Kegels: How (And Why) To Make Them Part of Your Routine

Kegels are just one tool to be able to help with pelvic floor symptoms, but they can be powerful. By the end of this article, you’ll understand not only what Kegels are, but how to do them and the science behind when to use them.

What are Kegels?

Arnold Kegel, a gynecologist at University of Southern California, published the first description of pelvic floor exercises in 1948. He “discovered” and described the voluntary contraction of the pelvic floor muscles as a first line treatment for female urinary incontinence caused by pelvic floor muscle weakness. He showed that voluntarily contracting and relaxing the pelvic floor muscles can make them stronger, thicker and more coordinated.

Ever since, the term “Kegel exercise” has been used to describe the action of voluntarily contracting the pelvic floor muscles. We’ll use the terms Kegel and pelvic floor muscle contraction interchangeably, because they mean exactly the same thing.

Clearing the Air About Kegels

You may have seen media sources publish broad claims about Kegels ranging anywhere from them being a miracle cure to a cause of damage to the pelvic floor. Like a bicep curl, sit up or knee extension, a Kegel is a purposeful contraction and relaxation of a muscle group. Like these other exercises, science is clear that Kegels are not inherently “good” or “bad.”

Exercise is like medication. Whether or not an exercise is appropriate and effective for an individual depends entirely on the person’s goals and how it is “dosed.”

Pelvic floor muscle training (PFMT) refers to a structured program of Kegels. Like any other strength training program, results come from choosing the right resistance level, reps, sets and rest periods. PFMT won’t work for you if you follow a program that’s too easy or too hard. It also won’t be effective if your concerns are not due to pelvic floor muscle weakness.

Should I Do Kegels?

It depends.

If you don’t have any pelvic floor-related symptoms, there’s no evidence that you have to do Kegels. The best way to keep your pelvic floor healthy is to keep your bowel and bladder function normal, stay active and regularly strength train. Some people enjoy the results of doing “extra” exercise for the pelvic floor. However, your pelvic floor will still get exercise if your whole body is as well.

If you have symptoms of pelvic floor muscle weakness, experts agree that Kegels are the gold standard first line treatment. What’s more, they’re free and easy to do anywhere!

Many women in midlife are experiencing the combined effects of aging, estrogen loss in menopause and changes from pregnancy and childbirth earlier in their life. When these factors add up to create symptomatic pelvic floor muscle weakness, it’s a great idea to use PFMT to help restore thickness and strength to the pelvic floor muscles.

Kegels are usually appropriate for:

• Stress urinary incontinence—leaking urine with coughing, sneezing, laughing, running, jumping or lifting. Get all the details about stress incontinence here.
• Incontinence of gas or stool—leaking gas or stool with coughing, sneezing, laughing, running, jumping or lifting, or not being able to hold back a bowel movement when you’re trying to get to the toilet.
• Sensations of vaginal or rectal heaviness, especially after prolonged standing or with coughing, running, jumping or lifting.

When not to do Kegels:

• If they’re not helping you. If you’ve been doing Kegels consistently for a couple of months (meaning at least once per day) and your symptoms aren’t even slightly improving, you probably need something new. You may need help with your coordination to get the most out of the exercise, or pelvic floor strength might not be the major contributor to your symptoms.
• If they’re too easy. Kegels are a great way to strengthen the pelvic floor muscles but they have diminishing returns when someone is already strong. Just like any strength training, the level of difficulty of your exercises has to increase as your strength increases. Strength training—especially weighted squats, deadlifts and other lower body movements—is a progression of pelvic floor exercise that helps relatively strong pelvic floors get stronger.
• If you don’t want to. Many women are told that they should do Kegels for their whole lives to have a healthy pelvic floor. This simply isn’t true. If you have none of the above symptoms of pelvic floor weakness and are consistently strength training and incorporating some impact activities like jumping, hopping or jogging, you can keep your pelvic floor muscles in good shape without Kegels. Should you ever develop symptoms, you can try adding Kegels to see if they give you the boost you need.

PFMT is not a one-size-fits-all solution, because pelvic floor muscle weakness is not always the primary contributor to symptoms. Pelvic floor-related issues are influenced by what you eat and drink as well as your toileting habits, sexual habits, stress, anxiety, sleep, exercise and more.

How Do I Do a Kegel?

While you can squeeze and relax your pelvic floor in any position, it’s easiest to start lying down or sitting on a firm surface with your feet flat.

1. Inhale naturally with a relaxed belly.
2. Exhale and squeeze like you’re trying to stop from passing gas. This should be subtle and isolated—no one should be able to see movement in your body. If you’re sitting down, you should feel the area between your vagina and anus move up, away from the chair and towards your head. If you’re lying down, you should also feel that area move towards your head.
3. Inhale and let go of the pelvic floor, feeling it return back to its starting position. If you’re sitting down, you should feel the area between your vagina and anus settle back towards your seat.
4. Repeat.

How Many Kegels Should I Do?

Muscle strength is built through progressive overload—fatiguing the muscles with each workout and increasing the challenge over time as your muscles gain strength.

A PFMT program usually consists of endurance contractions (longer) and fast contractions (quick, strong holds).

Start with this basic Kegel program

Endurance contractions

3 sets of 8-12 repetitions of your maximum hold, resting for about 10 seconds between each rep and a minute or two between sets

Find your endurance contraction hold time: Contract and hold for as long as you can before your squeeze drops off significantly. For most people, this is a few seconds up to about 10-15 seconds.

Fast contractions

1-2 sets of 10-15 repetitions as fast as you can

How to do a fast contraction: Try to squeeze for about one second and then relax fully before doing the next contraction. How many can you complete in 10 seconds? This can range from a few to no more than about 15.

Do I Have to Do Kegels Forever?

Once you have achieved your goals, you can switch to a “maintenance” schedule of 2-3 times per week instead of a daily schedule. You can also stop doing Kegels altogether, and see whether or not your symptoms return. Some people decide that they feel best on a maintenance plan, and others feel fine without it. Strength training and staying active are the most important ways to maintain results and keep your pelvic floor happy and healthy.

How Much Pelvic Floor Muscle Strength is Enough?

The truth is, we don’t really know. Each person’s pelvic floor strength is different due to genetics, childbirth history and past and current exercise. “Enough” pelvic floor strength probably varies based on what someone wants to do and if they have any symptoms.

In general, an appropriate goal for most people is to be able to confidently contract and hold their pelvic floor contraction from a seated position for about 10 seconds. Then, they should be able to repeat that for three sets of 10-15 repetitions without significantly losing power.

Are There Any Risks to Doing Kegels?

The most common negative side effect from PFMT is vaginal or rectal discomfort. When muscles get “overdosed” on exercise, they can feel achy. If this happens to you, it’s a sign that your muscles are sensitive to the exercise and that you may need different programming.

No muscle in the body, including the pelvic floor, gets “too tight” as the result of exercise. Exercise does make muscles thicker, which is one of the goals of strengthening exercise, but this is not a cause of discomfort.

Instead of stopping altogether, try reducing your level of effort, length of hold and/or number of repetitions to see if you can find a comfortable dosage. Don’t forget to rest between each contraction, even if it’s boring. If you’re still having trouble, consult a pelvic physical therapist.