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Kegel Exercises for Women and Physiotherapy

Kegel Exercises for Women and Physiotherapy

Fundamentally, your pelvic floor refers to a group of muscles (see picture), which looks a little like a hammock, extending from your pubic bone to the tailbone at the back.

It has the shape of a kite as it widens at the side bones (the bony structures you can feel if you sit on your hand on a hard surface).

So imagine that it's shaped like a kite, so the front half of the kite is called the urogenital triangle,and it contains the urethral and vaginal openings.

The back half is called the rectal triangle, and it contains the rectal opening.

Refer to picture below

Kegel Exercises For Women: Know Thy Muscles

You will need to refer to the picture above often as you learn how to do kegel exercises, as you need to visualize where the muscles are, how the muscle fibres are oriented so that you can be effective in strengthening these pelvic muscles.

To start off, you want to ensure that you are contracting both triangles while doing your Kegel exercise, focusing on contracting stronger in the front triangle.

So how would you know which triangle you're using?

The feeling of stopping the passage of gas or bowel is contracting the back muscles, and stopping your urine passage or stream is contracting the front triange.

As stopping gas or urine may be a little challenging to visualize at times, we support by providing visual tools to help patients understand how to find these muscles.

Another thing to note is that you can never contract the front triangle without contracting the back triangle, and this is applicable the other way as well (you can never contract the back triangle without contracting the front triangle). However, we raise this up to bring to your awareness that focusing on one triangle a time in the beginning will help your brain to pay more attention to locate muscles in both triangles so that no one triangle will become stronger than the other triangle, at any given time.

Kegel Exercises for Women: Visualize

To contract the front triangle, it's easier if you can visualize a ping pong ball sitting just right outside your vagina. What you then need to do is to try to squeeze the ping pong ball with your vaginal muscles inwards, and draw the ping pong ball inwards.

To verify that you're doing this correctly, place one finger inside your vagina to feel the contracting and lifting inside these muscles. This is the muscles of the front triangle.

The back triangle instead, you engage it by imagining drawing  a marble into your rectum. Close your eyes as you visualize as these hidden muscles work well under visualization.

Hold each front or back triangle for a few seconds, and repeat each type of contraction up to 15 times per day.

Do this for a few weeks, just practice the vaginal/ping pong and rectal/marble on their own (take note that even though you're trying to focus on just one, but both will contract too).

Once you're more comfortable and aware that you're engaging both triangle muscles equally, you are ready to contract your pelvis as a whole in kegel exercises for women.

Kegel Exercises For Women
Frequency & Repetitions

For the exercises above (vaginal/ping pong and rectal/marble):

  • Do 10 repetitions of each exercises,
  • Holding for 2 seconds, and
  • Resting for 2 seconds

For the kegel exercises for women below:

  • Do 10 repetitions of each exercises,
  • Holding for 10 seconds, and
  • Follow with resting for 10-20 seconds (to provide support to your pelvic floor and manage fatigue build up)

You can repeat these combined exercises 1-2 times per day, and by doing them daily for 3-4 months, you will likely see benefits of strengthening and training your pelvic floor.

You will need to slowly start and build up your exercise tolerance to do these exercises for ten seconds. First, start by testing how long you can hold each contraction without feeling the muscle let go - then once you've known the time, and add 1 second to it. This will be your baseline.

Slowly and gradually, over weeks of practice, add 1 second more, and keep adding until you can reach the 10 seconds hold.

Muscle activation of the pelvic floor always contracts both front and back triangles at the same time, and the contraction direction is in the direction of the muscle fibers.

Refer to the picture again, you can see that the pelvic floor muscles go lengthwise (from front to back), sideways (sitz bone to sitz bone) and diagonally from one sitz bone to the opposite pubic bone.

Please take time to orientate yourself with the picture so that you can easily visualize and feel what muscles you're trying to activate, and how it feels like.

Kegel Exercises For Women

1) Lie on your back, and contract your entire pelvic floor muscles. Visualize by imagining that you're squeezing both your pubic bone and tailbone together - hold for 5 seconds. Do not use your buttocks, inner thighs or abdominal wall muscles.

Progression: when this gets easy, level up this exercise. Imagine that your pelvic floor is an elevator, and after 5 seconds, draw the muscle up "another level/floor" - hold for 5 seconds.

2) Lie on your back with knees bent and feet comfortably on the floor. Draw in the edges of the front triangle (pulling the two sitz bones together) and then let them move back to their resting position when you let go of the contraction. This is a side-to-side contraction. Visualization cue: imagine a magnet drawing both your sitz bones together or squeezing out a spone with your vagina - hold for 5 seconds.

Progression: in the same position, draw the sitz bones together, lift inside for another 5 seconds, and then add another 5 seconds elevator.

3) To raise sexual awareness and strengthen the top layer of the front triangle of your pelvic floor, lie down with your knees bent and feet flat on the floor. Imagine drawing a diagonal "X" pattern by imagining a line going from your right sitz bone to your pubic bone, and the other "X" from the other sitz. Use your pelvic floor to do this.

Your contraction should feel like you're moving one of your sitz bones inwards towards the middle, up the midline and towards the opposite pubic bone.

Repeat 5 times each side, holding for 5 seconds each. Work towards 10 seconds hold each.

You also need to practice to get the timing of these muscle contractions, as it can be a little confusing in the beginning.

As you be diligent and consistent in your practice, your brain and pelvic floor muscles will get used to it, and it will get easier and easier to activate them.

If you find that you're not getting stronger, or it's too abstract to learn without a physiotherapist to guide and give you feedback, do call or sms us to make an appointment.

Visit our Women's Health Physiotherapy Page

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