Posts Tagged ‘pelvic floor training’

5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

I have always been fond of this sentiment, the words of which were immortalized for me on a coffee mug courtesy of then 10-year-old Jeff Siegel (my son).  This statement holds true for everything in life, including pelvic floor exercises. 

Dr. Arnold Kegel (1894-1981), a gynecologist who taught at USC School of Medicine,  popularized pelvic floor muscle exercises to improve the sexual and urinary health of women following childbirth. His legacy is the pelvic exercise that bears his name—Kegels.

“Do your Kegels” is common advice from many a gynecologist (and from well-intentioned friends and family), particularly after a difficult childbirth has caused problems “down there.”  These pelvic issues include urinary leakage, drooping bladder, and stretching of the vagina such that things look and feel different and sex is just not the same.

“Do your Kegels” is sensible advice since this strengthens the pelvic floor muscles that support the pelvic organs, contribute to urinary and bowel control, and are intimately involved with sexual function. Developing strong and durable pelvic floor muscles is capable of improving, if not curing, these pelvic issues. Unfortunately, mastery of the pelvic floor is not as easy as it sounds because these muscles are internal and hidden and most often used subconsciously (unlike the external glamour muscles that are external and visible and used consciously).  

  The Kegel problem is threefold:

  1. Many women do not know how to do a proper Kegel contraction.
  2. Of those that can do a proper Kegel contraction, most do not pursue a Kegel exercise training program.
  3. Even those women who do know how to do a proper Kegel contraction and pursue a Kegel exercise training program are rarely, if ever, taught the most important aspect of pelvic muscle proficiency: how to put the Kegels to practical use in real-life situations  (“Kegels-on-demand”).

If a Kegel pelvic floor contraction is done incorrectly, not only will the pelvic issue not be helped, but actually could made worse. Only doing pelvic muscle contractions without pursuing a well-designed pelvic floor muscle training program is often an invitation to failure. Finally, if “Kegels-on-demand” to improve pelvic issues are not taught, it is virtually pointless to learn a proper contraction and complete a program, since the ultimate goal is the integration of Kegels into one’s daily life to improve quality. 

How does one do a proper Kegel pelvic contraction?  Simply stated, a Kegel is an isolated contraction of the pelvic floor muscles that draw in and lift the perineum (the region between vagina and anus). The feeling should be of this anatomical sector moving “up” and “in.”

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

Breathe normally.  The Kegel muscles are the floor of the core group of muscles, a barrel of central muscles that consist of the diaphragm on top, the pelvic floor on the bottom, the abds in front and on the sides, and the spinal muscles in the back. Holding your breath pushes the diaphragm muscle down and increases intra-abdominal pressure, which pushes the pelvic floor muscles down, just the opposite direction you want them moving.

Mistake # 2: Contracting the Wrong Muscles

When I ask patients to squeeze their pelvic floor muscles during a pelvic exam, they often contract the wrong muscles, usually the abdominals, buttocks or thigh muscles. Tightening up the glutes is not a Kegel!  Others squeeze their legs together, contracting their thigh muscles.  Still others lift their butts in the air, a yoga and Pilates position called “bridge.” The worst mistake is straining and pushing down as if moving one’s bowels, just the opposite of a Kegel which should cause an inward and upward lift.

Fact: I have found that even health care personnel—those “in the know,” including physical therapists, personal trainers and nurses—have difficulty becoming adept at doing Kegels. 

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (as it strengthens the adductor muscles of the thigh), serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.


Learning to master one’s pelvic floor muscles requires an education on the details and specifics of the pelvic floor muscles, learning the proper techniques of conditioning them and finally, the practical application of the exercises to one’s specific issues.

Mistake # 3: Not Using a Kegel Program

Kegel exercises can potentially address many different pelvic problems—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to excessive pelvic muscle tension.  Each of these issues has unique pelvic floor muscle shortcomings.  Doing casual pelvic exercises does not compare to a program, which is a home-based, progressive, strength, power and endurance training regimen that is designed, tailored and customized for the specific pelvic floor problem at hand. Only by engaging in such a program will one be enabled to master pelvic fitness and optimize pelvic support and sexual, urinary and bowel function.

Mistake # 4: Impatience

Transformation does not occur overnight!  Like other exercise programs, Kegels are a “slow fix.”  In our instant gratification world, many are not motivated or enthused about slow fixes and the investment of time and effort required of an exercise program, which lacks the sizzle and quick fix of pharmaceuticals or surgery. Realistically, it can take 6 weeks or more before you notice improvement, and after you do notice improvement, a “maintenance” Kegel training regimen needs to be continued (use it or lose it!)

Mistake # 5: Not Training for Function (“Kegels-on-Demand”)

Sadly, most women who pursue pelvic training do not understand how to put their newfound knowledge and skills to real life use. The ultimate goal of Kegels is achieving functional pelvic fitness, applying one’s pelvic proficiency to daily tasks and common everyday activities so as to improve one’s quality of life.  It is vital, of course, to begin with static and isolated, “out of context” exercises, but eventually one needs to learn to integrate the exercises on an on-demand basis (putting them in to “context”) so as to improve leakage, bladder and pelvic organ descent, sexual function, etc.

