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I recently had the opportunity to get together with a group of moms through the Holistic Moms Network (HMN) in Fremont, CA. I had put together a talk on what I thought were the most common issues moms of any age might be facing, but I wanted to spend some time asking them what they felt they needed more information about, specifically.

The answer was a resounding question, “How, exactly, am I supposed to do a kegel?”

This answer was not surprising to me. Most women are instructed by their obstetrician (OB) to ‘do your Kegels’ without much direction. This is because an OB’s focus is to keep moms and babies safe, not to teach women how to properly do a kegel. Unfortunately, because musculoskeletal questions associated with pregnancy arise, OBs are put in a position to provide information that lies outside their area of expertise. This is where pelvic floor physical therapists can step in and help out.

The problem with just telling someone to ‘do your Kegels” is that, according to recent research, 51% of women could not perform a Kegel properly with verbal cueing alone. And 25% of the women in the study were actually performing the attempted-Kegel in a manner that could promote incontinence and pelvic organ prolapse – the very issues kegels are suppose to help! Kegel confusion has been confirmed through my own clinical experience and conversations with new moms. Most women reading this are probably nodding their heads, yes!

In order for readers to get the full picture of how to Kegel, let’s start with the anatomy:





There are two layers of pelvic floor muscles.

The most superficial (closest to the skin) are known as the urogenital diaphragm. These are the muscles that are primarily responsible for helping to close the urethra and anus so that we don’t leak urine/gas/stool when we don’t want to. i.e. laughing, coughing, sneezing, or jumping on the trampoline. When performing a kegel properly you may be able to bias these muscles by concentrating on closing the urethra or anus, and the vaginal opening.

The deeper layer of muscles (closer to the organs) are called the levator ani. These muscles are largely responsible for supporting our pelvis, bladder, uterus and rectum throughout our lifetimes as the forces of gravity, childbearing/rearing, respiratory issues, constipation weigh us down.

Here is a good video of the pelvic floor anatomy and if you haven’t yet become familiar with your vulva read Rachel’s blog.

The basic idea to keep in mind when trying to perform a pelvic floor muscle contraction (kegel) is to squeeze the urethra/vagina/anus closed and lift up. It is an “in and up” motion. When I am palpating someone’s pelvic floor muscles to assess for strength-I am looking for the muscles to squeeze my finger and gently pull it up (toward the head). It is the exact thing that we do if we stop our urine mid-stream. This is not something to get in the habit of doing during urination, due to the risk of urinary tract infections, however it is ok to try one time if it can help you isolate the correct muscles.

Over the past several years at PHRC, I’ve discovered clever cues to help patients find and contract their pelvic floor muscles. Here is my list, but I am sure that there any many other tips/tricks out there. Please share yours in the comments section:

-pull your pubic bone and tailbone together

-bring your sits bones together

-stop the flow of urine

-wink the anus

-nod the clitoris

-pull in like you are putting on a tight pair of jeans

-sit on a chair and pull your perineum up and away from the surface

-think of the muscles as an elevator and “lift” up towards your head

-pull the underwear in

-hold back gas

-like you’re holding a tampon in

If you still feel lost you can try inserting a finger into the vagina or anus and actually FEEL the muscles. C’mon just do it.

You can also try curling your toes while attempting to kegel. (Check out this picture of the homunculus to see how closely related the pelvic floor muscles and feet are.) Also, stay tuned for an upcoming blog on toe curling orgasms!

If you have made it this far and are still shaking your head in confusion/frustration here’s what you can do:

There are many different products out there that claim to be pelvic floor strengtheners. I strongly recommend checking with a physical therapist before choosing one, so you get the one that’s right for you. One tool that I have found to be pretty effective and harmless is this pelvic floor educator from Current Medical Technologies. It works like this: you insert it into the vaginal canal and if you are doing a kegel correctly, it gives you visual confirmation.

At PHRC we will sometimes use biofeedback or neuromuscular electrical stimulation (NMES) to help find and isolate these muscles. Biofeedback works by projecting the electrical signals from your pelvic floor muscles on to a screen so that you can see when you are contracting properly. NMES works by supplying electrical signals directly to the muscles making them contract.

Kegels alone are rarely a solution for overall musculoskeletal health but rather one component of an individualized exercise regime for new moms. It is important to learn to do them properly if they are part of your fitness regime (Read here for more info on postpartum rehab). However, not everyone needs to be doing a kegels on a regular basis. In fact, for some people it might even cause dysfunction. Read here to learn why kegels are not right for all of us.

Hopefully this post validates why you might feel confused about how to perform a Kegel, they are definitely an acquired skill! When in doubt, consult with a pelvic floor physical therapist. They can provide you with an individualized program that is right for you and ensure you know how to do each exercise right. To find a pelvic floor PT: click here.

*Men: I haven’t forgotten about you. Because we are focusing on what mom’s want to hear about I did not talk about the male pelvic floor. But FYI kegels can be really important for you too! Check out these past blog posts for relevant info: here and here.

Readers we want to hear from you! Are you confused about kegels? Please share in the comments section below!

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