There are questions that come up around the topic of pelvic floor muscle exercises. Here at Pelvic Guru, the most common questions we receive are:
- Where are the pelvic floor muscles and what do they do?
- What is a kegel and is it the same as a pelvic floor contraction?
- Is a pelvic floor exercise the same as squeezing?
- How do I know if I’m doing it right?
- How can I train my pelvic floor muscles?
- How many times should I do it and for how long?
If you don’t have much confidence in your answers to the above questions or want to learn more, you are not alone. Many people have heard of these mysterious pelvic floor muscles but aren’t exactly sure that they’re able to squeeze them correctly or when to do it.
What are pelvic floor muscles?
Every person has pelvic floor muscles. There are actually three layers of these muscles and they all work together on the outside and inside:
- 1st Layer – Superficial: They go from “sit bone” to “sit bone”, surround the anus, and go from the perineum to the clitoris, surrounding the vagina (in people with vaginas) and from the perineum to the base of the penis (in people who have penises) (see images below)
- 2nd Layer: Located around the urethra (see images below)
- 3rd Layer – Deep: Located inside the pelvis, they go from pubic bone to tailbone (see images below)
This is how the Layer 1 muscles are oriented in someone with a vulva and a vagina.
What do pelvic floor muscles do?
Here are a few of the functions that the pelvic floor is responsible for regardless of what type of genitals you have:
- Keeping pee & poo from coming out at the wrong time
- Allowing for pee and poo to come at the right times
- Helping your genitals get aroused during sexual activity and can improve orgasmic function
- Supporting your internal organs to keep them from sliding down into your vagina (for those who have a vagina)
That’s a pretty good list! Those are some important features to keep you living your best life.
Okay, so how do I do pelvic floor muscle exercises?
There are 3 phases to doing a full pelvic floor muscle exercise:
- Contracting (lift and squeeze)
- Relaxing (back to resting)
- Gently bulging (similar to releasing to urinate or have a BM without straining)
All are important, but for purposes of this article, we are focusing on the contraction part – or the squeeze, kegel, or strengthening part of it.
“Kegels” are considered the contraction part of a pelvic floor exercise. So, when someone says they do kegels, they are contracting the pelvic floor.
The contraction part of the pelvic floor exercise is excellent for working on strengthening, coordination, and endurance of the muscles, The pelvic floor contraction is gentle and one should not see movement of the gluteal muscles, the back arching, legs moving. There can be a very light abdominal contraction at the same time.
Some people have what is considered tight or overactive pelvic floor muscles (can be associated with pelvic pain conditions, vaginal, penile, or rectal pain) and then it would not be recommended to do the contraction pelvic floor exercises and seek out help from a trained professional.
Note: You may hear “contract your pelvic floor like you are trying to stop the flow of urine.” While this can be a good cue, one should not typically try to stop the flow of urine when they are actually sitting on the toilet. This disrupts the normal flow and natural process of voiding.
How many of these pelvic floor exercises/contractions should someone do to improve support, strength, coordination, and endurance of these muscles?
It’s important to do both long contractions as well as short quick contractions so the pelvic floor has all of its functions available when needed. While the true starting place for your exercises would best be found through a thorough examination by a pelvic floor therapist, here’s a place to start if you’re working on these on your own.
Long holds: Start with 5 sec and repeat 10 times. If you feel like you can do these fairly easily, then do a few sets or increase the time you’re holding up to 10 sec for 10 times. Gradually work up to 2-3 times per day.
Short, quick squeezes: Squeeze quickly and then relax quickly 5 times in a row. If you can do those, you might increase to 10 times in a row. Gradually work up to 3 sets of these 2-3 times a day.
Can I ask a professional?
Pelvic Floor Therapists help people learn how to make their pelvic floors contract effectively every day and in doing so, they’ve collected some tricks for getting people to engage these muscles. We’ve reached out to some of the fantastic therapists in our Global Pelvic Health Alliance Membership and directory for ways they help people understand how to get the right muscles to work for them. Here’s what they had to say:
Brooke Kalisiak, PT, DPT, WCS from St. Louis says:
“If we are trying to work on contracting the pelvic floor in sitting without getting the other buttocks muscles involved, I often use this cue: ‘Rock back and forth in the chair so that you can feel your 2 sit bones firmly on the chair. When you contract your pelvic floor, the sit bones should stay on the chair and you should only feel a gentle lift up of the tissue in between them.’”
Terri Robertson Elder, PT, DPT, CLT-LANA of Brevard, NC says:
“A cue that often works for people with all different types of genitals is ‘imagine you are closing both your front passage and your back passage, and then bringing them both together and lifting them back into the body–much like a turtle going back into its shell. Try it! Close the front, back, bring together, and draw in’. If you don’t feel it right away, that’s ok- different cues work for different people. Keep trying different things and remember to relax all the way afterwards “.
Elizabeth Kemper from Atlanta, GA says:
“Being able to feel the pelvic floor squeeze and relax can be challenging, especially if you’ve never tried to isolate that movement before. The traditional ‘testing’ position of laying on your back may actually be the most difficult one! You may find it much easier to feel by just putting your body in a different position: on your side, on hands-and-knees, sitting on a firm surface, or (my personal favorite) slightly leaning your whole body forward with your fingertips on a wall.”
Heather Edwards, PT, CSC from Asheville, NC says:
“The cue that seems to help my patients understand these squeezes the best is: ‘Imagine your pulling your penis or your clitoris back into your pelvis.’ When I have people who are trying to clinch their buttocks instead of doing a pelvic floor squeeze this one seems to help them get to the right muscles.”
Tracy Sher, MPT, CSCS from Orlando, FL says:
“I tell my patients it is just as important to know how to contract and lift the pelvic floor as it is to allow it to fully relax too. We work on contract, relax, and gently letting go as if letting gas out or urine out.
Some of the cues to help them contract the pelvic floor that work well are:
- Imagine squeezing around the anus from the tailbone to the pubic bone
- Think about drawing or lifting up the anus (or same motion for vagina) as if you want to stop gas from coming out without using your butt cheeks. Or as if sipping a straw – the pelvic floor goes up towards the head.
- For those with a penis/testicles: think of water rising while standing and try to lift or draw the testicles up so they don’t get wet.”
Need some help with this?
If you feel like you need some help with any of those functions above, look for a pelvic floor therapist around the globe! A good place to start is in the PelvicGuru.com Directory.
Are there any home options?
You can test to see if you are doing a pelvic floor contraction a few ways at home such as:
- Use a mirror to see if you notice your genitals moving as your contract (it will be subtle and you shouldn’t see large movements from your legs or buttocks)
- You can insert a clean or gloved finger (into the vagina or anus) to feel if there is a gentle tightening and lift
Attention Pelvic Floor Therapists or other Pelvic Health Professionals:
We know you’re crazy busy keeping up with life, clinic hours, continuing education, documentation – all of it. Pelvic Guru wants to help give you some of your time back by providing you with a fantastic and ever-growing collection of pelvic health handouts (and illustrations) that you can use with patients (live or via telehealth). How can you get them? It’s one of the many perks of being a member of the Global Pelvic Health Alliance Membership!
Not only will you have access to our current growing collection, but you can also put in requests for topics that we haven’t covered yet. How great is that? You can help decide what content is created!
A promise we are making with the content in these handouts that is that we will strive to make them as inclusive as we can for genders, genital-types, race, age, ability, and body size. We here at Pelvic Guru know that pelvic health is for EVERYONE.
For access to the handouts and other amazing content, check us out HERE.