Bottom Line: Kegel pelvic floor muscle exercises are a vastly under-exploited and misunderstood resource, despite great potential benefits of conditioning these small muscles.  In addition to improving a variety of pelvic issues (urinary and bowel leakage, sexual issues, dropped bladder, etc.), a strong and fit pelvic floor helps one prepare for pregnancy, childbirth, aging and high impact sports.  The Kegel Fix book is a wonderful resource that teaches the reader how to do proper Kegels, provides specific programs for each unique pelvic issue, and reveals the specifics of “Kegels-on-demand,” how to put one’s fit pelvic floor and contraction proficiency to practical use in the real world.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.




DON’T Exercise Your Pelvic Muscles… TRAIN Them

April 1, 2017

Andrew Siegel MD  4/1/2017

“Exercise” is not the same as “training” and “pelvic floor exercises” (“Kegels”) are not the same as “pelvic floor training.”

1116_Muscle_of_the_Perineum (1)

Male (left) and female (right) pelvic floor muscles–By OpenStax [CC BY 4.0 (, via Wikimedia Commons

To anybody interested in the nuances of exercise science, “exercising” and “training” are as different as apples and oranges. Don’t get me wrong—they are both healthy and admirable pursuits and doing any form of physical activity is far superior to being sedentary. However, exercise is more of being “in the moment,” a “here and now” physical activity– the short view. On the other hand, training is a well-planned and thought out process pursued towards the achievement of specific long-term goals– the long view. Every workout in a training program can be thought of as an incremental steppingstone in the process of muscle adaptation to achieve improvement or enhancement of function. The ultimate goal of a training program is being able to apply in a practical way the newly fit and toned muscles to daily activities—functional fitness—in order to achieve a better performance (and when it comes to the pelvic floor muscles, an improved quality of life.)

Muscle training is all about adaptation. Our muscles are remarkably adaptable to the stresses and loads placed upon them. Muscle growth will only occur in the presence of progressive overload, which causes compensatory structural and functional changes. That is why exercises get progressively easier in proportion to the effort put into doing them.  As muscles adapt to the stresses placed upon them, a “new normal” level of fitness is achieved. Another term for adaptation is plasticity–our muscles are “plastic,” meaning they are capable of growth or shrinkage depending on the environment to which they are exposed.

One obvious difference between pelvic floor muscles and other skeletal muscles is that the pelvic muscles are internal and hidden, which adds an element of challenge not present when training the visible arm, shoulder and chest muscles. However, the pelvic floor muscles are similar to other skeletal muscles in terms of their response to training. In accordance with the adaptation principle, incrementally increasing contraction intensity and duration, number of repetitions and resistance will build pelvic muscle strength, power and endurance.

The goal for pelvic floor muscle training is for fit pelvic muscles—strong yet flexible and equally capable of powerful contractions as well as full relaxation. The ultimate goal for pelvic floor muscle training—a goal that often goes unmentioned–is the achievement of “functional pelvic fitness.”  Pelvic floor muscle training really is the essence of functional fitness, training that develops pelvic floor muscle strength, power, stamina and the skill set that can be used to improve and/or prevent specific pelvic functional impairments including those of a sexual, urinary, or bowel nature and those that involve weakened pelvic support resulting in pelvic organ prolapse.

With occasional exceptions, most women and men are unable to perform a proper pelvic muscle contraction and have relatively weak pelvic floor strength. In my opinion, pelvic training programs should therefore initially focus on ensuring that the proper muscles are being contracted and on building muscle memory. It is fundamental to learn basic pelvic floor anatomy and function and how to isolate the pelvic muscles by contracting them independently of other muscles. Once this goal is achieved, pelvic training programs can be pursued.

Programs need to be able to address the specific area of pelvic weakness, e.g., if strength is the issue, emphasis on strength training is in order, whereas if stamina is the issue, focus on endurance training is appropriate. Furthermore, programs need to be designed for specific pelvic floor dysfunctions, with “tailored” training routines customized for the particular pelvic health issue at hand, whether it is stress urinary incontinence, overactive bladder, pelvic organ prolapse, sexual/orgasm issues, or pelvic pain. Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness and deficit is fundamental since each pelvic floor dysfunction is associated with unique and specific deficits in strength, power and/or endurance.

It is easiest to initially train the pelvic floor muscles in positions that remove gravity from the picture, then advancing to positions that incorporate gravity. It is sensible to begin with the simplest, easiest, briefest pelvic contractions, then advance to the more challenging, longer duration contractions, slowly and gradually increasing exercise intensity and degree of difficulty.

In my opinion, the initial training should not include resistance, which should be reserved for after achieving mastery of the basic training that provides the foundation for pelvic muscle proficiency.

