”

Pelvic floor muscles are made up of two main types of muscle fibers, slow twitch (type 1) muscles that help with endurance, and fast twitch (type 2) muscles, which help with short bursts of strength.  In women, the pelvic floor muscles are approximately 70% slow twitch and 30% fast twitch muscles. Because of this difference in the types of muscles, it is important to learn two different types of exercise.   

  1. Long holds - Slowly contract the pelvic floor muscles and hold for a count of five to ten seconds, then relax the muscle for five to ten seconds.  
  2. Short holds “Quick flicks” - Contract or tighten the muscle quickly and hard, hold for two seconds and relax the muscle for two seconds.  It is important to allow the muscle to fully relax in between each quick hold.  

When contracting the pelvic floor muscles, it is sometimes helpful to imagine that you are tightening or pulling in the ring of muscle around the rectum.  Many women find this movement different from what they have previously been taught, but because the contents of the bowels are heavier than the contents of the bladder, this movement will strengthen the entirety of the pelvic floor.  

It is also beneficial to practice these exercises in a variety of positions.  Initially, many women find it easiest to isolate the muscle while sitting or reclining, however, once you can identify the muscle, it is beneficial to attempt the exercises in lying and standing positions (as gravity can increase the resistance and improve training).  For some more advanced exercisers, the kegels can even be attempted in different yoga positions, which requires increased muscle, posture, and breathing coordination.  

Use of Biofeedback and Stimulation

Pelvic floor muscle exercises can benefit everyone (even men!) and are easy to practice in the comfort of your home.  However, when you find that you develop symptoms related to a weak pelvic floor such as leaking urine, it is advantageous to seek professional help for retraining these muscles.  At Women’s and Maternity Care Specialists, we use a system that incorporates biofeedback into the training program, which allows the patient to see real time results of her contractions.  Many patients enjoy this aspect of the training because we can ensure that you are truly isolating the correct muscles.  

We also incorporate the use of gentle neuromuscular electrical stimulation to further strengthen the pelvic floor muscles.  This is similar to the use of a TENS unit on an external muscle group, and allows for passive contraction of the muscle. This passive contraction increases the number of both fast and slow twitch muscles, improves baseline resting tone, and can help promote nerve growth.  The combination of biofeedback driven exercises, neuromuscular electrical stimulation, and increased practice at home is beneficial in improving urinary and pelvic floor symptoms in women of all ages. Please feel free to talk to one of our providers about how pelvic floor rehabilitation may work for you! 

Author
Sarah Wilson, ARNP “Personalized care for women of all ages.”

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