To Kegel or not to Kegel: you should know the answer

“Sometimes I leak urine when I cough or sneeze, but it’s just a little and it doesn’t happen all the time.” I hear this from mamas, friends, health professionals, and strangers alike. I can’t stress enough that although this is quite common for women to complain about only leaking “a little” or “sometimes,” it’s NOT normal and there IS something you can do about it that doesn’t require surgery or a product to absorb the urine. I repeat, it’s NOT normal, and there IS something you can do about it. 

Kegels alone will NOT solve your leaky problem as you may be quick to believe. First off, you may be doing them incorrectly. A Kegel is a pelvic floor contraction that requires not only a closing of the circular muscles around your anus, vagina, and urethra, but a deeper lift as well. If you perform what is known as a reverse Kegel which is not a contraction but a lengthening of the muscles, instead of a true pelvic floor contraction, your incontinence may actually worsen. Also, If your leaking is caused by a muscle spasm, Kegels will exasperate the spasm and therefore exaggerate the leaking. Some women do Kegels too often and too forcefully, which again does not help the situation if your muscles are already in spasm. Lastly, the pelvic floor muscles, like any other muscles, function at their best when they can fully contract or shorten and stretch or lengthen. When doing Kegels, the relaxation and lengthening are often forgotten about, resulting in muscles that are too strong and too short.  

Note the connection between the diaphragm, pelvic core, deep abdominals, and spinal muscles

Note the connection between the diaphragm, pelvic core, deep abdominals, and spinal muscles

There are other things to consider to help put an end to your leaky days. You can start by breathing. Your pelvic floor muscles work in conjunction with your main breathing muscle, the diaphragm, located underneath your rib cage. Take a few minutes per day to breathe fully, allowing your abdominal cavity to expand on an inhale and recoil on an exhale. As you inhale, your pelvic floor muscles will lengthen or stretch, while on the exhale, they will shorten. Remember, a good muscle should be able to do both.

Superficial pelvic floor layers

Superficial pelvic floor layers

Next, it’s a good idea to learn to do a Kegel the right way. But first, a brief anatomy lesson. Your pelvic floor muscles are made of of three layers; the first two layers (the superficial layers) are responsible for letting things go and keeping things in. By things, I mean pee, poop, gas, babies, and objects such as menstrual cups, speculums, or a penis. The third and deepest layer is responsible for supporting your uterus, bladder and rectum. Recall that a Kegel, or pelvic floor contraction, is a squeeze and a lift. The squeeze is the action of the first two layers while the lift is the action of the third layer. All layers are situated between your tailbone, pubic bone, and your left and right sits bones.

Deep pelvic floor muscle layers (Levator Ani)

Deep pelvic floor muscle layers (Levator Ani)

On to the fun stuff, let’s do some Kegels.

  1. Sit comfortably on a yoga ball or firm chair, moving the flesh away from your bottom so you can feel your sits bones on the surface you're seated on.

  2. Breathe (big inhale through your nose and exhale out the mouth) and relax your body as much as possible with special attention to the area between your pubic bone, sits bones, and tailbone.

  3. On the inhale, feel your pelvic floor muscles drop or bulge into the seat of your underwear, pants, or seat. On the next exhale, attempt to gently lift (not force) the area away from your seat. Think of closing off your anus, bringing your tailbone closer to your pubic bone without moving any other muscle in your body. If you’re having trouble here, pretend you’re in an elevator full of people and you're holding in a fart. Continue to breathe as you hold for a few seconds. Try a few of these.

  4. Relax and let go.

  5. Try again but this time, imagine you have a blueberry inserted in your vagina. On an exhale, squeeze your anus and vagina shut as you did above, but also lift the blueberry towards your head. Continue to breathe as you hold for a few seconds. Try a few of these.

  6. Relax and let go.

  7. Once you’ve mastered the above, imagine that same blueberry is in an elevator inside your vagina. When you’re relaxed, it’s on the ground floor. Squeeze and lift the blueberry (on an exhale) to the middle floor, the top floor, the penthouse, down to the first floor, back to the ground floor, and to the basement. Move from floor to floor and then change it up, moving to random floors. Try this for a few rounds.

  8. Relax and let go.

  9. To make sure you are totally relaxed, perform a child’s pose, downward facing dog, happy baby, or squat while you simply relax, no contraction needed.

Complete this sequence 1-2 times a day. Do what you can and work your way up to completing the entire sequence if needed. To really master the Kegel, you should be able to perform in a variety of poisons such as lying down, on hands and knees, sitting, standing, and moving. If you’re still having trouble with your leaking, a proper evaluation by a physical therapist, specially trained to treat issues such as these, may be warranted. 

If you get bored with your Kegels, you can try a pelvic floor muscle trainer such as the Elvie, which gives you real time feedback on how you’re doing. You can find it on Amazon here.*

*(Paid affiliate)