How to do pelvic floor muscle exercises, also known as Kegel exercises
Anatomy
The pelvic floor muscles fill the gap under your pelvic bones between the pubic bone at the front and the coccyx at the back. They need to be able to contract to support internal organs, controlling the passing of urine and faeces and during sex. They also need to be able to relax when having a poo and a wee, during childbirth and with sex too.
The pelvic floor has several layers, deeper and more superficial and wrap around the tube from your bladder (urethra), vagina if you are female and anus (back passage). Some muscles that are striated like your muscles in your arms and legs and some are smooth and can’t be controlled with your mind. These are called sphincters and are circular.
Cues to contract the pelvic floor
People often feel the need to do pelvic floor muscle exercises if they have a problem such as leakage of urine or faeces or if they have a prolapse. However, there are times when it is best not to do pelvic floor exercises unless you have been advised to do so by a specialist who has examined you. If you have pelvic pain, it is best to be assessed first. You could try the pelvic and hip muscle stretches at the end of this blog but it might be best not to try pelvic floor exercises.
If you struggle to be able to contract your pelvic floor here are some ideas to help:
Squeeze like you are trying to slow down the flow of urine
Imagine you are in a public place and squeeze around the back passage as if stopping wind coming out
Squeeze like you are trying to hold a tampon in
Imagine a jellyfish moving through water. Gently contract and relax your pelvic floor in a similar way
Imagine dropping a stone into water and watching the ripples move out. Now imagine that you are trying to use your pelvic floor muscles to collect the ripples and pull them back to the centre.
Imagine a zipper running from your back passage to pubic bone. Imagine doing up the zipper
Imagine the pelvic floor muscles as an elevator door. Close the doors and go up to the top floor
Coordination
It is often best to coordinate breathing with pelvic floor contractions.
Try to breathe out when you contract your pelvic floor. If you are holding a contraction for a long time you will need to breathe in again but keep the contraction going.
You might notice that your lower tummy muscles tighten too when you contract your pelvic floor muscles. That is OK. Just try not to pull in the upper tummy muscles, thighs or buttocks.
Find your starting point
First, breathe in, then breathe out to contract. See how long you can hold this contraction for. For example, imagine that you can hold for 4 seconds.
Repeat and see how many times that you can hold the 4 second contractions for. Let’s pretend that you can repeat the 4 second contractions 5 times.
Then let’s see how many fast contractions you can do. Imagine you can do 5 fast contractions.
Lastly see if you can contract 50% (submaximal) of your maximum contraction for as long as possible. Let’s say you can hold for 20 seconds.
In this case your slow exercises would be 4 seconds x 5 repetitions with a 3-4 second rest between each contraction.
You would do 5 fast contractions and 1 submaximal contraction for 20 seconds.
We like to encourage people to do their exercises 3 x day. The Squeezy NHS app helps as a reminder, and you can put your own starting point into the app so that it can count you down through your exercises. It can take 3-6 months to see some change, so don’t give up!
Progressions
One way to progress is to increase the number of slow and fast exercises and the time that you hold the submaximal contraction. Ideally you would work up to 10 seconds x 10 slow, 10 fast and up to 60 second submaximal.
People often start their exercises in lying, then progress to sitting, them standing and then with movement from other parts of the body such as when doing Pilates exercises.
Should I be doing pelvic floor exercises if I have pelvic pain?
Often it is useful to do some stretches before starting pelvic floor muscle exercises. Your physiotherapist will let you know when it is a good time to start pelvic floor exercise when you are able to contract, then relax the pelvic floor fully. Doing stretches that involve the hip muscles often help to relax higher tone pelvic floor muscles. It is always best to be assessed by a pelvic health physiotherapist to tailored your treatment to your needs.
Here are a couple that can be tried if you have pelvic pain.
Lie on you back with your knees bent and feet on the ground. Bend one knee to your chest then the other leg. Hug both knees to your chest and hold this for 30-40 seconds. There shouldn’t be pain.
Hip flexion (image designed by Freepik)
This next one stretches the back of the buttock. Again, only take into pull not pain
Piriformis stretch (image designed by Freepik)
When to seek help from a pelvic health physiotherapist
If you are not sure whether you are doing your exercises correctly, or if you have been trying to do pelvic floor exercises but still have leakage, pelvic pain or a sensation of a prolapse. So if you are struggling and would like an individual treatment plan please get in touch. Please remember that this blog is for informational purposes only and it is advised that you seek professional advice to ensure that treatment is tailored for your needs.