YAY! I’ve finally learned how to tell if I’m doing kegel exercises correctly. My teacher, Amy Stein, is a doctor of physical therapy and the founder of Beyond Basics Physical Therapy in New York City. Amy specializes in treating pelvic floor dysfunction, which can cause bladder and bowel issues, lower back and pelvic pain, and discomfort during sex. “We see a lot of incontinence, but also bladder urgency, retention, and incomplete emptying,” Amy told me.
“Kegels are essential for quality of life for anyone with urinary incontinence. You just have to do them,” Amy said. When our pelvic floor muscles lose elasticity as we age, we need to exercise them, just as we need to exercise muscles all over our body to maintain our strength and flexibility.
Before I share Amy’s expertise on doing perfect kegels, I wanted to pass on her description of our pelvic floor from her practical and worthwhile book Heal Pelvic Pain, A Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence, IBS and Other Symptoms Without Surgery.
Our pelvic floor serves three vital purposes: 1) It holds up and cushions the urinary, digestive and reproductive organs within the pelvis and lower abdomen. 2) It controls continence by signaling elimination urges to the bladder and bowel and by opening and closing the urethra and anal canals to allow voiding. 3) It controls sexual function by contracting the muscles around he female and male genitalia to respond to arousal and enhance enjoyment! “These are big and important jobs, which may be why so many thick, closely connected muscles are involved,” Amy writes.
Our pelvic floor muscles are attached to our skeletal frame, and we voluntarily and consciously control them, unlike the smooth, involuntary muscles of the bladder, intestines, lungs, and blood vessels. When we contract our pelvic floor muscles, the energy of the contraction applies force to the tailbone.
The pelvic floor muscle fibers come in two “speeds”: 1) Slow-twitch or slow-contraction fibers, which fuel endurance, provide support and resist fatigue. Accounting for about 70 percent of all pelvic floor muscles, slow-twitch muscles are slow to tire and persistently supportive. 2) Fast-twitch fibers help control the contraction and relaxation that open and close the bladder and bowel and serve sexual function. These “sprinter” muscles provide a quick jolt of power when needed.
“Although both the slow and fast-twitch muscles lose strength as the body ages, the fast-twitch muscles do so more readily. In a sense, the power to endure remains, while the power to perform some of the key functions of the pelvic floor can diminish. It’s no exaggeration to say that a healthy pelvic core is a major component of a healthy you, so it’s important to pay attention to any pelvic pain or disorder that could be signal something is wrong,” Amy explains in her book.
FINDING THE RIGHT MUSCLES
Kegels are “absolutely basic” to strengthening the pelvic floor muscles, but “half of those doing kegels are doing it wrong,” Amy said. Before you learn how to do them the right way, first find the muscles by using one of these methods: 1) Take a mirror, squeeze, and look to see if the anal opening is “winking.” This is called The Anal Wink. 2) Insert a finger and feel the movement 3) While urinating, stop the urine from flowing by tightening or squeezing the muscles, which are the muscles that need to be clenched and unclenched when you do Kegels. If you find that clenching the muscles minimizes but doesn’t totally stop the urine stream, you’ve found the right muscles, but you’ve also learned that they’ve very weak.
DOING THE KEGELS CORRECTLY
Lie or sit down, wedging a pillow under the small of your back if you want. Find the muscle you identified using one of the techniques above and clench it, then relax. Clench it again, then relax. One clench-and-relax constitutes a repetition, and both elements are important, so relax as deliberately and for as long as you clench the muscle.
Each repetition will increase the strength of the muscles. Do them three times a day if you have urinary issues.
Strengthen your slow-twitch pelvic floor muscles by tightening and holding for 10 seconds, then relaxing for 10 seconds. Do 10 repetitions. Strengthen your fast-twitch muscles by tightening and holding for two seconds, then relaxing for two seconds. Do 10 repetitions.The two different basic Kegel exercise differ only in timing, not in the process. When you perform both of them you’re strengthening both your endurance (slow-twitch) and sprinter (fast-twitch) muscles.
Learn more about Amy’s book, Heal Pelvic Pain, as well as a two-hour DVD on the subject so you can see the exercises she recommends. Amy advises that you also see a pelvic floor therapist to help guide you.