You are told to do Kegel exercises but most likely the instruction you received on how to do the Kegels is wrong! In this blog you will learn about what a Kegel is, Is the Kegel exercise for all pelvic floor dysfunction cases? Is Kegel the best exercise for incontinence? How do you know if you are doing your Kegel exercise correctly? Get all your answers here!

What Is A Kegel?

Kegel exercises are intended to make the muscles of the pelvic floor ‘fit’. but is the floor independent or is it connected to the wall muscles? How do we naturally work out those muscles? What makes sense is to try to provide the grounds for the natural course of things to happen.

While there is a general ‘instruction’ of holding the pee while on the toilet to connect to these muscles, I am against such instruction because it is unnatural and does not help the nerves that are in charge of assisting with the urination process.

So what is another set of instructions given generally to connect to the muscles of the floor? Women are typically instructed to imagine picking up marbles with their vagina and trying to hold gas in the anus; for men, it is to hold gas and urine at the same time. I like this one better and perhaps it can be used for better-guided visualization when we try to condition the muscles inside the pelvis.

So how do we automatically strengthen and stretch the muscles inside the pelvis? Breathing but not any kind of breathing!!

What Is Nature’s Alternative To Kegel Exercise?

If we had a normal lifestyle, we never would need to ‘pretend’ to pick up marbles with our vagina or stop urinating midstream!

With proper Biological breathing, with inhalation, we relax the muscles inside the pelvis and with it is because of the contraction of the same muscles that we actually breathe out! That is biological breathing, the breathing we all did as babies and we now understand from studying babies!

Once the foundation is in place, walking and sexual intercourse are other ways that our body naturally maintains the strength in these muscles. In an industrialized nation such as the United States, with a sedentary lifestyle, all 3 of these simple yet profound mechanisms are missing.

The deconditioning in the forms of tightness and weakness of these muscles leads to pelvic floor dysfunction which is more than urinary incontinence!

Is Kegel Exercise The Same In All Genders?

Yes. Regardless of the type of external genitalia, vagina, or penis, the pelvic floor, pelvic wall, and pelvis are the same and issues related to the muscles of the pelvic girdle remain the same.

pelvic floor

Are There Any Side Effects To Kegel Exercise?

No, as long as you do them the natural way, Biological breathing!! One of the most difficult exercises that my patients do is Biological breathing explained in the video above. I recommend doing it correctly for 3 breaths twice a day and working their way up to more, in the seated and standing position.

The key is to not engage the anus or the external genitals! and to breathe in, sending the abdominal diaphragm down toward the feet instead of toward the wall in front of you or up toward your head!! That is more than likely the hardest part of this exercise.

What Is Kegel Exercise Good For?

Kegel exercises are to strengthen the pelvic floor muscles so they are good for all pelvic floor dysfunction symptoms. These include not only urinary incontinence and fecal incontinence, but organ prolapse, chronic lower back pain, chronic sacroiliac joint pain, postural decline with a sway back or a tucked under pelvis to name a few.

There is more to the Biological Breathing than Kegels and there are a lot more to the correct breathing than just strengthening the muscles of pelvic inlet.

Tips To Kegel Exercise

  1. Do them- meaning Biological Breathing- twice a day, first thing in the morning and before going to bed.
  2. Do them lying down for ease and a better understanding of how it feels.
  3. Make sure you are not using your glutes, the thighs, or arching your back.
  4. Start by doing a few seconds of hold and increase the number of seconds over time as you gain strength.
  5. Remember to breathe and don’t hold your breath.
  6. Remember to think of holding ‘gas’ in while pulling ‘marbles’ up the vagina or penis (ouch).
Pelvic Floor viewed from outside

Pelvic floor showing anus and external genital

Should I Buy Kegel Exercise Equipment?

The most effective non-surgical equipment I am aware of is the BLT Emsella Chair. The Emsella chair is an FDA-approved chair for incontinence, providing 400 Kegel’s per minute with a hefty price tag; last time I checked, it was offered to patients by a few Urogynecologists, Gynecologists, medspa, and now our office. Patients describe it as feeling the whole inside of their pelvis uniformly contracting and lifting! Others feel more ‘vibration’ at one site of their seat than other sections at the beginning which goes away with consequent sessions. Some patients have claimed to have better sexual intercourse while others reported 100% resolution of their incontinence after only 1 session. The bottom line is that the results vary!

We use the Emsella chair for all pelvic floor dysfunction patients. Unlike all other offices that we know have this chair, at our clinic, the chair session is followed by biological breathing and neuro-kinesiology exercises to assure the postural integrity necessary to ensure the pelvic floor muscles are intact and in place.

You see, the pelvic floor muscles line the inside of the pelvis and play a huge role in holding the pelvis pieces (2 iliums’ and sacrum) together and assisting in pelvis stability. That means the integrity of the pelvis plays a huge role in the strength of the pelvic floor as well.

Pelvis bones

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

When working on the pelvic floor muscles, all muscles surrounding and attached to all of the areas named in the pic above are addressed. The hips and the spine are the influencers of the pelvis as well and are almost always at least partly dysfunctional in movement.

Will Emsella Chair Help My Weak Pelvic Muscles?

According to the Core Pelvic Floor Therapy website, it applies ” a High-Intensity Focused Electromagnetic technology (HIFET) to deeply stimulate pelvic floor muscles and restore neuromuscular control. The focused electromagnetic energy and intense stimulation allow your body to create powerful muscular contractions. These muscle contractions work to repair the pelvic floor to enable patients to regain bladder control. One session can produce the equivalent of 11,200 Kegel exercise contractions. The procedure is administered using a patented chair device that allows patients to remain fully clothed and comfortably seated during treatment.”

Who Do I See For My Pelvic Floor Dysfunction?

While most pelvic floor therapists are physical therapists; chiropractors (depending on each state), registered nurses, and medical doctors trained in pelvic floor therapy also perform the treatment. As a chiropractor, I work on pelvic floor dysfunction and utilize postural neurology and neurokinesiology exercises to assist in strengthening the posture. Pelvic floor muscles are a part of your musculoskeletal system and as such within the scope of chiropractic.

Not all physical therapists and chiropractors choose to work with the pelvic floor muscle area because of the nature of the work. While many patients with weak pelvic floor muscles have a history of trauma, there are many sports injuries and postural presentations that result from our sedentary lifestyles that lead to weak pelvic floor muscles and seeking treatment by a pelvic floor therapist.

If you have pelvic floor dysfunction and are unsure what to do, if you have sought care elsewhere but your problem persists, please contact me and mention this blog.

Dr. Shakib

Recommended Reading:

Constipation And Pelvic Floor Dysfunction

The Top Pelvic Floor Exercises For A Healthy Core And Beyond