How to Do Kegels (& How Not To), From a Pelvic 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

We’ve covered this ad naseum.  

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.   Which is fancy speak for “How to do kegels” 😉

Dr. Kelly’s Favorite Starter Exercises for Pelvic Health: The Big 3

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.  

Analogy Time!!  Lightswitch!!

It’s like you have three switches on a wall.  One for your diaphragm, one for your deep abs, and one for your pelvic floor.  During any given day, you’ll need to use a myriad of combinations of “on-off” between those switches.  

With pee, poop or seggsy time problems, the brain gets confused, and decides that it’s easier to just have them “all on” or “all off” at the same time.  The longer it stays confused, it even starts to not be able to tell when the switches are on or off, which is a problem.  If the brain can’t tell if a muscle is on or off, and furthermore can’t use it in a specific way (like how many of you can’t breathe while your doing sit-ups? Asking for a friend…), then of course we have dysfunction!  Luckily, this is a problem that Dr. Kelly’s Big 3 can help to rectify 🙂  Are you ready?? 

1. Relaxed (Diaphragmatic) 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: 

Image showing location of diaphragm, which is an upside down bowl of muscles, located at the bottom of the ribcage.

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 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.  

Image showing relaxed belly breathing, or diaphragmatic belly breathing, where the belly gets bigger with each inhale, and smaller with each exhale, while there is minimal motion of the chest and ribcage.

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.  

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.  

If they are actually relaxed, they too should be getting longer with each inhale, then passively rebounding with each exhale. 

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.  

Stiff isn’t strong, team.  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.  

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’ll talk about it in another post). 

Great job.  You’re done with Exercise #1. That was needed to show the brain how it is allowed to breathe at rest.  

2. Supported Breathing

Exercise #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.  

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, and NO WAY you’re going to have amazing orgasms.  

This simple exercise helps us master this task. Let’s try. 

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.   

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.  It looks like this: 

image of supported diaphragmatic breath. Here, the muscles of the deep abdomen stabilize the belly, so it cannot expand as you inhale. Because the lower belly cannot move, the expansion during breathing in is into the lowest portion of the ribcage. No movement in belly or neck here. All movement in lower ribcage. Belly stays engaged as you breathe in AND 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.  🙂 

3. How to do Kegels: 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.

So when learning how do do kegels, it’s VITAL to know that 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 vag OR under the balls and rectum if you have an p3nis.  

In real time, “Your Pefect Kegel” from Dr. Kelly’s Big 3 can be simplified to the following mantra, when you are practicing how to do kegels: 

  1. From a resting position, first draw your deepest/lowest abs in towards your lowest spine, while pelvic floor stays relaxed.
  2. Keeping deepest abs drawn in, add your gentle kegel (lift & squeeze) 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.  

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

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!  If you want even more miracles, check out my Instagram for fun, FREE, life changing tips on all things pelvis.  

And if you don’t see a change…get your cute butt into a Pelvic PT, or try one of my online programs!

xoxo, Dr. Kelly

Dr. Kelly, in pajamas and hair wrapped a towel, smiling and holding a plush vulva puppet. Text "Lifelong Care for Down There" appears.

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Pelvic PTs Can Teach You How to do Kegels & So Can My Courses!

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