Kegels: Everything you ever wanted to know

Kegel exercises are a great way to strengthen pelvic floor muscles, and anyone can perform them — both women and men, regardless of age.

Pelvic floor muscles support your bladder, uterus, vagina and rectum, and they can lift and control the muscles that close the urethra (the tube carrying urine from the bladder to the outside of the body).

For women, Kegel exercises involve contracting and then relaxing the pelvic floor muscles to help strengthen and improve that support provided to your uterus, bladder, vagina and rectum. These exercises are especially helpful for preventing or improving urinary incontinence. They can be effective years after delivering a baby or as muscles weaken with age.

When and how often should you do Kegels?

As a urogynecologist, I advise my patients to perform sets of 10 squeezes, three to four times a day.

How do you know you’re doing a Kegel correctly?

When you’re first learning how to perform Kegel exercises, you can use the following strategies to help understand the muscles you’ll be strengthening:

• Insert a finger in the vagina and squeeze only the vaginal muscles around your finger
• Imagine you’re sitting on a marble and have to pick it up with just the vaginal muscles

If you are still having difficulty, you can try it out while urinating. Try squeezing only the vaginal muscles and see if the flow of urine is interrupted — that’s how you know you’re squeezing the right muscles. However, once you learn which muscles to engage, I don’t recommend performing Kegels while peeing, because over time it can actually lead to issues with bladder emptying and affect your ability to control urine.

And if you aren’t sure if you’re doing them correctly or at all, you can ask your Ob/Gyn during your next pelvic exam to evaluate your muscles — we can tell if you’re performing them correctly.

Other tips:

Be patient — practice makes perfect. It can take time to see progress in pelvic floor strength, and everyone is different.

Don’t hold your breath; stay relaxed, trying to tighten only the pelvic floor muscles — not the muscles in your stomach, legs or buttocks.

How can you tell if your muscles are getting stronger from doing Kegels?

Try holding the squeeze of a Kegel for up to 10 seconds. That’s a long time for these muscles! The pelvic floor muscles tend to fatigue much more quickly than a 10-second squeeze, especially when they’re not used regularly.

For those new to Kegel exercises, I recommend starting with “zero-gravity” Kegels, meaning you lie down while doing them. Start by holding them as long as you can — typically for three seconds to start. Then work on your endurance. Gradually work up to holding them for up to 10 seconds with each squeeze, with a rest break in between squeezes that’s at least as long as each squeeze.

Next, you can try Kegels while sitting — again, working up your endurance over time.

As your pelvic floor muscles become stronger and you’re able to hold these squeezes for longer amounts of time, you can work up to doing Kegels while standing. You have the full impact of body weight on the pelvic floor while you’re standing, so this position is most difficult for performing Kegels.

Tools that can help with Kegels

Some people find free apps, such as Kegel Trainer or many others, a helpful tool for their routine.

There are vaginal weights and devices that stimulate the pelvic floor muscles, but these are typically best used by women who are under the care of a specialized physical therapist who’s an expert in the pelvic floor, or who have been directed by their health care provider to use these devices.

Before you spend money on extra gadgets, just work on practicing with your own muscles. If you’re concerned that they aren’t working, you should talk to your health care provider.

The best time to do Kegels

The good news about Kegel exercises is that you can do them in everyday life, and no one can tell! Once you master those zero-gravity Kegels, you can perform them anywhere — just add them to your daily routine, such as during teeth-brushing or when you’re sitting at a stop light in your car.

You can do them whenever it works best in your day — just remember to do them!

When to stop doing Kegels

There isn’t much risk of injury or infection when performing Kegel exercises alone. My advice, though, is that if it hurts or you have any concerns, stop doing Kegels and talk to your health care provider.

When to see a doctor about pelvic floor concerns

Women who have weak pelvic floor muscles may experience difficulty with bowel or bladder control, or experience pelvic organ prolapse, which is a weakening of the pelvic supports of the bladder, vagina, uterus/cervix and rectum. Some women feel a general laxity of the vagina or less sensation during intercourse after they have had a baby. Any concerns that you have about changes in bowel, bladder, or vaginal function, sensation or pain is worth a conversation with your health care provider.

Know the symptoms of pelvic floor disorder