Kegels During Pregnancy: Separating Facts From Fiction

Everyone has heard of Kegels, right? Everything from “tightening” the vagina after pregnancy, to the little flappy bird games - squeeze the insert, and the little bird jumps over obstacles. They’ve been considered the best (or at least, the most common) advice for maintaining pelvic floor health since they were named by Dr. Arnold Kegel. Let’s go over a few facts though:

• Kegels were originally described by a female physical therapist in 1936, but they weren’t officially named until Dr. Kegel described them in 1948.

• Kegels are intended to strengthen the pelvic floor to help treat incontinence.

• Kegels can be very helpful, but only for certain populations (and often, those populations aren’t expecting moms!).

• Instead of squeezing the pelvic floor muscles, many women actually need to relax the muscles of the pelvic floor leading up to birth.

For most individuals, pregnant or not (think urination and bowel movements), but especially expecting moms, we want to think about the pelvic floor as a doorway - it needs to be flexible and pliable enough for an entire human to make its way into the world. Even if Baby is delivered via Cesarean, the pelvic floor is still being affected by 9+ months of pressure, hormonal changes, core muscle separation, and an abdominal wall incision. Moms who deliver vaginally or via Cesarean can experience pelvic floor weakness, leaking, core instability, and back or hip pain. These struggles are not necessarily going to be fixed by Kegels - but they can be addressed by something as simple as…your breath.

Now, please keep in mind that one of the best things you can do during pregnancy is book an appointment with a pelvic floor physical therapist in your area - while these tips and advice can be helpful, ultimately, I highly recommend getting an individualized diagnosis and treatment plan designed for you. If you’re in the Charlotte / Belmont / Gastonia area, we highly recommend Joanne Price!

In general, pelvic floors can fall into two categories: hypertonic and hypotonic.

A hypertonic pelvic floor can feel like:

• Uncomfortable penetration

• Leakage upon sneezing, coughing, laughing, squatting, jumping, etc.

• Difficulty getting a full, deep breath

• Difficulty starting to urinate / “a second pee” (standing up to get a little more out) / difficulty voiding completely

• Constipation

• UTIs / urethra irritation

• Tailbone pain

• Tender at inner edge of sitting bones

• Difficulty engaging the pelvic floor muscles

• Symptoms getting worse with Kegels

A hypotonic pelvic floor can feel like:

• Leakage upon sneezing, coughing, laughing, squatting, jumping, etc.

• A tampon falling out

• Penetration not feeling “like it used to”

• SI / hip pain

• The vagina feeling heavy

• Deep breaths feeling like too much pressure

Now, to address the hypertonic mommas out there - I want you to think about your biceps muscle. Bend your elbow to bring your hand towards your shoulder, and now squeeze. Keep squeezing. Don’t stop squeezing while you read.

By keeping the biceps muscle squeezed and engaged, we’re not strengthening the muscle - but we’re definitely making it tighter (is that muscle cramping yet?). Now start to pulse - don’t release the muscle, just squeeze that forearm tighter to your bicep. This is kind of what doing a Kegel in a hypertonic pelvic floor feels like. We’re getting tighter, but the muscles are not stronger.

Now, release your bicep curl, and shake your arm out a few times. Extend your arm all the way out (it should feel absolutely lovely by now), stretching the biceps muscle before curling your hand towards your shoulder again. That movement - the full range of motion - is what actually strengthens the biceps. We want to recreate that same theory for the pelvic floor.

Find a comfortable seat - an Easy Seat (especially on a bolster or pillow) and Child’s Pose both can help the pelvic floor relax - in a quiet space where you can begin to notice your breath.

Typically when we inhale, we breathe into the chest, and we tend to get a little stuck. In yoga classes, teachers talk about “belly breath”, which allows for a little more space, but isn’t ideal for pregnant bodies, due to the additional pressure on the linea alba (the connective tissue between the two 3-packs of the 6-pack muscles). I want you to breathe all the way around your body - flaring the ribs in all directions, and filling up all the way down into the pelvic floor. Think of the pelvic floor almost like one of those circus balloons - we’re breathing all the way to the end.

As you exhale, I want you to just…relax. Don’t squeeze, don’t Kegel, don’t hug in, don’t do anything. Give your pelvic floor muscles permission to just…relax.

Repeating this breath - inhaling to fill all the way up, and exhaling to relax - can gradually encourage the pelvic floor to release, relax, and find a little more space for when Baby makes their way into the world. Our priority for your pelvic floor is S P A C E, and this breathing exercise can help find a little more.

Now to talk to my hypotonic mommas - I want you to think about that same biceps muscle, fully extending to release, and curling inward to build strength. We still want to fully extend and release those muscles before curling inward.

Your inhales will look exactly the same as our hypertonic moms’: Inhale all the way around your body, filling up all the way down into the pelvic floor.

Your exhales are where we shift gears.

The pelvic floor is shaped like a diamond - the top and bottom “points” are the clitoris and anus, and the edges of the vagina make up the two side “points”. As you exhale, I want you to imagine the four points of the pelvic floor drawing up and inwards towards each other. An easy to remember cue is - imagine that you’re drawing a blueberry up through the vagina (thankfully, nobody that I’ve met has ever actually had a blueberry in their vagina, but everyone seems to know what I’m talking about when I cue it).

Repeating this breath - inhaling to fill all the way up, and exhaling to draw that blueberry upwards - maintains the elasticity of the pelvic floor while also building strength, both of which are important during pregnancy and delivery, and after birth.