Like any other workout, getting it right means better results. Your pelvic floor will thank you.
We’ve all heard “Do your Kegels! Let’s get that vagina nice and tight!” from a plethora of medical providers, mainstream media, good ol’ women’s magazines, and friends around the happy hour table.
But what really happens when you do a Kegel, why do we do them, and can we do too many? Allow me to explain.
First of all, let’s talk about what a Kegel is and what it’s doing. You’ve heard the term “pelvic floor muscles” or “Kegel” muscles, right? The pelvic floor is a bowl or hammock of skeletal muscles (think the same stuff your biceps or quads are made up of) that’s literally the “floor” of your core.
These magical muscles attach from front to back (pubic bone to tailbone) and side to side (sit bone to sit bone). There are three layers, and they have three main functions:
- Continence. These muscles help keep us dry by contracting and holding in urine, stool, and gas, and then (when it’s time to void or evacuate our bowels) relaxing so we’re able to do what we need to do.
- Support. Since these are the “floor” of the core, they hold up our pelvic organs, our body weight, and support us against gravity.
- Sexual. The first layer of muscle has to relax and lengthen to allow vaginal penetration, and then the muscles of the pelvic floor aid in pleasure by providing the rhythmic contractions associated with orgasm.
When we actively perform Kegel exercises, we’re performing a shortening action of the pelvic floor, which contracts the muscles toward the middle of the vagina and up toward our heads.
When teaching this to patients, I like to tell them to squeeze and lift with their pelvic floor like they’re picking up blueberries with their vagina, or squeeze and lift like they’re trying to hold in gas.
- leaking urine with exercise or upon laughing, coughing, or sneezing
- painful intercourse or vaginal penetration
- pelvic organ prolapse
- abdominal or core weakness
- back pain
But when we talk about a “healthy pelvic floor,” we need to make sure that the muscles are not only strong but strong and long, versus weak and tight.
It’s difficult, however, to perform a Kegel the correct way. In fact, it takes practice and perhaps a skilled provider to teach you how to do it. It’s not just about squeezing your vagina, it’s a symphony of muscle contraction of the lower abdominals synchronized with proper breathing techniques.
Sorry to be the bearer of bad news, but if you’re doing the following, you’re not doing it right:
- holding your breath
- sucking in your belly
- tensing your neck
- squeezing your thighs or booty
Ever have a charley horse in your calf or a knot in your neck? The same thing can happen in your vagina. Yes, it’s true. I know. Shocking.
Because the pelvic floor comprises skeletal muscles, it can experience the same type of injuries as other areas of your body, such as your biceps or hamstrings. As such, you can 100 percent overdo it with Kegels, just like you can overdo it at the gym lifting weights or running.
The pelvic floor can get too tight or short and develop muscle tension or spasm. This can be from doing too much activity or strengthening, performing Kegels incorrectly, or not training the muscle to lengthen or release after strengthening.
Rest phases are just as important as contractions, and if we don’t rest or train the muscle to move through its entire range of motion (lifting up and full release), we see muscle injury like we’d see in other parts of the body.
Common symptoms of a pelvic floor that’s too tight or short may include:
- painful sex or difficulty with tampon use or gynecologic exams
- urinary leaking
- urinary frequency or urgency
- bladder pain or feeling like you have a urinary tract infection (UTI)
- constipation or difficulty evacuating bowels
- pain or soreness in other areas, such as the tailbone, pubic bone, tummy, hips, or low back
If you’re experiencing these issues, it’s worth talking to your healthcare provider or a physical therapist about possible treatments.
Remember this pearl of wisdom: It’s not good advice to tell someone to do hundreds of Kegels a day for a “tight” vagina. We don’t want a tight vagina. We want a strong, functional pelvic floor that can contract and release fully.
Think of the shape of a bell curve. We need to see a full and symmetrical contraction and relaxation.
We don’t do hundreds of bicep curls every day and not have a rest period, right? We train the bicep in a functional way with proper stretching and release strategies. It’s the same idea for the pelvic floor.
Think of sets of strengthening with rest phases, days off, and then return to training.
So just like anything — all good things in moderation. Strength is definitely important, and Kegels are important. Yet, we don’t want to do them all the time. Give the vag a break, she works hard and deserves some good R&R.
Marcy is a board certified women’s health physical therapist and has a passion to change the way women are cared for during and after their pregnancies. She’s the proud mama bear to two boys, drives a minivan shamelessly, and loves the ocean, horses, and a good glass of wine. Follow her on Instagram to learn more than you want to know about vaginas, and to find links to podcasts, blog posts, and other publications related to pelvic floor health.