As a physical therapist at Rebound Physical Therapy in Topeka, Kansas, I specialize in treating pelvic floor dysfunctions. I want to talk today about how to do a pelvic floor or a Kegel contraction.
Many people may have been told by the doctor to just “do some Kegels” and they may not be confident that they know what they’re doing. Or they may think they know what they’re doing, but they actually aren’t doing it correctly. Therefore, today I want to just break it down a little bit and give you some pointers on how to contract the pelvic floor correctly.
Keep in mind that this exercise can be challenging. If you’re struggling with not knowing whether you’re doing it correctly or not, it would be helpful to do some physical therapy and work with a pelvic floor therapist to make sure that you are doing it correctly
All the same, we’ll go over the basics today and hopefully give you some useful advice.
About the Anatomy of the Pelvic Floor
When we’re talking about the pelvic floor, there is a pubic bone in the front and a tailbone in the back. If we look at it from the underside, there’s a whole bowl of muscles down in the bottom of the pelvis. That is what we are talking about when we talk about your pelvic floor.
It really is just a sling of supportive muscles that go from the tailbone clear to the pubic bone. It provides support for the pelvic organs. For a woman, that includes the bladder, uterus, and bowels.
When you are just going through your day or you’re lying down or sitting, we want those muscles to be relaxed. We want them to be pretty shut off. We don’t need to keep those muscles contracted all the time, but when you do get up and move or you cough or you sneeze, or you lift or do something exerting, we do want those muscles to then contract and provide more support for those pelvic organs.
How the Pelvic Floor Muscles Provide Support
There’s a two-part action when those pelvic muscles contract. Here’s how you can understand that: Imagine your arm when it’s at rest. There’s a little bit of muscle activity going on, but not very much.
When your pelvic muscles contract, they are going to do two things: they’re going to squeeze in and then they’re going to lift up and provide a little bit more support for those organs. When they’re relaxed, that bowl is deeper. When they contract, they’re lifting up and that bowl becomes more shallow. It’s moving everything upward towards the head.
Whenever those muscles contract, they’re going to lift up. But then in between each contraction, we want those muscles to shut all the way back down.
What Problems Occur with Pelvic Floor Exercises
When doing these exercises, some people may have trouble shutting those muscles off. Being really mindful of getting a good contraction is important, but then letting the muscles shut all the way off is equally as important as the contraction.
Another point to think about is that you may be getting the muscles to contract, but you have to pay attention to your abdominal pressure as you’re contracting too. When some people contract these muscles, they may hold their breath as they’re contracting. When you hold your breath, your stomach gets pressurized and that just pushes everything back down, so it really cancels out that benefit of the contraction.
What I like to have people do is to try to breathe out as they contract. So take a breath in, and then as you breathe out, try to contract and lift that muscle up while you’re letting that breath out. That helps to keep that pressure balanced in the abdomen so that you’re actually getting a benefit. At the same time, you’re providing more support to those pelvic organs.
That tip carries over to day-to-day functionality too. Maybe you have some leaking when coughing or sneezing, or when lifting things up or moving around. Get used to coordinating the contraction of the pelvic muscles with breathing. That coordination enables you to use the Kegel exercise correctly in real life. I hope that that gives you a little bit of food for thought on how to do that contraction correctly.
Incontinence—Too Little or Too Much Tension in Muscles
One reason that it may be beneficial to do pelvic floor contractions is if you’re experiencing incontinence, especially incontinence due to weakness of the muscle.
Sometimes there may be some incontinence but the reason underlying that problem is that there’s too much tension in the muscles.
If you’re experiencing incontinence, if you’re having prolapse issues—maybe the bladder or the uterus is dropping—it is really beneficial to use these exercises to help strengthen the muscles.
But in those conditions where those muscles are actually too active and they’re holding too much tension in them already, we don’t really encourage you to do a lot of contractions of the muscles. It can still be beneficial to figure out how to control those muscles so you can contract and relax them at will.
For More Help, Contact Me!
So hopefully that gives you a little bit of help in finding those muscles and doing a Kegel contraction the right way. But if you still feel like you’re struggling, definitely reach out to me at 785-271-5533. I would love to sit down and go through this exercise on a one-on-one basis and help you get that figured out. That way, the work that you’re doing is going to be beneficial for you.
Christina Bausch graduated from Kansas University in 2008 as a Doctor of Physical Therapy. Her specialty is women’s health and pelvic floor therapy. She loves seeing the improvements her patients make in their lives through physical therapy. She is married, has three kids and lives on a farm north of Topeka.
