Kegel Do’s and Don’ts

Kegels are something that many women begin postpartum to help their pelvic floor return to pre-pregnancy state. This is generally good advice but I want to cover a couple other considerations in this blog: 1. There is a right way and a wrong way to do Kegels and 2. Using Kegels to treat a condition vs. doing them as part of an overall prevention/maintenance routine are two different matters and therefore they require different approaches.

Do’s and Don’ts

Do’s:

• Coordinate with the breath (see blog post on ‘Diaphragmatic Breathing’)

  • Lift/squeeze on the exhale, and release fully on the inhale.

  • A proper contraction should feel like you are ‘sucking liquid up through a straw’ with the muscles of your pelvic floor - hold for 2-4 seconds.

    • Other cues that may be helpful to conceptualize the sensation:

      • Imagine a blueberry sitting at the opening of your vagina and on a contraction you are trying to lift and pull it in.

      • Imagine an internal string from your belly button to your vagina, on a contraction you are trying to shorten the length of the string.

• Allow the muscles to fully relax between contractions.

  • You don't want to train your muscles to be in a constantly tightened state - you want them to have a full range of motion, capable of relaxing when necessary, like when you need to use the restroom, and tighten when needed, like when coughing or sneezing.

  • Fully relaxing means you should feel your perineum drop down towards your underwear in coordination with your breath (inhale).

• Take it slow during the early postpartum period.

  • Start with 5 Kegels twice per day.

  • Gradually work up to 10-15 Kegels twice per day by week six.

Don’ts:

• Start and stop your stream of urine as a regular part of your Kegel routine.

  • Starting and stopping the stream of urine can be a tool for teaching yourself to identify your pelvic floor muscles, but doing this regularly can lead to your bladder being unable to fully empty when you need it to. 

• Squeeze your butt - Kegels should be a small movement isolated to the muscles of the pelvic floor.

• Clench your jaw. Seems like a random point to add to the list, but many people do this without even realizing it and clenching your jaw actually affects the coordination of your pelvic floor muscles.

• Rush.

  • Take some deep breaths between sets of Kegels and don’t do them to the point of exhaustion.

Prevention vs. Treatment

Kegels get a lot of hype but to actually provide the promised benefits they must be done correctly, consistently and they must be addressing the right underlying cause…Did you know that there can actually be some overlap in symptoms with pelvic floor muscles that are too tight or too weak and that pelvic floor dysfunction is often attributed more to the coordination of the pelvic floor muscles than to their strength?

We often assume that all pelvic floor issues (leaking, weakness, bulging, etc.) can be attributed to muscles that are too weak but this isn’t the case. Although symptoms such as pelvic pain or urinary incontinence might be the first thing to signal you to the presence of dysfunction, they are not always a reliable source of information as to the underlying cause. If you begin Kegels and the underlying issue is muscles that are too tight, then you could actually make the problem worse. 

So while kegels do have a place in postpartum recovery, they are not a magic bullet for everyone and a pelvic floor therapist can assess how they may or may not play into your individual recovery.