Kegel Exercises: Understanding Pelvic Floor Muscles, Movement, and Proper Technique

What moves when you do a kegel?

When you perform a Kegel exercise, the primary structures that move are the muscles of the pelvic floor, a sling-like group of muscles and connective tissues that support your pelvic organs. These muscles contract and lift, creating an internal squeeze and upward pull.

Introduction to Kegel Exercises

Kegel exercises, also known as pelvic floor muscle training (PFMT), are simple clench-and-release exercises that you can do to make the muscles under your uterus, bladder, and bowel stronger. While often discussed in the context of women's health (especially post-childbirth or for urinary incontinence), they are equally beneficial for men, supporting bladder and bowel control and contributing to sexual health. Understanding the specific muscles involved is crucial for effective execution and maximizing benefits.

The Core Muscles: The Pelvic Floor

The most significant structures that move during a Kegel exercise are the muscles that form the pelvic floor. This anatomical structure acts like a hammock or sling at the base of your pelvis, extending from the pubic bone at the front to the tailbone (coccyx) at the back, and from side to side across the sit bones (ischial tuberosities).

The pelvic floor is comprised of several distinct muscles, working synergistically:

• Levator Ani Group: This is the largest and most crucial component, forming the main muscular floor of the pelvis. It consists of three primary muscles:
  • Pubococcygeus: Originates from the pubic bone and inserts into the coccyx, forming the medial part of the levator ani. This muscle is particularly important for supporting the urethra and rectum.
  • Puborectalis: Forms a U-shaped sling around the rectum, playing a vital role in maintaining fecal continence by creating the "anorectal angle." Contraction of this muscle helps close off the rectum.
  • Iliococcygeus: Originates from the ischial spines and inserts into the coccyx, forming the lateral part of the levator ani.
• Ischiococcygeus (or Coccygeus): Located posterior to the levator ani, this muscle extends from the ischial spine to the sacrum and coccyx. It provides additional support to the pelvic organs and helps stabilize the sacrococcygeal joint.

When you perform a Kegel, these muscles collectively contract, drawing upwards and inwards.

How Pelvic Floor Contraction Works

Imagine the sensation of trying to stop the flow of urine mid-stream, or holding back gas. This internal action is precisely what a Kegel aims to achieve.

• Upward Lift: The primary movement is an internal upward lift. The entire pelvic floor sling elevates towards the head. This lifting action is essential for supporting the bladder, uterus (in women), and rectum, and for closing off the urethral and anal openings.
• Inward Squeeze: Concurrently with the lift, there is an inward squeeze. The muscles tighten around the openings of the urethra, vagina (in women), and anus. This constrictive action is what helps maintain continence.

It's a subtle, internal movement, not visible externally, but the sensation of a gentle "squeeze and lift" deep within the pelvis is the hallmark of a correct Kegel.

Beyond the Pelvic Floor: Co-Contractions and Common Mistakes

While the pelvic floor muscles are the intended movers, it's common for beginners to inadvertently engage other muscles. Understanding what shouldn't move is as important as knowing what should.

• Muscles that SHOULD NOT move (or move minimally):
  • Gluteal muscles (buttocks): Squeezing the glutes indicates incorrect technique.
  • Abdominal muscles: Tensing or bearing down with your abs means you're not isolating the pelvic floor.
  • Inner thigh muscles (adductors): Squeezing the knees together suggests engaging larger, external muscles.
  • Diaphragm/Breath holding: Holding your breath or straining indicates improper pressure and technique. The breath should remain calm and steady.

Engaging these accessory muscles reduces the effectiveness of the Kegel by diverting effort from the target muscles. The goal is precise isolation of the pelvic floor.

The Importance of Pelvic Floor Health

Strong, functional pelvic floor muscles contribute significantly to overall health and quality of life:

• Urinary Continence: They control the flow of urine, preventing leaks when coughing, sneezing, or exercising.
• Bowel Continence: They support the rectum and anus, helping to prevent accidental bowel leakage.
• Pelvic Organ Support: They keep pelvic organs (bladder, uterus/prostate, rectum) in their proper positions, preventing prolapse.
• Sexual Function: In women, they can enhance vaginal tone and sensation. In men, they can contribute to erectile function and ejaculatory control.
• Core Stability: They are an integral part of the deep core stabilization system, working in conjunction with the transverse abdominis and diaphragm.

Proper Technique for Kegel Exercises

To ensure you are moving the correct muscles:

1. Find the Muscles: Imagine you are trying to stop the flow of urine or prevent passing gas. The muscles that contract are your pelvic floor muscles.
2. Contract and Lift: Gently squeeze and lift these muscles upwards and inwards, as if drawing them up into your body. Avoid tensing your glutes, abs, or thighs.
3. Hold: Hold the contraction for 3-5 seconds, breathing normally.
4. Relax: Completely relax the muscles for 3-5 seconds before the next repetition. Full relaxation is as important as contraction.
5. Repetitions: Aim for 10-15 repetitions, 3 times a day.

When to Seek Professional Guidance

If you are unsure whether you are performing Kegels correctly, or if you experience persistent symptoms of pelvic floor dysfunction (e.g., incontinence, pain, prolapse), consulting a pelvic floor physical therapist is highly recommended. These specialists can provide personalized guidance, biofeedback, and tailored exercise programs to ensure you are effectively engaging and strengthening your pelvic floor.

Conclusion

When you do a Kegel, the primary movement involves the coordinated contraction and upward lift of the pelvic floor muscles – specifically the levator ani group and the coccygeus. This internal, subtle action is crucial for maintaining continence, supporting pelvic organs, and contributing to sexual health. By focusing on isolating these deep muscles and avoiding the engagement of surrounding muscle groups, you can optimize the effectiveness of your Kegel exercises and harness their profound benefits for long-term pelvic health.