Learning How to do Kegels (Women)
Getting Started
First of all, the pelvic floor is a group of muscles, which extends from the pubic bone in the front to the tailbone in the
back, and it forms the bottom of your abdominal container. It is in the shape of a kite since it widens at the sitz
bones (which are the bony structures you feel when you sit on your hand on a hard wooden chair). If you think
about a kite, it is like two triangles back to back. The triangle in the front is called the urogenital triangle, and the
back, the rectal triangle. The front triangle has the urethral and vaginal openings, and the back triangle, the rectal
opening.
Refer to the picture of the pelvic floor muscles frequently while you are learning how to do these exercises. You
need to be able to visualize where these muscles are and how the muscle fibers are oriented in order to be effective
in strengthening these muscles.
The first thing that you want to do is to make sure that you are contracting both triangles equally while doing a
Kegel, or if anything, slightly stronger in the front triangle. How do you know which triangle you are using? Stopping
the passage of gas is contracting the back triangle, and stopping your urine stream, is contracting the front
triangle. The other thing to remember before we go any further is that you can never contract the front triangle
without the back triangle, and vice versa; however, focusing on one triangle at a time initially will teach your brain to
equally locate muscles in both triangles so that one triangle doesn't become stronger than the other.
To contract the front triangle, imagine that there is a sponge sitting right inside your vagina. Squeeze the imaginary
sponge with your vaginal muscles, and draw it inward as if you are wringing it out. To verify that you are doing this
correctly, place one finger inside your vagina to feel the tightening and lifting inside of these muscles. This is the
front triangle. The back triangle is engaged by imagining drawing a marble into your rectum. Close your eyes as
you are visualizing these things since these muscles work well under visual guidance. Hold each area for several
seconds, and repeat 10 of each type of contraction, 1-2 times per day.
For several days or weeks, just practice engaging the vaginal/urogenital triangle and rectal/anorectal triangle on
their own (remember, you will feel tightening in the other triangle as you work, but your focus is going to be on the
triangle that you are visualizing). Once you feel that you are equally engaging your muscles in both triangles, and
your brain recognizes that the pelvic floor has both vaginal and rectal components, you are ready to contract the
pelvic floor as a whole.
Just a word about exercise frequency and repetitions: with exercises 1-3 below, do 10 repetitions of each exercise
holding for 10 seconds, and resting for 10-20 seconds (provides support to the pelvic floor and resists fatigue), and
the same amount holding for 2 seconds, resting for 2 seconds (helps open and close bowel/bladder and for sexual
function). You can repeat these combined exercises 1-2x/day. If you do them daily for 3-4 months, you will
definitely see the benefits of training your pelvic floor.
You will need to build up your tolerance to doing these exercises for ten seconds. To start, test how long
you can hold the contraction without feeling the muscles let go, and add one second. That will be your
starting point. Slowly, over the following weeks of practice, you can build up to the ten second holds.
Muscular action of the pelvic floor uses both areas together, and contracts the pelvic floor in the direction of the
muscle fibers. If you look at the picture again above, you can see that the pelvic floor muscles go lengthwise (from
front to back), sideways (from sitz bone to sitz bone) and diagonally from one sitz bone to the opposite pubic
bone. Take some time to orient yourself with this drawing so that you can visualize and feel what you are doing.
Adapted from: http://www.pelvichealthsolutions.ca/for-the-patient/