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Pelvic + Sexual Health

All Your Kegel Questions Answered by a Pelvic Floor PT

Sep 20, 2022Dr. Ashley Rawlins, PT, DPT4 MIN
a smiling, cool-looking young woman in a mustard colored hat contemplating kegels as she sits outside on some moss-covered concrete stairs

As a pelvic floor physical therapist who specializes in treating women and individuals with vaginal anatomy, there are few things I enjoy more than answering questions about kegels. Research shows that kegels can be highly effective in treating a variety of pelvic floor symptoms, particularly when muscle weakness is at play. I frequently recommend kegels to patients with pelvic or low back pain, bowel or bladder leaks, or pelvic organ prolapse.

If you're curious about kegels, you're in the right place. Below are some of the most common questions I hear from patients, friends, family members, and random people at cocktail parties who find out what I do for a living.

How do you pronounce the word "kegel"?

Kegel is officially pronounced “kay-gl” and rhymes with "bagel." But if you've been pronouncing it “kee-gl,” so that it rhymes with "seagull," don't feel bad — we hear that all the time.

“What are KEGELS & HOW DO THEY the benefit women?”

Kegels are pelvic floor strengthening exercises that, when performed correctly, will improve the power, endurance, flexibility, and coordination of your pelvic floor muscles. As a result, strong and healthy pelvic floor muscles will help to improve your control over bowel and bladder function, increase support to the pelvic organs, improve core muscle strength and lumbopelvic stability, enhance sexual function, and encourage optimal blood flow and circulation to the pelvic floor tissues. 

"Who INVENTED kegels?"

Kegels are named after Dr. Arnold Kegel, who published a study back in 1948 on the impact of "progressive resistance exercise" on the pelvic floor. But the idea of pelvic floor muscle exercise (PFME) didn't originate with him. More than ten years earlier, a ballet dancer and movement instructor turned physiotherapist named Margaret Morris was known for instructing women on how to voluntarily contract the vaginal muscles to build strength and prevent bladder leaks. In her time, Morris was seen as a leading authority on strength and rehabilitation, yet Kegel was the name that everyone remembered.

“Are kegels safe during pregnancy and postpartum?” 

Yes and no. Kegels can be a safe and effective exercise to perform during pregnancy, as well as after 6 weeks postpartum, if your OBGYN has cleared you for activity.

When done properly and under the guidance of a pelvic floor PT, kegels can help with all of the following:

That said, there are times during pregnancy when kegels should be avoided, including if you are placed on pelvic rest or specifically told to avoid them, due to certain medical conditions. And, depending on your symptoms and the condition of your pelvic floor, kegels may not be appropriate for you. In some cases — for example, if your pelvic floor muscles are tight and/or overworked — they can even backfire.

In both pregnancy and postpartum, it’s always best to ask your OBGYN or a pelvic floor PT before jumping into a kegel routine.

“How do I know if kegels are right for me?”

In general, kegels are best for those with symptoms of pelvic floor muscle dysfunction who have pelvic floor muscles that are weak and underactive. Since kegels strengthen and increase the tone and performance of the pelvic floor muscles, they can often help to improve symptoms in individuals with pelvic organ prolapse, bowel and bladder leakage, or back or pelvic pain due to decreased joint stability. A pelvic floor physical therapist can evaluate your pelvic floor muscles and help determine if kegels are the right exercise for you.

“What are the signs that you're overdoing kegels?”

Every body is different, but if you are overdoing kegels, or if kegels aren’t the right exercise for you, you will likely notice an increase in your symptoms after doing them consistently. For example, if you are using kegels to decrease your urinary incontinence, and as you exercise you notice more leakage, you may be overdoing it. You may also feel an increase in pain from the muscles being overworked. If this is your experience, check with a pelvic physical therapist and they can help you troubleshoot your symptoms and get you back on track. 

“How do I know if I'm doing a kegel right?”

