When and why to kegel in pregnancy

As pelvic floor physical therapist, I want to chat with you about something that might (and might not) be on your radar yet: Kegels.

In case you're not clear on what kegels are, here's the 101: kegels are the contraction or tightening of the pelvic floor muscles. When you kegel, you close the urethral opening (where you pee from), the anus (the poop shoot) and lift inward toward the body.

I know, Kegels might sound a bit boring or unnecessary, but they’re actually super valuable for supporting your pelvic organs (bladder, bowels, and uterus), enhancing core strength, and increasing your awareness of this crucial part of your body as you prepare for birth. Trust me, a strong and responsive pelvic floor can make a world of difference during and after pregnancy.

Why Kegels Matter

First off, let’s talk about why Kegels are so essential during pregnancy. Your pelvic floor muscles act like a hammock, supporting up your bladder, bowels, and uterus. As your baby grows, there’s more pressure on these muscles. Kegels help strengthen the support system, preventing issues like incontinence (leaking pee when you sneeze or laugh) and pelvic organ prolapse (when these organs drop due to weak support).

But it’s not just about strengthening. Kegels also help you gain awareness and control down there, which is super helpful when it comes time to birth. You’ll want to know how to both engage (contract) and release/open your pelvic floor during pregnancy.

5 Simple steps to doing Kegels

1. Breath: Start with a deep breath in, allow your belly and lower ribs and pelvic floor to expand. The next 4 steps use one slow exhale.

2. Close: As you exhale, gently close around your posterior pelvic floor muscles (like you’re trying to hold in a fart).

3. Close: Close the anterior pelvic floor muscles (like you're holding in urine).

4. Lift: Next lift those muscles up towards your upper vaginal canal or lower abdomen.

5. Center: Finally, bring your focus to your core and hold everything centered for a the remainder of the exhale before releasing.

Remember, it’s not just a squeeze.

And doing kegels in the car while driving isn't ideal or functional in any way. I advise practicing at a time when you can be mindful and choose a position that is easiest for you. Some positions to try are seated, table top, on your back, standing or sidelying.

After you gain a sense of awareness, feeling that you are activating the muscles correctly, you can add them into various core exercises. If you're unsure, it's best to see a pelvic physical therapist to guide you appropriately.

Now, here’s the twist: while Kegels are great for building strength, you also need to learn how to relax those muscles for birth. This is where the reverse Kegel comes in. Think of it as the opposite of a regular Kegel—you're gently opening the anterior and posterior pelvic floor muscles and pushing outward instead of lifting in. This helps open up the passageway for your baby during delivery.

So, while you’re practicing your Kegels, make sure to also practice releasing and relaxing those muscles. It’s all about balance. The best place to do this is while pooping.

Preparing for Birth: The Reverse Kegel

1. Breath: Start with a deep breath in, allowing your belly and lower ribs and pelvic floor to expand. The next 4 steps use one slow exhale.

2. Center: Imagine energy moving down through your center into you pelvic region.

3. Open: As you exhale, gently open around your posterior pelvic floor muscles (like you’re trying to let out a fart).

4. Open: Open the anterior pelvic floor muscles (like you're release to pee).

5. Lower: Next, imagine the anus and vagina moving down as if pulling a tampon out.

Both the kegel and the reverse kegel are done on the exhale! The main difference is the kegel is an upward/contracting energy while the reverse is downward/releasing energy.

Incorporating Kegels into your routine can really support your body through pregnancy and beyond. It’s a simple practice that pays off in a big way. So, start slow, be consistent, and remember that both strength and release are key.

I’m here for you every step of the way. If you want more pelvic floor guidance and video trainings for birth prep, check out my online programs here.

Wishing you a healthy and joyful pregnancy!

Love,

Dr. Ashley