How to Kegel...Correctly

Maybe your doctor suggested you do kegels. Or maybe your friend swears by kegels to keep her pelvic floor strong, and that sounds good to you. Or maybe you know that kegels are supposed to help prevent incontinence and you want to get started. But then you kegel and wonder, am I doing it right? Am I supposed to feel something?

Here’s a quick guide to cues that can help you to achieve a proper kegel, and some ways to determine if they’re right for you.

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But first, what is a kegel?

“Kegel” is the name for a pelvic floor muscle contraction. The pelvic floor is not just one muscle, but a bunch of muscles that create a “floor” for your core. They support your organs, maintain continence for bladder and bowel, function in sex and reproduction, and stabilize and support your posture and movement.

The pelvic bones form the tip of your spine (the tailbone), and the sockets of the hip joints. So, it’s a pretty important area. Some muscles are circular (sphincters), and other muscles are long, running front to back like a hammock. When a person kegels, they contract the pelvic floor muscles. So the circular muscles close the openings of the vagina, urethra, and anus; and the long muscles shorten and lift (imagine the hammock drawing upwards), counteracting against downward pressure.

When the muscles relax, they are able to stretch and open, like for sex, bowel movements, and giving birth. Think of the pelvic floor as a trampoline - it needs to be responsive, contracting and relaxing depending on the demands put on your body. So the pelvic floor must be strong and mobile. Being able to contract well and relax well is equally important. And some people may need to focus more on relaxing than on strengthening!
(For more fun facts about the origin of the name “kegel”, check out the history of Arnold Kegel on Wikipedia.)

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So, how to kegel…

Common visualizations include the: marble, claw, elevator, and anatomical landmarks. Each of these is described below. Go with the one that works best for you, and forget the rest. Keep it simple.

Sit comfortably in a chair with your feet firmly on the floor. Sit relaxed and supported (not slumped and not with over-corrected posture). If you find that kegels are challenging for you, an easier position to practice in is lying on your back, with knees bent and feet flat on the surface on which you are lying.

Marble:
Imagine a marble in the vaginal entrance. To kegel, imagine gripping this marble (close your vagina around it) and then draw it upwards into your body. Hold for 1 second, then relax and imagine letting the marble drop back down and out of the body. Repeat 10 times. Keep track of your sensations:
- Do you feel a distinct contract and a distinct relax?
- Do you have a hard time contracting or relaxing?
- Are other muscles kicking in?
- Are you holding your breath?

Claw:
Imagine the pelvic floor as a claw, like in one of those coin games where you try to win a stuffed animal from the bin. To kegel, the claw closes and then lifts upwards. To relax, the claw drops down and opens.

Elevator:
Imaging your vagina is an elevator, and the door is at the vaginal entrance. To kegel, close the elevator door, then bring the elevator to the top floor. To relax, imagine the elevator dropping back down to the lobby and the door opening.

Anatomy:
If you have trouble with imagery like the marble or claw, try visualizing the body parts. To kegel, imagine the sit bones pinching in together; and to relax, imagine the sit bones spreading apart.

Other:
If you still have trouble with imagery, you can try to distinguish these muscles by doing what you’d do to stop the flow of urine or to prevent passing gas. However, do not practice kegels on the toilet regularly, because this can lead to dysfunctional voiding.

After you have chosen the visualization that works best for you, you can take it to the next level by syncing your kegel with your breath. Start with a few slow breaths without any pelvic floor action. Just inhale and exhale slowly. Imagine the flow of air as you breathe - on each inhale, air enters and fills the belly. On each exhale, the belly flattens as the air leaves the body. When you’re ready, kegel on your next EXHALE. (This will feel foreign for some people. That’s ok, just keep practicing.) Relax on each inhale. Kegel on each exhale. Repeat 10 times. Keep track of your sensations again:
- Does synching the pelvic floor with the breath help, or make it more challenging?
- Do you feel a distinct contract and a distinct relax?
- Do you have a hard time contracting or relaxing?
- Are other muscles kicking in?
- Are you holding your breath?

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Is a kegel program right for me?

Not everyone may benefit from routine kegels. Sometimes pelvic floor issues relate to tight muscles, and the treatment for this typically starts with relaxation and stretching techniques, with progression to a kegel program only when and if appropriate. Possible signs and symptoms of pelvic floor muscle tightness include:
- Painful sex
- Tailbone pain / painful sitting
- Painful bladder or bowel voiding
- Constipation
- A delay in starting the stream of urine
- A thin or spraying stream of urine
- Bladder retention or stop/start pattern
- A diagnosis of interstitial cystitis, IBS, or endometriosis
- Intolerance to menstrual cups, discs, tampons and/or gynecology exam

If you have one or more of the above symptoms, pelvic floor muscle tightness may be involved, and a kegel program is not recommended without guidance from a pelvic health physical therapist. An in-person evaluation can confirm the state of your pelvic floor muscles, whether or not they contribute to your symptoms, and to determine what type of pelvic floor programming is appropriate for you.

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** Note: the contents herein do not constitute medical evaluation, treatment, or advice. This serves as educational content only. Any participation in information provided here is at your own risk. Please consult with your medical provider(s) as needed, before partaking in changes to your medical or health care practices.