If you’re experiencing bladder control problems, you may have been told to “do your kegels”. Unfortunately, they can be done incorrectly, leading to poor progress. If you avoid the common mistakes listed below, you can get a great result in a shorter period of time. Kegels are exercises that help strengthen the pelvic floor, which supports the bladder and bowel. If your pelvic floor is damaged or weakened you might start experience fecal or urinary incontinence. You might dribble after urination or leak a little when sneezing or coughing. There are many reasons why people may experience urinary control problems such as childbirth, menopause, heavy lifting with poor technique, medication, chronic constipation or surgery.

In 1948 Dr. Arnold Kegel, an American gynecologist, published an article describing a non-surgical method of strengthening the pelvic floor in order to help women control incontinence following childbirth. He explained that by exercising the pubococcygeus muscles of the pelvic floor women can reduce their likelihood of experiencing bladder issues after pregnancy. Today pelvic floor exercises are regarded as the first line of treatment for stress incontinence, as recommended by the National Institute for Heath and Care Excellence (NICE). Getting accurate information can be tricky. If you’ve looked for kegel information online you’ve probably seen many brief, vague instruction pages, which may contradict each other (and may not have current information).

A study published in the early 1990’s in the American Journal of Obstetricians and Gynecologists (Bump, et al) looked at the performance of women doing Kegels after verbal instruction. They were then re-tested and only 49% of these women performed the contraction correctly. Worse yet, 25% of the women were performing them in such a way that would actually PROMOTE incontinence. It was their conclusion that simple written or verbal instruction is inadequate when prescribing a Kegel exercise program.

Here are some of the most common kegel mistakes people make.

Kegel Mistake #1: Contracting the wrong muscles Many people mistakenly contract the muscles of their lower abdomen, inner thigh, or buttocks instead of the muscles of the pelvic floor. Because pelvic floor muscles are not as easy to see as other muscles in the body (such as muscles in your leg) it can be difficult to know if you are correctly engaging them.

Kegel Mistake #2: The wrong movement with the right muscles Instead of pulling it up and forward some people push the pelvic floor muscle group down and out. This incorrect movement can damage the pelvic floor and cause incontinence, hemorrhoids and prolapse (or worsen this problem if already present).

Kegel Mistake #3: Hundreds of kegels a day I’ve seen any number of patients who do hundreds of kegels every day. This is much more than is needed, and can be harmful.

Kegel Mistake #4: Performing a generic program instead of a specific prescription A lot of people do kegels as a generic program instead of following one that is designed specifically for them. By this I mean that they perform 10 contractions, 10 times, holding for 10 seconds, etc. Much like other exercises, pelvic floor exercises should be specific to the individual (not so difficult that compensation patterns take over and true pelvic floor strengthening does not occur, or so easy that gains are not made). Also, strength gain is just one goal of pelvic floor exercises. Programs should target strength, endurance, and return of normal reflexes (important in the presence of stress incontinence, which is the presence of accidents when coughing, sneezing, and laughing or with movement).

Kegel Mistake #5: Performing kegels when your pelvic floor is overactive or hypertonic Many people with incontinence or pelvic pain present with hypertonic muscles, or muscles that are too tight. When your pelvic floor muscles are tight and weak, the tension is usually treated before the weakness. Once the muscles have reached a normal resting tone and are able to relax fully, strength is reassessed and pelvic floor strengthening exercises are prescribed if appropriate. By attempting to perform kegel exercises before this tightness is addressed, symptoms of pelvic pain and incontinence usually become worse.

Learning to perform pelvic muscle contractions correctly can be frustrating, especially if you are trying to eliminate or reduce incontinence or prolapse. If you feel you are unsuccessful, contact a pelvic Physical Therapist who is trained in identifying the appropriate type and amount of pelvic muscle contractions you should be performing to be successful.

– Kristen Digwood, DPT, CLT