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Kegeling isn’t working! What am I doing wrong?

My clients have 99 problems, and I would say about 87 of them have to do with kegeling. Questions around “I can’t get my pelvic floor to engage at all,” or “I’m doing my kegels daily but I still have urinary leaking,” are some of the most common questions I get.

First, let’s start with, “what is a kegel?”

A kegel is an engagement of the pelvic floor muscles. Often kegels are taught as a tightening or contraction of the urinary sphincter, which is not an accurate description of how to contract the pelvic floor muscles. Instead, what I call a kegel 2.0 is a controlled and conscious contraction of all of the superficial pelvic floor muscles.

Let’s dig a little deeper into the pelvic floor. Your pelvic floor is the hammock of muscles throughout your pelvis that holds your pelvic organs in place. Some people also include some of the deep hip rotators and other postural muscles within the pelvic floor as well, because these muscles often contract along with the pelvic floor.

The pelvic floor is shaped like a hammock (or even completely flat) when relaxed, but shaped like a dome when contracted. So a full-range movement of the pelvic floor looks like a jellyfish swimming. There are several layers of muscles in the pelvic floor. The most superficial layer is what we can really consciously engage, and includes the openings of the urethra, vagina, and anus. We can consciously contract these muscles, and when we do, they should lift and tighten.

However, it’s also imperative that we can also release and relax these muscles. Just like every muscle in the body, the pelvic floor muscles cannot function properly if they are contracted all the time. When the pelvic floor is functioning optimally, it rests at neutral and can both lift and engage and release and soften.

For example, the pelvic floor should lift and engage when sneezing, stepping off a curb, or supporting the internal organs on an exhale. These muscles should soften and release when inhaling, when eliminating, and in childbirth.

So, practicing kegels – or what I call a “kegel 2.0” – does not just mean lifting and squeezing. It is a movement through the pelvic floor’s full range of motion.

Why can’t I get my pelvic floor to engage at all?

Let’s get into the meat of this question “I cannot get my pelvic floor muscles to engage. Or, I am engaging my pelvic floor regularly, but it doesn’t seem to be helping with XYZ.”

If you are having trouble even getting your brain to communicate with your pelvic floor you may be experiencing one of a few things:

  • You may have nerve damage. Nerve damage can be caused by trauma to the pelvic floor, childbirth, stitches, etc. To some extent, nerve damage can be repaired (but perhaps not entirely). A few of the options that are available to all of us at home are: biofeedback (physically touching the area and trying to contract/engage into or away from physical touch), stimulation, and meditation or, essentially, practice.
  • You may already be way too contracted. You can check this by palpating with your finger tips just inside your sit bones. If the tissue is very sensitive, your muscles are probably overtightened. There are some other obvious indications that the muscles are too tight, like pain with intercourse or an inability to fully empty the bowel or bladder. If this is you, consciously release and relax your pelvic floor muscles when on the toilet. You can also massage the overly tight muscles around the sit bones. (Message me for more suggestions!)
  • In my experience, it is less likely that you’re weak if you’re struggling to get the muscles to engage at all, but it could be! You may just need some biofeedback in order to feel that you’re lifting away from something.

I kegel all the time but I still leak!

If you are kegeling regularly but nothing is getting better:

  • It may still be that you’re too engaged. An overly tight pelvic floor is unable to engage when needed for support and so can cause leaking just like an overly weak one. Use the same tests described above: palpations, observing if you have pain or trouble fully eliminating.
  • Or, it may be that you’re only engaging one part of your pelvic floor. Sit on something like a blanket so you have some biofeedback. Try lifting more the pelvic floor muscles of the front or back, left or right. Is there an area that you can’t connect to at all? This can be exacerbated by posture, for example, slouching back in a chair or always crossing one leg over the other. It’s possible to be too tight in one area but too weak in another. You may need to focus on strengthening just one area of the pelvic floor.
  • Or, it could be that you’re only training fast or slow twitch muscle fiber in your pelvic floor. Try lifting and engaging your pelvic floor muscles slowly and intensely, as if you were sipping a smoothie through your vagina. If that’s easy, try practicing pelvic floor “blinks,” or many rapid small contractions in a row. Practice more of whichever you find more challenging.

I have so much more detail on this topic in my Facebook group, so join there to watch a video version of this blog post. If you want a more personalized recommendation, schedule a free consult with me.

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