I remember struggling with urinary incontinence after giving birth. It was so stressful and I would worry about whether this would be a permanent feature in my life. Luckily with the right changes, including kicking a caffeine addiction, reducing added sugars, and consistently doing Kegels exercises, I recovered.

Many of you reading this may dismiss an occasional leak of urine while coughing or sneezing as normal. However, it isn’t. Urinary incontinence comes with too much stigma. Most women don’t like admitting they have a problem and often live with it. In severe forms, women live in social isolation with gross disruption of their quality of life.

You may have come across literature on pre-pregnancy pelvic floor exercises, pelvic floor exercises while pregnant, how to do pelvic floor exercises after birth, or the benefits of pelvic floor exercises and wondered what’s that about. Some of you may have been advised to add Kegels to your postpartum routine by your doctor or physiotherapist.

What constitutes your pelvic floor?

You could spend years learning the anatomy of the pelvis, but here are the essentials that will help you understand why addressing a weak pelvic floor can help.

Organs that reside within the pelvic cavity or “true pelvis” include the bladder, rectum, terminal part of the urethra, and the internal reproductive organs. Along this hammock are openings for the urethra, rectum, and vagina to pass through.

For men, pelvic floor muscles support the bowel and bladder; the urethra and the anus all pass through the pelvic floor muscles. For women, pelvic floor muscles support the bladder, bowel, and uterus; the urethra, anus, and vagina all pass through the pelvic floor muscles.

Why are pelvic floor muscles important? Here are the functions of the pelvic floor muscles:

• Primarily provide pelvic support.
• Resist the increases in intraabdominal pressure during coughing, sneezing or lifting weights, etc.
• Enable urinary and fecal continence.

A weakened pelvic floor: Causes and complications

Common causes of a weakened pelvic floor include:

• Childbirth
• Obesity
• Increasing age
• Multiple births in short intervals
• An underlying respiratory disorder associated with chronic coughing
• Constipation
• Chronic diseases that weaken immunity
• Collagen vascular diseases
• Idiopathic (unknown)

When pelvic floor muscles are weakened, they can create bladder and bowel control problems. Here are some of the pelvic floor muscle issues:

• Urinary incontinence – an occasional or persistent leak of urine.
• Fecal incontinence – passing motion without voluntary control.
• Flatal incontinence – passing wind involuntarily.
• Genitourinary prolapse – the descent of pelvic structures.
• Sexual dysfunction – either pain or discomfort during intercourse.

Pelvic floor exercises for women

Now that you have understood the role of the pelvic floor, you are now ready to learn how to strengthen it. Dr. Arnold Kegel is a pioneer of women’s pelvic health. He published an 18 year study in 1948 documenting nonsurgical methods to increase the tone of the pelvic floor that have since helped hundreds of women.

So what are they?

How to work your pelvic floor

It’s easiest to lie down and place your hands along the bony edges of your hips from the top of the panty line along the groin to the pubic symphysis—the joint in front of the pelvis connecting the left and right pubic bones and is located above the genitalia. You can feel the pubic symphysis by pressing the lower front pelvic bone. After planting your fingers and applying some pressure, you could then pretend to stop passing urine midstream. This will give you an understanding of the muscles to recruit.

It would also help to get comfortable seeing yourself in the mirror to visually see what’s happening while you work the muscles. Once you have identified the muscles, you can now perform the set of exercises referred to as Kegels, which are nothing but tightening your pelvic muscles, holding the squeeze, and releasing it.

Imagine you have to pass urine, and while you are in the middle of the act, someone opens the door and you hold your urine in. Or if you were to hold your urine in because you were stuck in traffic. Initially, it may only feel like a fraction of a millisecond that you could hold anything remotely like a contraction. Still, with consistent effort, you will see a remarkable improvement.

Some women like to compare this to sucking a blueberry with your vagina and letting go.

What’s the best way to strengthen your pelvic floor?

The best way to get the full benefits of pelvic floor exercises is really to incorporate this as a daily practice for the rest of your life. With age, the pelvic floor weakens, and consistently doing Kegels will prevent the muscles’ early sagging and natural atrophy.

How often should you do Kegel exercises? The perks of Kegels are that you can do them any time and literally anywhere. You could aim to do at least 3 sets of 10-15 repetitions at a time.

I tell patients to put a reminder alongside a regular daily activity. For example, every time they brush their teeth or sit down at the office desk. Often, women forget to do this exercise, not because of lack of time or space but simply because they forget to. So I say put a reminder on your productivity apps or your phone for a specific time each day. It will slowly become second nature.

With time, you will perfect your technique and start reaping the benefits of this exercise. It’s important not to stop breathing or not to flex your abdominal, thigh, or buttock muscles while doing so.

FAQs about Kegel exercises

1. Who needs Kegels?

Anyone with a pelvic floor is the simple answer. The long answer is that it’s a great practice to incorporate even by anyone without any issue. But particularly beneficial for women who suffer mild degrees of incontinence, mild prolapse, or pain during intercourse, and postpartum women.

Although it’s beneficial and recommended to do postpartum pelvic floor exercises due to the hormone relaxin released during breastfeeding, you may not see a dramatic improvement in abilities because the hormone loosens joints and makes ligaments lax.

2. How long before you see improvement?

It may be a few weeks to a few months, depending on how regularly you practice and how well you have understood your own pelvic floor.

Nowadays, there are many free pelvic training apps based on Kegels with built-in reminders you could install on your smartphone to make this a part of your day.

Examples of Kegel exercise apps are:

• Easy Kegel – Apple Store, Google Play
• Squeeze Time – Apple Store

3. What problems cannot be treated with pelvic floor exercises?

• Severe degree of prolapse
• Moderate to severe urinary leakage
• Overflow incontinence
• Primary vaginismus
• Collagen vascular diseases

4. Who should you approach when in doubt?

If you feel unsure whether you’re doing the Kegels correctly, visit a physiotherapist near you or an ob-gyn. Some women may require more advanced physiotherapy, including using weighted vaginal cones, biofeedback, digital manipulation, or a host of other techniques by a trained professional.

5. Which other exercises can you do to strengthen your deep core?

In addition to Kegels, the exercises you can do to strengthen your deep pelvic core muscles or fascia include:

• Bridges
• Pelvic tilts
• Heel slides
• Heel drops

Although I’ve been a fitness buff, it was not until my core was disrupted by pregnancy and vaginal delivery that I got an idea of what instructors would refer to when they said, “Engage your core.”

But by regular practice of Kegels, especially as part of a postpartum exercise regime, engaging the deep pelvic muscles, and focusing on abdominal breathing, I was able to build awareness, and so can you.

Final thoughts

Being patient with your body is key. Every new skill takes time to build, and with time, you will see the results of your hard work.