You’ve probably heard that you should do kegels but wondered what exactly is a kegel–the term is pretty vague. A kegel is simply a pelvic floor muscle contraction.
The term “kegel” was coined in the late 1940s after gynecologist Arnold Kegel. He recommended performing pelvic floor muscle exercises to help decrease urinary incontinence and severity of pelvic organ prolapse.
The women’s health field continued to grow to include using biofeedback training and now is fully integrated into women’s health physical therapy and occupational therapy.)
Types of kegel exercises
There are a few types of kegels.
A quick flick kegel is a pelvic floor muscle contraction is when you contract and release the pelvic floor muscle without holding.
This trains the fast twitch muscle fibers, which allows your pelvic floor muscle react unconsciously and quickly to sudden and forceful intra-abdominal pressure. This automatic reaction can prevent urinary incontinence and increase core stability, which is important for back and hip health.
For example, if you leak a little when you sneeze, your fast twitch pelvic floor muscle fibers could use a boost. Quick flick pelvic floor muscle contractions can help strengthen these fast twitch fibers, which make up 30% of the muscle fibers in the pelvic floor.
Slow twitch muscle fibers make up 70% of the muscle fibers of the pelvic floor. Try contracting for 5 seconds. If that is possible, try 8 seconds, then 10 seconds.
This trains the slow twitch muscle fibers, which helps with endurance. For example, if you need to use the toilet and you are stuck in traffic you will be happy your slow twitch fibers have been in training.
When a muscle contracts we look at two phases: concentric contraction (shortening) and eccentric contraction (lengthening).
Picture a bicep curl: as you lift the weight up toward your shoulders the biceps gets shorter (the bump in the front of the arm). As you bring the weight back down, the muscle lengthens. This is the eccentric contraction phase.
The pelvic floor also contracts eccentrically and it’s a nice challenge to control. We can find great strength gains when working eccentric control. Try this elevator exercise:
- With your pelvic floor muscles resting at baseline, imagine you are getting into an elevator on the first floor of a three-story building.
- Contract your pelvic floor muscles 50%. This is as if you have gone up to the second floor. Hold here for 3 seconds.
- Now contract your pelvic floor muscles fully. This is as if you have gone up to the third floor. Hold here for 3 seconds.
- Here is the tricky part: only release your pelvic floor halfway and hold here at the second floor. Hold here for 3 seconds.
- Now fully release down at the first floor.
How did that go? Eccentric training can be quite challenging and fun. Just be sure to fully release afterwards. If you want to spend more time focusing on releasing after strengthening, especially if you are uptraining after having had pelvic pain in the past, try breathing and releasing in Modified Happy Baby Pose.
The ”bulge”…sounds like a 1960s sci-fi movie!
Similar to the eccentric control exercises, the bulge is a lengthening, bearing down movement where the pelvic floor muscles elongate.
This elongation is what needs to happen when we have bowel movements. For some folks with constipation, their muscles have rewired to pull up and in rather than elongate out. With mindfulness, practice, and seeing a pelvic rehab therapist, it is possible to retrain.
This elongation is also what needs to happen during childbirth to get that cute little nugget out of there!
How to do a kegel: different cues
Cues are an important aspect of contracting pelvic floor muscles. If you just squeeze, you may see the opposite result—a bearing down.
It helps to visualize the pelvic floor muscles and the roles different muscles play in contractions. There are three layers of pelvic floor muscles.
The first and second layers squeeze around the ends of the tubes (urethra, vagina, and anus) to prevent leakage. This is the first aspect of the contraction.
The third layer, shaped like a hammock or sling, helps hold the pelvic organs up. This aspect of the contraction is a lift up and in.