You can refer to the picture above of the pelvic floor muscles while you are learning how to do these exercises. It may helpful to visualize where these muscles are and how the muscle fibers are oriented.

Key Points on Strengthening Exercises:

• The front and back triangles are connected and will contract together.
• Based on your symptoms, you can focus on one triangle (front triangle for urinary incontinence, back triangle for fecal incontinence).
• Close your eyes as you are visualizing the contraction since these muscles work well under visual guidance.
• To contract the front triangle, imagine that there is a blueberry sitting at the opening of your urethra (where urine exits) and your vagina. Squeeze the blueberry at each opening and draw it inward towards your bellybutton.
• Another cue for the front triangle is imagining you are stopping the flow of urine (never actually stop the flow of urine on the toilet, this can prevent you from completely emptying your bladder).
• You can verify that you are doing this correctly by placing one finger inside your vagina to feel the tightening and lifting inside.
• To contract the back triangle imagine you are stopping the passage of gas or as if you are drawing in a marble into your rectum.
• Other cues you may connect with include drawing your pubic bone and tailbone together and inwards or drawing your two sitz bones together and inwards.
• To start, test how long you can hold the contraction without feeling the muscles let go and add one second to this starting point. Slowly, over the following weeks, you can build up to 10-second holds.
• Hold each area for up to 10 seconds without feeling the muscles let go and repeat up to 30 times, once per day.
• You should rest for 10 seconds in between each contraction.
• Make sure you are not holding your breath or using your buttocks, inner thighs, or abdominal wall.
• Nobody should see any movement while you are doing your pelvic floor contractions.
• Start practicing your pelvic floor contractions in a lying position and progress to different positions (sitting, standing) and during various functional activities (sit-stand, squat, lift) when you feel ready.
• Coordinate your pelvic floor contractions with your breath. Breathe in and relax your pelvic floor, breathe out and contract your pelvic floor.
• It will take daily practice for 3-4 months to see the benefits.
• These muscles take a little bit of concentration, but with some effort, your brain will make a better connection.

Please note: Kegels are NOT always indicated and can sometimes aggravate your symptoms.

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises may be prescribed.

If your symptoms are not improving, or you think you have tension in your pelvic floor, seek out the help of a Pelvic Health Physiotherapist who has training in internal palpation of the pelvic floor muscles. A customized program (not just Kegels) will be designed for you based on their subjective and objective findings.