How to Do Kegels (& How Not To) from a Pelvic Floor Expert PT

“Just doing Kegels” is seldom helpful.  Being told to “just do kegels” as medical advice is crap.  But as it is actually useful to use your amazing pelvic floor muscles in real life, it might be nice to have a much more detailed description of what a kegel is.

Hi  :) My name is Dr. Kelly Sadauckas. I am a Doctor of Physical Therapy, one of a handful of Doctors of Physical Therapy IN THE WORLD that are double board certified in Pelvic Health and Orthopedics.  Today, since so many of you asked, I will be giving you the exact sequence of exercises that I use in my programs to improve your brain-body connection to your pelvic floor and deep core.  Let’s begin!  

Telling someone to do kegels is crap.

Training Someone To Connect to their Pelvic Floor and Deep Core is Gold!

When I first launched this blog in 2019, my blog posts were a million pages long, and the actual title to this post was “Best Starter Pelvic Floor Physical Therapy Exercises to Reduce Urinary Urgency and Frequency” 

I can’t believe ANYONE read it.  This revision (July of 2023), I hope to do a better job speaking to the people :)   

Without further ado, here are my “Big 3” Starter Exercises that I use with clients, and in my wellness programs, to improve how your brain recognizes and communicates with, your core muscles (breathing muscles, ab muscles and pelvic floor) in real life.

Dr. Kelly’s "Big 3" Brain-Core Connectors 

The Big 3, as I call them, start with teaching your brain to recognize that there IS a difference between your diaphragm (breathing muscle), abs (generally stabilize the pelvis), and pelvic floor (can help stabilize the pelvis when needed, primarily control pee, poo and sexual functions).   

To not have pee, poop, or seggsy time problems, our brain needs to be able to identify these three groups, and know how to use them by themselves…AND together at different times. Because while, yes, there are some times that the abs and pelvic floor need to fire together...and a lot of times that they don't.  And matching that "tension to task" and retraining the body to not overuse the Pelvic Floor Muscles is EVERYTHING in recovering normal pelvic function. 

Big 3 #1: Relaxed Breathing

Life is stressful, and sometimes we forget to rest.  This first exercise is needed to show the brain how it is allowed to breathe at rest. 

The first exercise is relaxed (diaphragmatic) breathing.  As the name implies, it uses the diaphragm to breathe. 

In case you didn’t know, your diaphragm is your main breathing muscle.  It lives inside the bottom of your ribcage, and looks like this:

Relaxed diaphragmatic breathing teaches your brain that your diaphragm is for breathing, and that when we are truly at rest (relaxed in a recliner chair, sleeping, etc), that the diaphragm should have little to no resistance from the abs and pelvic muscles.

It sounds simple, but it’s really not.  Let’s practice.

Start in a seated position, with okay posture and a relaxed stomach.

Place one hand on your belly, one on your chest.  Relax your belly, and breathe in.

As you breathe in, in true relaxed diaphragmatic breathing, your lower belly should expand out like a balloon, and there should be no movement (or tension)  in your bra line or chest or neck.

Then as you breathe out, your belly should passively rebound back inwards on its own to the start position. 

This movement is easy and not forced.  The belly expands because no other muscles are resisting it.  There are many reasons why this might be hard , but there are also many reasons why this is vital to your recovery . Here’s how to master it.

Step 1: Relax Your Belly and Neck

Work on relaxing the belly and ensuring that all movement is indeed in the lower hand, and there is no movement in your ribcage here. 

REALLY try to calm the breast-bone and breathe into your lower belly.  

If your pelvic floor were an elevator in a four story building...that elevator is meant to rest on the ground floor of the four story building.  In this exercise, the building should be getting broader and wider with the inhale....then a bit skinner with the exhale...broader with the inhale and skinner with the exhale...can you sense that??

Step 2: Now Turn Your Attention to Your Pelvic Muscles

Once you’ve mastered step 1, now turn your attention to your pelvic floor muscles...the "elevator" in our building example. 

