Doing a kegel isn’t as straightforward as you may think, and there are many considerations to keep in mind. Here’s how to do Kegels in postpartum, the right way.
In case you missed it, a “Kegel” is a voluntary squeeze of the pelvic floor like you’re trying to hold back urine. Before we dive into an actual kegel or pelvic floor contraction, let’s talk about pelvic floor physical therapy.
Many patients and their physicians think that pelvic physical therapy is ‘just doing Kegels.’ In fact, nothing could be further from the truth. However, many physical therapists are still using Kegels to solve just about any physical issue in postpartum. Plus, many women are cruising around in their car, doing Kegels whenever they think about doing them (red lights, anyone?).
Why Kegels don’t always work
In most cases – especially in pelvic pain, prolapse, constipation, and urinary urgency/frequency/retention – the pelvic floor muscles are already too tight.
And then, using Kegels, you continue to squeeze them over and over again deliberately? That sounds crazy, doesn’t it?
Imagine if you had a lot of pain in your neck because your neck muscles were too tight and then continued strengthening those tight muscles each day to feel better. Chances are, your neck will continue to hurt.
The truth is, most of the time, you should learn to relax those muscles. If you’re having any pelvic pain, you should never be doing Kegels as part of your daily routine. That includes painful sex, difficulty using tampons, constipation, or difficulty emptying your bladder fully.
But what if I have incontinence?
Incontinence is when you are either having bladder leakage or are going to the bathroom frequently throughout the day and night. Incontinence can be a complex issue that a simple kegel cannot fix. Finding where those muscles are and how to use them properly is crucial for a happy and healthy pelvis.
We often hear incontinence because the pelvic floor is ‘weak.’ But often, it’s actually because parts of the pelvic floor are already overly tight. Kegels do the exact opposite of what we want.Megan Rome
Plus, there’s often something else going on, such as low back pain, prolapse, urinary urgency/frequency, painful intercourse. All of these are signs of a too-tight pelvic floor. After all, before you were incontinent, you weren’t wandering around Kegeling every two seconds.
Even if there is some weakness, we have to look at the system as a whole. Find the underlying ‘why’ of the problem and address it for lasting relief.
Finally, did you know that most people can’t do a Kegel correctly when given instructions? Even gynecologists couldn’t do it. Most people recruit the backside of their pelvic floor muscles over gripping rectally, which will not help support your bladder and any leaks that come with it.
How do I know if I am doing a kegel correctly?
Let’s give this a try! I want you to sit with your legs uncrossed and both feet flat on the floor. Now, sit up nice and tall and try to perform a kegel. Now, I want you to pay attention to a few things.
- Did you squeeze your butt when you did a kegel?
- Did your core brace when you did a kegel?
- Do you feel the squeeze more vaginally or rectally?
Now, I want you to slouch back in your chair in really poor posture and answer the questions above. More than likely, you will feel your pelvic floor squeeze in different places based on where your weight is shifted.
Now, go back to that upright posture. Can you perform a kegel and then quickly relax those muscles? Did you feel those muscles “drop” or let go? If not, typically, that is a sign of pelvic floor tightness. If you are unsure of what you felt, you may have a coordination issue with these muscles.
Regardless, if you’re being told to ‘just Kegel,’ only using biofeedback with your pelvic PT, or having a physician tell you to practice squeezing, you need to find someone who is looking at the whole picture.
What should I do if I think my pelvic floor is too tight or too weak?
If you think your pelvic floor is too tight or too weak, I would highly suggest reaching out to a pelvic floor physical therapist for a thorough internal examination. This is the best way to determine the state of your muscles. You can also read more about common pelvic floor issues in postpartum.
Feel free to reach out to our pelvic floor Physical Therapist, Dr. Megan, with Rome Physical Therapy with any questions you may have!
As a Pelvic Floor and Obstetrics Physical Therapist in Charleston, South Carolina, I offer both in-person and virtual visits to help your pregnancy and postpartum journey. My classes are designed to take you through preparing your body for birth, training your birth partner to be your constant support and advocate, as well as everything you need to know postpartum from taking your first poop, pain-free sex, and healing your core and pelvic floor. You can also learn all things about bladder leakage and how to make it stop.