A proper Kegel is performed by contracting your pelvic floor muscles to pull them up and in, creating stabilizing tension on your pelvic joints, and closing the urethral, anal, and vaginal openings. This is accomplished by squeezing your muscles as if you're trying to stop your urine mid-stream, and/or hold back gas at the same time. This is not always an intuitive movement, so it can be helpful to try and contract your pelvic floor muscle using these verbal, tactile, or visual cues: 

Verbal Cues:

  • Squeeze your muscles like you are trying to pick up a blueberry with your vagina
  • Squeeze your muscles to move your tailbone towards your pubic bone

Tactile cues:

  • Try inserting a clean finger into the vaginal or anal opening and squeeze your muscles around your finger
  • Place your fingertips on the tissue between the vaginal and anal openings (aka the perineal body) and try to contract your muscles to lift them away from your fingertips.

Visual cues:

  • Take a mirror and hold it between your legs so you can see your vulva. Pull open the labia slightly so you can see your vaginal opening as well. Squeeze your pelvic floor muscles and you should be able to see your perineal body pulling up away from the mirror, your anal and vaginal openings closing slightly, and you may even be able to see your clitoris tuck in a bit. These are all visual signs that you are kegeling correctly.

“Can kegels be bad for you?”

Bad? Not exactly. Unless there's a medical reason that prohibits you from being able to use your pelvic floor muscles or from exercising in general, it's not common for kegels to cause a great deal of harm. That said, not everyone will benefit from kegels. And, if you have pelvic floor muscles that are overactive and painful, kegels will likely make your pain worse and should be avoided.

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“Is there more than one type of kegel exercise?”

Just like there are dozens of ways to exercise your abdominal muscles, there are many ways to strengthen your pelvic floor. Pelvic floor physical therapists have created several, highly-effective exercises that build on the basic kegel. These exercises involve doing multiple small muscle contractions and releases (mini-kegels), adding intra-abdominal pressure by coughing as you kegel (the knack), combining kegels with exercises like plank or movements like jump squats — we could go on and on.

If you're ready to move beyond basic kegels, check out this blog for more information on how to level-up your routine.

“What is the best time of day to do kegels”

Like any exercise, the best time of day to do your kegels is whenever you'll actually do them. Like with any habit, doing it at the same time every day will help you create and maintain a routine. If you want to start a kegel routine, try attaching it to something else you do every day. That might be first thing in the morning as you check your phone, while you commute to work (try kegeling at every red light or subway stop), during nightly TV time, while you brush your teeth, or before you go to bed at night.

“Should I feel kegels in my lower abdominals?”

It’s very common to feel your lower abdominals engaging when you contract your pelvic floor. Your deep abdominals and pelvic floor muscles work better together, and in the majority of your daily movements and activities, are supposed to work together as part of your core muscles. While you can isolate and contract each muscle individually, these muscles are stronger when contracted together, at this co-contraction is something we can help you re-learn.

When feeling your lower abdominals engage, the key is to make sure that you aren’t forgetting to also engage your pelvic floor muscles, or letting your stronger more superficial abdominal muscles take over (your “six-pack” for example).

“Is there such a thing as an anal kegel?”

Remembering that the pelvic floor muscles wrap around the anal opening as well, the part of the muscle around the anus also contracts as well when performing a Kegel. If you increase your focus to this area of the muscle you may be more able to strengthen these particular muscle fibers, which can be really helpful if you inadvertently leak gas or stool. Check out this blog for more information on anal kegels.

“Can a kegel Exercise device or app help ME?”

There are apps and gadgets for everything these days, including for your kegels. Apps can help remind you to exercise your pelvic floor muscles, track your progress, and help keep you motivated. Gadgets such as pelvic floor trainers (Perifit, KGoal,Elvie) are electromyographic biofeedback devices, which are kind of like a video game for your pelvic floor — insert the device into your vagina and it will guide you through an exercise routine, and monitor your performance during training, using extremely smart sensor technology.

While not a great substitute for a rehabilitation program supervised and provided by a pelvic PT, these can be really helpful for those who are typically motivated by apps and gadgets. But motivation aside, research does not show that there is a statistically significant benefit in using these devices over kegels alone.

Ashley Rawlins Headshot
Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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