Kegels Part Two

Jill Heath, PT, DPT

In the last blog post we talked about whether or not Kegels were a good idea.  (If you haven’t read it yet, read it here that first!)  Sometimes we don’t need to strengthen a muscle group that is already too tight and turned on all the time.  But sometimes we do need to strengthen to give support to the pelvis.  So how do we Kegel?

Being able to contract the pelvic floor muscles is challenging for many women.  First of all, we have very little awareness of the muscles - we don’t see them doing anything (unless we put a mirror down there), our cultural or family background may have influenced how our brain perceives them, and after kids, moms often have more trouble because the brain-muscle connection gets disrupted.  In the clinic, we go through many steps until my client “gets it”.

Here are some things you can try at home to connect with your pelvic floor and activate the muscles.  With all of them, remember that the pelvic floor is best when it works as a team with the core - connect it with your breathing by contracting with the exhale and releasing with the inhale (read more about that here):

• While voiding, see if you can stop the flow of urine midstream.  Good strength means you should be able to stop it completely.  These muscles you are using are the sphincter muscles - part of the pelvic floor.  (Note - don’t “practice” this more than once/week, otherwise your bladder-pelvic floor communication can get confused.)
  
• Sit on a physioball with a towel rolled up and placed under your perineum (vulva, bottom, whatever you want to call it).  Sit up tall, squeeze the muscles as if you are trying to stop the flow of urine.  Then, continue that squeeze as you lift the perineum up and away from the towel.  Think about your sit bones gently drawing closer together.  You should feel less skin contact or pressure on the towel at the top of your lift.  Release completely until you feel it return to the “rest” position.
• Try one of these positions and see what works best for you (everyone is different!)

• Lying on your side
• Lying on your back 
• Lying on your back with your hips elevated
• Lying on your side
• Hands and knees

• Think about drawing in drawing a marble into your vagina and anus.  Release completely to let them “go” and return to rest position.
• If this is still tricky, place your hand over your vulva so you can feel the urethra and anus coming closer together as you contract, and the tissues softening as you release.  Sometimes holding a handheld mirror to view the perineum can help your brain connect to it.  
• After every contraction, be sure to release fully.  Your pelvic muscles need a full range of motion and you want to avoid too much tension.  

Remember this is general information only, not intended as medical advice.  Contact me to schedule a consult for the right program for you!