Pelvic Floor Exercises: Performing Kegels in Bed, Benefits, and Proper Technique

Can I do pelvic floor exercises in bed?

Yes, performing pelvic floor exercises (Kegels) in bed is not only possible but can be an excellent starting point for many individuals, particularly those new to these exercises or recovering from certain conditions, due to the reduced influence of gravity.

The Short Answer: Yes, But With Nuance

Pelvic floor exercises, commonly known as Kegels, involve the conscious contraction and relaxation of the muscles that support the bladder, bowel, and uterus (in women) or act as the base of the pelvis (in men). While they can be performed in virtually any position, lying down in bed offers unique advantages, especially for beginners or those with specific physical limitations. However, to achieve full functional strength, progression beyond this position is often necessary.

Benefits of Performing Pelvic Floor Exercises in Bed

Starting your pelvic floor exercise routine in bed can be highly beneficial for several reasons:

• Reduced Gravitational Load: When lying down, the pelvic floor muscles are not working against gravity to support the abdominal organs as they are when standing or sitting upright. This reduced load can make it easier to isolate and feel the correct muscles contracting, preventing recruitment of accessory muscles like the glutes, thighs, or abdominals.
• Enhanced Muscle Awareness: The relaxed state of being in bed, free from the demands of posture and balance, allows for greater focus and proprioception (awareness of your body's position and movement). This heightened awareness is crucial for correctly identifying and engaging the pelvic floor muscles.
• Convenience and Consistency: The ease of incorporating pelvic floor exercises into your morning or evening routine while still in bed can significantly improve adherence. Consistency is key to seeing results with any muscle training.
• Accessibility for Specific Populations: For individuals recovering from surgery, childbirth, or those with mobility issues, performing these exercises in bed provides a safe and accessible starting point.

Considerations for Effective Pelvic Floor Exercises in Bed

While beneficial, there are important considerations to ensure your in-bed exercises are effective:

• Proper Isolation: The primary challenge, regardless of position, is ensuring you are only activating the pelvic floor muscles and not clenching the glutes, inner thighs, or abdominals. Lying down can help, but conscious effort is still required.
• Breathing: Avoid holding your breath. Proper breathing (diaphragmatic breathing) should be maintained throughout the exercises.
• Relaxation: Equally important as the contraction is the full relaxation of the muscles between repetitions. This allows the muscles to recover and prevents over-fatigue or hypertonicity (excessive muscle tension).
• Progression: While starting in bed is excellent, the ultimate goal is often to strengthen the pelvic floor for functional activities in upright positions, where gravity and other forces come into play. Eventually, you will want to progress to sitting and standing exercises.

How to Perform Pelvic Floor Exercises in Bed (Proper Technique)

Follow these steps for effective pelvic floor exercises while lying down:

• Finding the Muscles:

  • Lie on your back with your knees bent and feet flat on the bed, hip-width apart. Your spine should be in a neutral position, not overly arched or flattened.
  • Imagine you are trying to stop the flow of urine mid-stream. This sensation primarily engages the front part of the pelvic floor.
  • Alternatively, imagine you are trying to stop yourself from passing gas. This sensation engages the back part of the pelvic floor, lifting the perineum (the area between the anus and genitals).
  • The correct action is an internal lift and squeeze, not a visible movement of the hips, buttocks, or abdominal muscles. You should feel an upward and inward pull.

• The "Lift and Squeeze":

  • Once you've identified the muscles, gently but firmly contract them, lifting them up and in towards your navel.
  • Avoid bearing down or pushing outwards.
  • Keep your outer muscles (glutes, inner thighs, abs) relaxed. A gentle hand on your abdomen can help you monitor that your belly isn't bulging or pushing out.

• Breathing:

  • Breathe normally and continuously throughout the exercise. Do not hold your breath. Inhale on the relaxation, exhale on the contraction, or simply maintain steady breathing.

• Types of Contractions:

  • Quick Contractions: Squeeze and lift the muscles quickly, hold for 1-2 seconds, then fully relax. These train the fast-twitch muscle fibers for quick responses (e.g., preventing leaks when coughing or sneezing).
  • Endurance Contractions: Squeeze and lift the muscles, hold for 5-10 seconds, then slowly and fully relax for an equal amount of time. These train the slow-twitch fibers for sustained support (e.g., maintaining continence throughout the day).

• Repetitions and Sets:

  • Start with 5-10 repetitions of each type of contraction (quick and endurance).
  • Aim for 3 sets per day.
  • As your strength improves, gradually increase the hold time for endurance contractions (up to 10 seconds) and the number of repetitions.

Progression and When to Move Beyond the Bed

While excellent for beginners, lying down removes the functional challenge of gravity. To build true functional strength for daily activities, you should gradually progress your exercises:

• Sitting: Once comfortable and confident with the technique in bed, try performing the exercises while sitting upright in a chair. This reintroduces some gravitational load.
• Standing: Finally, progress to performing Kegels while standing. This is the most challenging position as it requires the pelvic floor to work against the full force of gravity, mimicking real-life demands.
• Functional Integration: Incorporate pelvic floor contractions into daily activities, such as bracing your core and lifting your pelvic floor before coughing, sneezing, lifting, or jumping.

Common Mistakes to Avoid

• Holding Your Breath: This increases intra-abdominal pressure and can be counterproductive.
• Bearing Down: Pushing outwards rather than lifting inwards strains the pelvic floor and can worsen symptoms.
• Engaging Other Muscles: Squeezing glutes, inner thighs, or abs indicates incorrect isolation.
• Not Fully Relaxing: The relaxation phase is as important as the contraction for muscle recovery and preventing over-tightening.
• Over-Exercising: More is not always better. Excessive Kegels can lead to muscle fatigue or hypertonicity. Stick to recommended repetitions and sets.

When to Seek Professional Guidance

While self-directed pelvic floor exercises are often effective, it is highly recommended to consult a specialized healthcare professional if:

• You are unsure if you are performing the exercises correctly.
• You experience persistent symptoms of pelvic floor dysfunction (e.g., incontinence, pelvic pain, prolapse).
• You have pain during intercourse or other pelvic pain.
• You are pre- or post-partum and seeking tailored guidance.

A qualified Pelvic Floor Physical Therapist (or Physiotherapist) can provide a thorough assessment, confirm muscle identification, and develop a personalized exercise program for optimal results.

Conclusion

Performing pelvic floor exercises in bed is a highly effective and accessible starting point for strengthening these vital muscles. It offers the advantage of reduced gravitational load, enhanced muscle awareness, and convenience, making it easier to master the correct technique. However, for comprehensive strength and functional integration, it's important to eventually progress to more challenging positions and incorporate these exercises into your daily activities. Consistency and correct form are paramount, and professional guidance should be sought if you have any doubts or specific concerns.