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While most of us have probably heard of the kegel, there is a lot of confusion about how to do it correctly and what the benefits are. Here are a few tips and tricks to improve the understanding and the health of your pelvic floor!
What is a kegel?
A kegel is a pelvic floor contraction exercise that has numerous health benefits for both men and women. Since this exercise is one that is rarely heard or talked about, many people have trouble understanding what the exercise really is or how do use it correctly. One way that both men and women can think of the exercise is imagining contracting the pelvic floor to stop the flow of urine. After briefly holding this contraction, relax the pelvic floor, and repeat. While imagining urinating is a good trick to learn the kegel, it is not recommended to actually stop urine flow due to risk of urinary tract infections from retaining urine.
What are the benefits of kegel exercises?
One benefit to the kegel exercise is the health of the pelvic floor musculature. As with training any muscles, contractions of the pelvic floor will increase strength, endurance, and motor control of the involved muscles. Kegels have also been shown to help individuals with stress urinary incontinence, or the involuntary leakage of urine when doing “bearing down” activities such as laughing and coughing. Kegel exercises decrease both the prevalence and the severity of stress urinary incontinence by addressing the leading cause, which is weak pelvic floor musclulature.1 It is also theorized that kegels can improve sexual health and pleasure by improving the tone of the pelvic floor, increasing orgasmic intensity, and awareness of sexual response.2 Performing kegels during and after pregnancy has been shown to improve pelvic floor strength and reduce risk of developing stress urinary incontinence following childbirth.3,4
What are the best kegel exercises for women by level of capability?
- Beginner: The beginner should first practice the kegel exercise while lying down. This eliminates the effects of gravity and improves focus on the exercise since other muscles are relaxed. Since it can be difficult to know whether the exercise is being done correctly, a beginner may find it helpful to place two fingers over the pelvic floor to feel that the contraction is occurring in the right place. Another way to do this is using biofeedback. Biofeedback machines are relatively easy to use. This tool measures the amount of electrical activity occurring at the pelvic floor. The user will be able to see whether a contraction is occurring and how strong the contraction is. This allows the beginning user to feel more confident that the contraction is being executed correctly. These devices can be purchased for home use or used at a physical therapy office or other health clinic.
- Intermediate: Once the kegel can be completed without difficulty, the intermediate-level exerciser should progress to kegels in the standing or seated position. This allows the contraction to be done against gravity, which increases the difficulty.
- Advanced: If the kegel can be performed in the sitting or standing position easily, it may be time to progress to using resistance. A few examples of resistance tools are weighted vaginal cones and toning balls such as Ben Wa Balls. These tools provide a downward and outward force on the vaginal wall, which increases the difficulty of contraction of the pelvic floor.
- Expert: For those who wish to further improve the health of their pelvic floor, there are several smartphone applications available that can help. The Tät app provides guidance on a pelvic floor training program that includes both basic and advanced exercises. The Kegel Trainer PFM Exercises app includes ten exercise sessions that take only a few minutes each. This app also allows users to set reminders in order to stay on track with their goals. For the more motivated exerciser, the Perifit app operates using an internal sensor to assess the contraction of the pelvic floor. It also allows the user to play games using the sensor and to track their progress over time.
What routine should you follow? For how long?
The guidelines for how you design your exercise program will vary based on your goals. For example, if the goal is to improve pelvic floor strength, using resistance cones or balls would be most beneficial. If reducing or preventing urinary incontinence is the goal, it would be helpful to improve strength as well as endurance. For this, the kegel exercise should be completed with resistance and the contraction should be held for increasing amounts of time. To improve sexual health and pleasure, the exerciser would likely improve strength with resistance exercises and motor control using biofeedback or a pelvic floor training smartphone application. Motor control refers to the connection between the brain and the pelvic floor muscles. Both biofeedback and smartphone apps would help with motor control by providing an assessment of the strength of each contraction. As with any exercise routine, the key to success is to incorporate your training into your schedule regularly. This could mean doing your pelvic floor exercises everyday at a certain time, or using reminders such as the one in the Kegel Trainer PFM Exercises app to ensure you don’t forget to practice your exercises.
Can kegels help with urge incontinence?
Urge incontinence is the sudden urge to urinate regardless of how full the bladder is. This can occur for a variety of reasons including bladder cancer, bladder infection, prostate conditions, or neurological conditions. However, in many cases, no cause can be identified. Since potential causes are so variable, there is no one treatment for all individuals with urge incontinence. However, it has been found that strengthening the pelvic floor musculature will provide support to individuals with urge incontinence and potentially prevent leaks5.
What else can I do to reduce incontinence?
For those using the kegel exercise to help with urinary incontinence, it may be helpful to incorporate a few other strengthening exercises into the routine. Think of the trunk as a container. The top of the container is the diaphragm, the walls are the core muscles (stomach, back, and sides), and the bottom of the container is the pelvic floor. When an individual coughs, for example, the pressure in the container increases. As this occurs, the contents will leak out through the weakest part of the container. When the weakest part of the container is the pelvic floor, stress urinary incontinence occurs. Strengthening the pelvic floor will be very helpful in reducing the symptoms of incontinence. However, ideally all of the “walls” of the container should be strong. Because of this, it is important to incorporate core exercises to improve success and have a strong “container” on all sides. This will give the trunk all the support it needs to lift, cough, sneeze, and laugh without any leaks.
With all the great benefits of kegel exercises, everyone has reason to incorporate a pelvic floor program into their health routine. The best pelvic floor training program is the one that coincides with your goals. Use these tips to guide you on your way to pelvic floor health!
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2. Phillips NA. Female sexual dysfunction: Evaluation and treatment. Am Fam Physician. 2000;62(1):127-136+141.
3. Mørkved S, Bø K, Schei B, Salvesen KÅ. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol. 2003;101(2):313-319. doi:https://doi.org/10.1016/S0029-7844(02)02711-4.
4. Harvey M-A. Pelvic Floor Exercises During and After Pregnancy: A Systematic Review of Their Role in Preventing Pelvic Floor Dysfunction. J Obstet Gynaecol Canada. 2003;25(6):487-498. doi:10.1016/S1701-2163(16)30310-3.
5. Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas. 2010;67(4):309-315. doi:10.1016/J.MATURITAS.2010.08.004.