Kegels. We've all heard the word "kegels," but do we actually know what it means to truly kegel? Why should we care?

Where did Kegels come from?

Kegels are the brainchild of Dr. Arnold Kegel. As a gynecologist, he was looking for a non-surgical way to help women "tone" the pelvic floor muscles to prevent leakage after having a baby. Today, kegels are the first-line treatment option for incontinence, prolapse, and more. They've become somewhat of a blanket approach treatment for everyone reporting any bladder, bowel, or pelvic dysfunction. Examples: Pain with sex, leaking urine, urge to empty your bladder, back pain, painful sex, etc.However, kegels are not the answer to everything. Yes, they work well for some people, but they are not appropriate for others (like me!).

What is a Kegel?

A kegel is a contraction of the pelvic floor muscles (shortening action), which sit at the bottom of your pelvis. They lie sort of like a hammock, front to back (pubic bone to tailbone), and side to side (sit bone to sit bone). Within these muscles there are three openings: rectum, vagina, and the urethra. And surprise - men have pelvic floors too!

The pelvic floor has 3 main functions:

1) Support: holds us and our organs up against gravity.

2) Sexual: aids in orgasm and allowing vaginal penetration for women.

3) Continence: keeps us dry.

The pelvic floor is also part of the deep stabilizing system, which also includes the diaphragm, multifidus, and transverse abdominis. As part of the deep stabilizing system the pelvic floor responds to breathing and changes in intra-abdominal pressure. 

When should I Kegel?

I've gotten this question a lot. When should I kegel? How should I kegel? How do I know if I'm doing them right? I've also heard some pretty crazy answers to the above questions.Pregnancy and early postpartum is a good time to consider adding kegel exercises to your routine. There's the 9-10 months of carrying a baby with the added weight on the pelvic floor (baby, placenta, organs, increased fluids) holding a baby, the force of actually pushing a baby out, and the pelvic floor lengthening and stretching to get out of the way for baby to exit. Wow! It's no surprise that we may see issues with holding in urine or stool. Add in perineal tearing or pelvic floor trauma or prolapse, and yes, kegels may be a good idea to strengthen the pelvic floor.

But, kegels are not for everyone. In some cases, these muscles can be tight/contracted, and adding in more contractions on top of that isn't always the way to go. Think about holding a constant bicep curl. Your elbow is stuck in a fixed position and isn't going anywhere. By adding extra curls your bicep is probably just going to get super tired, and ultimately - may just give out.

Another issue is often kegels are prescribed without a ton of detail. "Just do 100 a day" or "perform them when going to the bathroom" (gasp) is not doing anyone any favors. Would we sit and do 100 biceps every day? It's important to assess every mom individually, and create an individualized program. For me, my biggest challenge is working on the lengthening/relaxation phase of a kegel. I work a lot on visualization and imagine a "dropping" of my pelvic floor on my inhale breath. This "tightness" is the source of a lot of my symptoms and dysfunction. Work in progress.

5 Tips for Mastering your Kegels

Below are 5 Tips for Kegel Exercises. Above all, my biggest recommendation is to see a Pelvic Floor Physical Therapist. Unsure of what to expect. Watch this :)

1. PERFORM QUICK AND LONG HOLD CONTRACTIONS: Your pelvic floor muscles have sprint muscle fibers and marathon muscle fibers. By doing quick and longer hold contractions (~10 seconds) you will be able to work more of the muscle.
2. RELAX BETWEEN CONTRACTIONS: It's just as important to relax between a contraction. To get the most out of your pelvic floor exercises, you should contract fully and then relax fully before performing your next contraction. We want muscles that can contract to relax fully. Think about how you squat all the way down and come all the way up. We don't squat down, come halfway up, and then just keep moving through a small range of motion in that spot, right? That sounds tiring :)
3. PERFORM IN DIFFERENT POSITIONS: Often people do kegels when they are sitting in their car, doing dishes, etc., but your muscles need to work in all different positions. Practice kegel exercise while standing, side lying, seated, and incorporate them into activities like strength training.
4. CHILL YOUR SQUEEZE: Oftentimes a kegel is taught to squeeze as hard as possible. But, ideally we're shooting for that 20-30% effort, unless we need a bit more support (tension to task). You only want to bring as much tension (strength of contraction) as needed for the task at hand. In other words, you don’t have to try and lift a 50 pound kettlebell with your pelvic floor when you pick up a pencil. Being overzealous with contracting the pelvic floor can lead to pelvic floor tightness.
5. KEGELS ARE NOT FOR EVERYONE: Many people have pelvic floor muscles tension, and kegels can make that tension worse. Tense pelvic floor muscles can contribute to painful sex, tailbone pain, vaginal and rectal discomfort, incomplete bladder emptying, incomplete bowel movements or constipation. Oftentimes you can have leakage or pelvic organ prolapse with tense muscles too. Working with a pelvic floor therapist is key. That is really the only true way you will know.