If they are actually relaxed, they too should be getting longer with each inhale, then passively rebounding with each exhale.  If they are the "elevator" and actually relaxed, they should actually be moving from the "ground floor" into the sub-basement with the inhale (as the building gets a bet "fuller"...then gently coming back up to the ground floor with the exhale, as the building gets a bit more slender.

In real life, this means that as you sit and inhale, if you tune into your “bike seat muscles”, or the muscles that would be touching your bikini bottoms or Speedo…that these muscles elongate and move downward into the chair surface with each inhale…then maybe rebound and move a bit back up and away from the seated surface with each exhale. 

But for most of us, our pelvic floor muscles ARE NOT resting on the ground floor.  They are resting on the 3rd floor...4th floor...or even "resting" on an antenna up on the roof...so they might NOT be moving downward with each inhale...or if they are moving downward with each inhale...they're rebounding back up to the roof with each exhale, back to their "too stiff" resting state...

Stiff isn’t strong, team.  And this exercise is designed to help you recognize the stiffness.  If "stiff isn't strong" is hard to understand, check out these silly Instagram Reels that I made to try to explain the concept (Wall Sit Analogy Flour Analogy)

Work on this breathing for 5-10 breaths, or 2-3 minutes and see if you can start to feel passive movement in the pelvic area.  Sit on a rolled towel, or Cooch Ball if needed for improved feedback of muscle movement, as it REALLY makes a difference.  

80% of people can’t feel the pelvic muscles moving on their first try.

That’s because the brain and pelvic floor aren’t on speaking terms AND/OR the pelvic floor might not be moving, even though it’s supposed to.  But as long as you understand the general concept of what’s supposed to happen, the brain will learn over time. (it’s called neuroplasticity and I have a whole post about it, here).  And if you CAN'T FEEL ANYTHING, just think "wow, that's curious"...don't freak out...continue to try the other two exercises...then remove the towel or ball...and be amazed to notice "a new space and movement" in an area where you didn't even know you were lacking space and movement!!! (That's your pelvic floor!!)

Let's move on!!

Big 3 #2:  Supported Breathing 

Big 3 #1 was needed to show the brain how it is allowed to breathe at rest. 

Big 3 #2 is Supported Breathing.  It teaches us that we can, indeed, activate the deep muscles of the abdomen to support our pelvis and low back while still being able to breathe. 

In other words, Big 3 #2, Supported Breathing, shows our brain that our deep tummy can activate to a certain degree (like what it needs to do for 'easy' tasks in life), and our diaphragm (breathing muscle) should be wholly unaffected, such that we can breath easily throughout the entire task.

This skill is vital to being a kick ass human, as “most” of our waking lives are not spent resting, rather we are up and about walking, lifting, carrying, etc.  To do these things requires that the muscles of the deep abs increase the amount of work they do from rest…but we should still be able to engage them while breathing…and furthermore, you ought to be able to leave your pelvic floor muscles relaxed while you perform this.

This concept of Supported Breathing is a cornerstone of the Pelvic Floored Pelvic Wellness Philosophy. 

If your brain cannot separate the deep abs from the diaphragm, or the deep abs from the pelvic muscles, in “simple” tasks (like sitting and breathing), there is NO WAY it is going to coordinate them well enough to be pain free or leak free in physical activities that require a lot of muscle power, fast-twitch activation and elongation, and DOUBLE NO WAY that you’re going to have amazing orgasms.

But there's hope. The "simple yet extremely specific" task of Supported Breathing helps us master this task. Let’s try it together:

From your Relaxed Breathing Position, find a spot between your belly button and your pubic bone.  Draw this lowest abdominal muscle up and in, so that you are “lifting and hugging” your lowest pelvic organs up and back towards your spine.  Picture hugging your bladder towards your spine...

Can you do this and still breathe??

