The Importance of Kegels: Getting to Know Your Muscles "Down There"

By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

One exercise that is unique to many prenatal or postnatal exercise classes, including yoga, is a round or two of pelvic floor exercises, also know as Kegels.

I am often surprised how many women do not know about the importance of a healthy pelvic floor. I would have thought their doctor should have enlightened them. Each time we do Kegels in our yoga classes, I ask the students, Who is practicing their Kegels at home? Usually this brings about a few smirks, sheepish looks and a few nods. (These nods often come from the all-knowing second time mothers who know what happens when you don't do your Kegels! Depends adult diaper anyone??)

The strength and flexibility of the pelvic floor is especially important to address during and after pregnancy, when the healthy function of the pelvic floor is really tested. Because of the hormones relaxin and progestrone and the weight of the growing fetus, the pelvic floor can become weak and vulnerable. Over time, if a woman does not maintain a strong, flexible and healthy pelvic floor, she can suffer prolapsed bladder, prolapsed uterus, prolapsed anus, urinary incontinence, back pain and pelvic pain. Even if a woman gives birth by Cesarean section, she will still have carried the weight of her baby for an average of 40 weeks, and the pelvic floor will have experienced some weakening.

Besides the obvious reason to do your Kegels, (not peeing on yourself!), you will gain greater sensitivity and circulation in that area, making sex more enjoyable for both you and your partner. You will also lessen your chances of tearing when your baby's head is crowning, since a toned muscle will stretch more effectively than a weak one, and should you tear, you will likely heal more quickly. You will experience more support for your body, leading to less back pain, you will minimize your chance of getting hemorrhoids and you may experience a shorter second stage of labor -- PUSHING!!!

It is a misconception that it is only important to focus on the strengthening aspect of the pelvic floor. It is equally important to remind the students to learn how to relax the pelvic floor. When a woman is in the second stage of labor (the pushing stage) she needs to access the ability to let these muscles relax and let her baby out. If she goes into labor never having familiarized herself with her muscles down there, how can she expect to know how they work?

One way I like to teach students to relax the pelvic floor is have them focus on the letting go of the pelvic floor during Kegel exercises. For example, I ask the students to do an elevator Kegel, by imagining there are four floors at the base of the body and that they are to slowly engage and lift the pelvic floor up all four floors, and then slowly release the muscles floor by floor. (Typically, most women say they cannot control the descent of the muscles. They drop from the fourth floor straight down to the bottom.) This type of exercise uses the slow muscle twitch fibers, which make up 70% of the muscles of the pelvic floor, and asks the woman to be more aware of what it is like to consciously relax the pelvic floor muscles. To focus on the fast muscle twitch fibers, I would ask the students to pulse the muscles, quickly engaging and releasing.

If you are brand new to Kegels and are unfamiliar with how to access the pelvic floor muscles, you can practice on the toilet. Try stopping the flow of urine mid-stream. But don't practice that too often, since you don't want to inadvertently give yourself a urinary tract infection. Once you feel comfortable with focusing on the front of the pelvic floor, you can include some of the muscles to the back of the pelvic floor. One of my students, a physical therapist, said you should engage your rectum as if you were trying not to pass gas in public. But don't tighten your butt muscles. You can work your Kegel practice up to 20-100 Kegels per day. Find a way of incorporating them into your day that works for you. I recommend making a game of it: as a New York City subway rider, I used to begin doing my Kegels when the subway door opened to let passengers on, then stop when the doors closed again. Now that my son Shay is 7 months old, I do my Kegels while nursing. Find a way to incorporate your Kegels so that doing them is not an arduous task!

Without getting into a whole anatomy lesson, the muscles that we focus on when practicing Kegels are part of the superficial layer of the pelvic floor, which resembles a figure eight. The bulbospongious muscle is the front loop of the figure eight, which runs from the clitoris to the central tendon (the perineum), and the anal sphincter is the back loop of the figure eight. Here is a link to a picture of the superficial pelvic floor muscles.

Now that you are a little bit more familiar with the workings of your pelvic floor, Kegels will not be such a mystery. Happy Kegeling!