For many of us, the word “Kegel” entered our lexicon when Samantha Jones proclaimed she was “doing [them] right now” on Sex and the City. But when it comes to your pelvic floor—the three layers of muscles that lie like a hammock from your pubic bone to your tailbone, supporting the function of your bladder, bowels, and genitals—keeping it in optimal shape goes far beyond the occasional squeeze at a stoplight.
“Just like you can strengthen your biceps, you can do exercises that work on your pelvic floor muscles,” says Alexandra DiGrado, DPT, a pelvic floor physical therapist in Boston. Such therapists work with clients who suffer from incontinence, constipation, pain, or muscle malfunction in the pelvic region, as well as postpartum musculoskeletal conditions. Beyond muscle strengthening, therapies include relaxation exercises, manual therapy, heat and cold therapies, diet changes, and electrical stimulation to help muscles contract.
While men aren’t immune to pelvic floor issues, women are overwhelmingly afflicted, with one in four reporting a pelvic floor disorder (a blanket term for conditions resulting from weak or damaged muscles, such as incontinence). Still, it’s not something you hear much about—the intimate nature of the issues tends to keep people from discussing them publicly or reaching out for help.
A few companies are trying to break the silence.
The Squeezy app ($4) tracks your symptoms and creates a schedule with Kegel instruction to combat common leakage (such as while laughing or exercising). Not sure if you’re doing it right? The Elvie Trainer—a small silicone gadget that’s used intravaginally—uses Bluetooth to sync with an app that lights up with your contractions so you can see your progress in real time. But don’t expect these tools to be a cure-all for everyone: Experts say anyone with more than occasional incontinence should seek professional care. “If you’re someone who has trouble initiating the stream of urine, has to strain to have a bowel movement, or has pain during sex, Kegels would not be the place to start,” DiGrado says.
To test your own muscle strength, “imagine you’re picking up a blueberry with your vagina,” DiGrado says: Lie down and place a finger on your perineum (the skin linking your genitals and anus) and contract the area between your pubic bone and tailbone, as if you’re holding back gas or stopping your stream mid-pee.
Count to 10, then release, feeling the muscles lengthen as you let go. You can also do a quick series of squeezes instead. (You should be able to feel the movement with your finger.) From that baseline, you can build up to doing the exercise while standing, eventually adding little leaps or jumps while you squeeze to train your muscles to contract while you’re in motion.
Doing Kegels sporadically isn’t going to help much, DiGrado says. In fact, not everyone even needs to strengthen their pelvic floor: Some folks need to learn how to slacken it. “Some people’s pelvic floor muscles are already so short and tight that they experience pain—maybe during sex, or in their sacrum or tailbone,” DiGrado says.
The bottom line? There’s a lot you can do to improve your pelvic floor function. “People live with [these issues] for years because they’re too embarrassed to talk about it,” DiGrado says. “But you can come to pelvic floor physical therapy and be completely cured.”