Can you do this AND keep your pelvic floor muscles heavy and in contact with your bikini bottoms or speedo, and still breathe?? (PS, I just imagined you all in your Speedos!).

Now that the lowest abdominal muscle is supporting our pelvis and low back, the diaphragm suddenly has some resistance, so it can’t expand your belly and pelvic floor contents out. 

Because the deep abs are (appropriately) offering some resistance, now, the diaphragm expansion will cause the lower ribcage to expand and broaden with each inhale, then return to resting position with each exhale.

The deep abs ought to be able to maintain their gentle contraction regardless of whether we are breathing in or out…and once you can do that, it shows that your brain has control over 2 of the 3 ligthtswitches, the deep abs and the diaphragm (at least in easy tasks!)

Over time, you’ll increase the focus to ensure that you also relax your pelvic muscles with this, but at first, just focus on deep ab activation and breathe.  :)

Try "Active Abs & breathe" for 3-4 breaths...then relax everything....Over time, you'll advance to "active abs & breathe...& relaxed rectum"...but don't let yourself be overwhelmed! 

Big 3 #3:   Your Perfect Kegel

Here’s the money maker.  Appropriately doing kegels is one of the hardest things anyone could ever do, which is also why they get a bad rep.

When kegels ‘don’t work’ for individuals, it is usually because they are too focused on the “kegel” (the up and in contraction), which is only a small piece of the pie. 

It’s generally more important to relax the Kegel, than to tighten it.

Rather than focusing on “the big squeeze”, let’s focus on relaxation of the pelvic muscles AND ensuring that the muscles of the diaphragm, deep belly, pelvic floor and butt can activate independently of each other. 

We can do that with Pelvic Floored’s Perfect Kegel.  Let’s try it.

Sit with one hand on your lower abdomen and one hand on your bra line. If you are able, I’d like you to sit on a small rolled towel, or the edge of a sofa/chair armrest, to have some position-sense feedback to the bike seat parts.  If you’re on a towel or arm rest, I want there to be gentle pressure on the vag AND rectum if you have a (taco) OR under the balls and rectum if you have an (eggplant). 

In real time, “Your Pefect Kegel” from Dr. Kelly’s Big 3 can be simplified to the following mantra:

1. Deep abs draw in while pelvic floor stays relaxed.
2. Keeping deep abs drawn in, add your gentle kegel at urethra, vag and rectum. Hold 3-5 seconds.
3. Keeping deeps abs draw in, relax just your pelvic muscles.
4. Relax the deep abs. 

Told you that was hard 😊  It will get easier, though. Try that sequence 5x in a row, 2-3x a day and watch the miracles begin! 

Psst–there is another part called Bearing Down , that we’ll get to another time.  Just FYI.

Thanks for learning about Kegels with me! 

Ready to take action?  Follow me on Instagram for fun, jaw-dropping pelvic truths, then book an in person or online appointment with me here!  If a one on one visit isn't in the cards, for any reason, please consider one of my online programs that are specifically designed to reach YOU, to get YOUR body function and confidence back, including my newest offering, my “Treasure Chest”, where I give you practical exercises and tips on various body parts, meal plans, etc, in a bit more depth (and with a bit more specific language than I can use on social media!), for one low monthly fee, that is cancellable at any time. 

Regardless of how you move forward, however, THANK YOU for being here.  And if this post has helped you in any way, PLEASE tell one or two people about it.  You can help me change the world.  We are not alone.  We are not broken.  Help is here.  All of our pelvises are worth fighting for :)

A bonus of ALL my online courses is that you can watch them on your computer...but also, through the FREE Kajabi App (a red or blue K, wherever your get your apps!), I am never more than a single click away, on your tablet or phone, whether you are at the gym, or a hotel!  You'll have your personal pelvic coach at your fingertips!  Easy-peasy, and ALL the support that our parents and grandparents never had.

K--Thanks SO MUCH for being here.  I sincerely appreciate you.  YOU are why I am here.

XOXO

Dr. Kelly 

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