You might have heard about doing “Kegel exercises" to strengthen your pelvic floor muscles. In simplest terms, Kegels are a repetitive movement to lengthen and tighten those pelvic floor muscles to improve strength and muscle control.

Sounds easy enough, right? It turns out, a lot of people do Kegel exercises wrong when first starting out.

“There are definitely times when people do their exercises incorrectly," says Anne Stachowicz, MD, a urogynecologist with The Christ Hospital Physicians. “That's mostly because they're not really isolating their pelvic floor muscles appropriately."

But with a few pointers and a little practice, you can Kegel with confidence.

What is the pelvic floor, and why might I need Kegel exercises?

Let's get started with a quick anatomy lesson. Your pelvic floor muscles sit at the base of your pelvis. They're part of your “core" muscles that provide stability like your back muscles, glutes and abs.

The pelvic floor muscles support your bladder, urethra, bowel, rectum, and anus. In men, they also support the penis, testicles and prostate. In women, they support the clitoris, vagina and uterus.

Those pelvic floor muscles play an important role in controlling when we pee, poop, and pass gas. When those muscles are weak, it can lead to leakage.

“Ideally, Kegels are used to help with muscle activation at appropriate times of pressure, like before a sneeze, laugh or cough," says Lauren Hill, OTR/L, MS, CSRS, an occupational therapist who specializes in pelvic floor therapy at The Christ Hospital.

“Knowing when the muscles are active and when they are at rest can help with timing and coordination," Lauren continues.

Kegels can improve pelvic floor health

 Both men and women can benefit from Kegel exercises. “The most common misconception about Kegels is that only women need them," says Hannah Hong, MD, a urologist with The Christ Hospital Physicians.

“Men and women have the same external sphincters (for urination and passing stool) which are comprised of pelvic floor muscles," Dr. Hong explains. “Kegels can help if the sphincter is injured or weakened for whatever reason."

Kegels for men

For men, one of the most common times Kegels will be recommended is to help prepare for prostate cancer treatments like surgery or radiation.

Dr. Hong recommends men “start Kegels before cancer treatment to improve incontinence effectively." Kegels can improve treatment side effects, such as:

• Bladder and bowel leakage: Prostate cancer treatment can temporarily weaken the pelvic floor muscles that control your bladder and bowels. “Some men will leak urine after surgery," says Dr. Hong. “They often notice significant improvements after about three months of reliably doing Kegel exercises."

• Sexual function issues: Kegels can improve erectile function by strengthening the muscles that activate during an erection.​
  

Kegels for women

Dr. Stachowicz recommends Kegel exercises for women in multiple situations, including:

• Bladder leakage: Women experiencing bladder leakage when coughing, sneezing or laughing may have stress incontinence. Kegels can help strengthen the muscles for better bladder control.

• Pregnancy and after delivery: Women can use Kegels during pregnancy to prepare for birth. After delivering their baby—whether a vaginal or C-section delivery—Kegels can help women recover pelvic floor strength and coordination. Women can use Kegels during pregnancy as a way to learn how to contract and relax their pelvic floor prior to birth, then to strengthen and improve blood flow for healing after birth.

• Pelvic organ prolapse: Women with pelvic organ prolapse have one or more pelvic organs fall lower than their usual position due to muscle weakness. Kegels can help strengthen those muscles and provide support to lessen symptoms. With prolapse, it may be helpful to perform Kegels in a gravity assisted plane like laying down with a couple pillows under your hips to have proper position of the pelvic organs.​

Performing Kegels correctly

Unlike your biceps, you can't see your pelvic floor muscles. To find the right muscles to engage, men and women should think of stopping their stream of urine or holding in gas. The muscles you use during those actions are your pelvic floor muscles.

• For men, Dr. Hong also cues, “Imagine pulling the head of your penis into your body like a turtle into its shell. Or imagine wading into a pool and trying to keep the cold water from hitting your scrotum."

• For women, Hill gives the analogy of imaging you had to draw a smoothie up a straw with your vagina.

To do one repetition of a Kegel: ​

1. Start in a relaxed position. You can lie down, sit or stand.

2. Inhale and allow your pelvic floor muscles to lengthen or blossom.

3. Exhale gently and contract your pelvic floor muscles. It should feel like the sensation of squeezing up.

4. Hold for three to five seconds.

5. Fully relax your muscles.

Isolate your pelvic floor muscles and avoid engaging extra muscles, like those in your abs, legs or buttocks. If you're not sure you're engaging the right muscles, talk to your urologist, gynecologist, or a pelvic floor therapist. 

Incorrectly doing Kegels can strain your pelvic floor muscles rather than strengthening them.

​“Don't routinely practice Kegels when on the toilet or stopping your stream of urine," says Dr. Stachowicz. While it's an effective way to identify the right muscles, regularly interrupting yourself while going to the bathroom can cause complications.

Do Kegels regularly, but don't overdo it

​You can start out doing just a few Kegel exercises at a time then working your way up to doing several sets throughout the day.

Just like any strength training program, you have to do Kegel exercises regularly to feel results. Luckily, you can do Kegels anywhere, even while at work or watching TV. The key is consistency.

“It's really like any other muscle group," says Dr. Stachowicz. “With regular practice, you'll gain endurance quickly."

“I tell my patients to do about 20 to 30 Kegels spread across the day," Dr. Hong says. “So they can do a set of Kegels in the morning when they wake up, lunchtime, dinner time, and before they go to bed."

In some cases, your doctor may recommend doing a higher volume of Kegel exercises or additional sets for your specific strengthening goals – which is why it's very important to follow their recommendations.

As with any exercise, there can be risks with doing too many Kegels. Overdeveloping your pelvic floor muscles can make them too tight or tense.

“If you have urinary urgency or chronic constipation, you may make your symptoms worse by over-strengthening the pelvic floor," Hill says. This can lead to straining when you go to the bathroom.

When to avoid Kegels

Practicing Kegels may not be the right option for everyone. It's important to follow your healthcare provider's advice so you get the results you want.

“There are a few times when I discourage people from doing pelvic floor strengthening like Kegels and that's when they're having a lot of pelvic pain," Dr. Stachowicz says. “If someone is having painful intercourse or pelvic pain, they should see a doctor first because Kegels can make pelvic pain issues worse."

Want more pelvic floor help?

You can see your primary care provider, gynecologist, urologist or pelvic floor therapist for more help with your pelvic floor muscles. They can help you perform Kegels correctly and explore other treatment options.

If you've consistently done Kegels for six weeks but are not getting the results you want, it may be time to try something else. Kegels are a great starting point for many people, but they won't fix every pelvic health issue.

“At The Christ Hospital, we offer women and men options for almost every pelvic health issue," says Dr. Stachowicz.

Find a physician and consult a specialist to explore your options. Pelvic floor therapy is available through The Christ Hospital Physical & Occupational Therapy Centers in Green Township, Liberty Township, Miami Township, Mt. Auburn, and Red Bank.