One of the most common questions I get from friends, acquaintances, and patients is “How do I know that I’m doing Kegels right?” With patients who see me for pelvic floor problems, this is easy to assess. But I can’t really do that with my friends and readers, which brings us to this post!
We know that about 60% of women are not doing Kegels properly, even if they were given instructions. But we all seem to think we know how to do them right? Well in this post, I am going to talk you through how you can check if you are performing a pelvic floor contraction correctly. While you can feel a pelvic floor contraction externally, it is much harder to explain and oftentimes people are not feeling the correct muscles. That's why I am going to explain the visual and internal exam methods. Ideally, you would start with the visual and then do the internal. If you really want to be a pelvic overachiever, do a self exam followed by this mini exam!
This is not by any means meant to be a substitute for an evaluation by a qualified healthcare professional. I strongly suggest that you do NOT do this exam if you have pelvic pain, pain with penetration and/or pooping, prolapse, or other symptoms of pelvic floor problems. You should see a pelvic floor physical therapist to perform a thorough evaluation and instruct you in the correct exercises to perform. Remember, Kegels aren’t for everyone! Speak with your guiding healthcare provider about performing Kegels if you are currently pregnant.
Undress from the waist down and lay on your bed, with your legs spread. Use a hand-held mirror to look at your vulva.
This is similar to the pelvic sex exam, but this time you will be focusing specifically on the perineum (the space between your vaginal opening and anus). When you do a contraction, this area should look like it’s tightening and moving AWAY from the mirror (i.e. like it’s trying to go up towards your head!).
If you try to contract and see the perineum move TOWARDS the mirror (i.e. like it’s moving down towards your toes) then you are actually doing the opposite of a contraction. Take a deep breath and try to do a contraction as you exhale, like you are blowing out birthday candles. This usually helps as the pelvic floor works in sync with the diaphragm. Still struggling? Try squeezing your thighs together as you contract.
If you are trying to do a contraction and don’t see anything move then don’t panic. No movement could mean that you are having difficulty coordinating the contraction (which is common) or that you have a weak contraction. If you fall within this last group, then I would highly recommend that you check yourself internally!
Once you release the contraction, you also want to see if the perineum returns to its starting position. You wouldn’t do half of a bicep curl and never let your arm relax right? Same goes for your pelvic floor! You should be able to fully contract and relax healthy muscles. Difficulty relaxing muscles is a very common cause of pelvic floor problems. Again, you will likely have symptoms and should see a healthcare provider.
Undress from the waist down and lay in a comfortable position. You will be inserting one finger into your vagina so I suggest you use a lubricant. When you are ready, insert one finger into your vagina, just up to the first knuckle. This is the first layer of pelvic floor muscles. There are 3 layers total, and you will check all three.
Do a contraction. You should feel like your finger is being squeezed and pulled deeper into your vagina. You may feel just a squeeze, with no lift. That’s okay. It means your muscles could be stronger. FUN FACT: This is what all those “squeeze and lift” instructions are about. Your pelvic floor muscles should squeeze and lift. Be sure that it's the pelvic muscles, and not your butt lifting up!
Got that down? Okay, now insert your finger up to the second knuckle, then the third knuckle, and repeat the contraction at each level. As with the visual exam, you also want to be sure that after you squeeze, you fully relax. You can also move your finger from side to side to feel if one side is weaker than the other.
Did you struggle to do a pelvic floor contraction? Are you freaking out right now? Well… if you have no signs and symptoms of pelvic floor dysfunction, but can’t do a strong contraction, then don’t worry. Your pelvic floor is working just fine otherwise you’d have some type of problem!
This just means that you need to work on coordinating and activating those muscles. Think about your triceps for example. You might struggle to do a push-up, but that doesn’t mean your triceps aren’t functionally working. They work all the time as you reach into a cabinet to get a drink and other daily activities. It’s just a muscle group which needs to be trained if you want to do a push-up! Now if you have severe pain when trying to do a pushup… that might be problematic right? Same for the pelvic floor muscles. If you have symptoms of pelvic floor dysfunction then you should see a pelvic floor physical therapist.
Are you completely symptom-free and struggling to do a contraction? Start by doing 30-40 contractions per day and using the mirror or your finger for feedback. This is just to help you confirm that you are doing it correctly. You will get to a point when you no longer need that external feedback to be sure you are doing it correctly. Once you can feel yourself fully contract, relax, and feel a strong squeeze and lift, you can add it holds. Work up to doing a 10 second hold 10 times.