Bottom Line: If you are serious about improving or preventing a pelvic floor dysfunction, you need to do pelvic floor muscle training as opposed to pelvic floor exercises. There are numerous differences including the following:

  • Training is motivated by specific goals and purposes while exercise is done for its own sake or for more general reasons
  • Training requires a level of focus and intensity not demanded by exercise
  • Training requires a plan
  • Training can be a highly effective means of improving and preventing pelvic floor dysfunction

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

When Stress Causes A “Headache” In The Pelvis

November 26, 2016

Andrew Siegel MD 11/26/2016


Image above attributed to Dr. David Potter, licensed under the Creative Commons Attribution-Share Alike 4.0 International license.

It is virtually impossible to avoid stress in our lives. A small and manageable amount of stress—“eustress”—triggers adrenaline release, which increases pulse, respiratory rate and blood pressure, dilates the pupils and makes one hyper-alert, focused and motivated. All things considered, this can improve performance—think “caffeine on steroids.” However, excessive stress—”distress”—is clearly a bad situation, causing anxiety that can decrease performance, un-motivate and make life rather unpleasant.

The immediate manifestations of stress-mediated adrenaline release are due to the primitive “flight-or-fight” response that causes us to brace, tighten, clench and compress our bodies. Stress triggers rapid, shallow and less efficient chest breathing as opposed to proper breathing from the diaphragm, which is slow, steady deep and efficient. Slouching and poor posture from clenching and muscle tensioning further exacerbates the breathing issues.

Chronic stress—internalized—can have many physical manifestations, often tension headaches involving taut muscles in the head, neck and back. Other signs of stress-turned inwards are insomnia, fatigue, altered immune system function, depression and loss of sex drive. It can also be responsible for high blood pressure, angina, heart attacks and strokes as well as give rise to gastritis, peptic ulcer disease and irritable bowel syndrome. Urinary frequency is a not uncommon urological manifestation of chronic stress.

When stress is internalized within the pelvic floor muscles it can cause pelvic floor tension myalgia, which causes pelvic pain often accompanied by sexual, urinary and bowel symptoms. It can cause knots within the pelvic muscles—discrete sights of hyper-tensioned muscle. This tension myalgia is a very difficult and frustrating situation that often requires a number of different treatment approaches.

Because the pelvis is the site of important functions– urinary, sexual and bowel–it is a particularly bad location for holding tension. Pelvic “hypertension” can cause urinary, genital and rectal pain as well as adversely affect the proper performance of these systems. It can cause difficulty starting one’s urinary stream, a weak stream, incomplete emptying of the bladder and symptoms of overactive bladder (urgency, frequency, etc.). It can be responsible for pain with sexual stimulation and intercourse, sometimes to the extent that sexual intercourse is not possible. It can also cause constipation, hemorrhoids, fissures and other bowel symptoms.

When anxiety expresses itself through tension in the pelvic floor muscles, the physical tension and pain further contribute to emotional anxiety and stress reaction, which creates a vicious cycle. Poor posture, muscle overuse and abnormalities with the nerve pathway that regulates muscle tone are other factors that contribute to the pelvic tension.

Characteristically, the pain waxes and wanes in intensity, may “wander” to different locations and can be perceived to be superficial, intermediate or deep in the pelvic tissues. It can involve the lower abdomen, groin, pubic area, genitals, perineum, anus, rectum, hips and lower back. The pain is often described as “stabbing,” although it can be cramping, burning or itching in quality. Urination, bowel movements and sexual activity can aggravate the pain.

Because the symptoms of pelvic floor tension myalgia can be vague and variable, those afflicted often have difficulty precisely expressing their symptoms, although they usually have many complaints and have typically seen numerous physicians and have had multiple prior interventions. Many patients thought to have interstitial cystitis/chronic pelvic pain syndrome, irritable bowel syndrome, chronic prostatitis, vulvodynia and fibromyalgia in actuality have pelvic tension myalgia. In fact, this pelvic floor issue is probably one of the most common problems that urologists and gynecologists see and is likely one of the most misunderstood, misdiagnosed and mistreated conditions. Many suffering with it are miserable and deeply frustrated after having endured years of episodic agony without relief.

How Is Pelvic Floor Tension Myalgia Diagnosed?

Most important are a rectal exam in men and a pelvic exam in women to evaluate the pelvic floor muscles. Typical findings are tight, tender and weak pelvic muscles, spasticity, and difficulty in relaxing the muscles following contraction. Localized, knot-like bands can often be felt, similar to tension knots that can develop in back muscles. The pain can often be localized by a vaginal or rectal exam that identifies these trigger points, the sites of origin of the myalgia that when manipulated cause tremendous pain, often replicating the symptoms.

How Is Pelvic Floor Tension Myalgia Managed?

The key to treatment is to foster relaxation and “down-training” of the spastic pelvic muscles in order to untie the “knot(s).” By making the proper diagnosis and providing pain relief, the vicious cycle of anxiety/pain can be broken. Managing it often requires multiple approaches including stress management, anti-inflammatory and anti-spasmodic medications, and physical interventions.

Pelvic muscle training can be a useful piece of this multimodal management approach by its focus on developing proficiency in relaxing the pelvic muscles. The emphasis here is not on contracting these already over-contracted and over-tensioned muscles, which could aggravate the problem. This demands a different spin on the usual concept of pelvic training, which in this instance is not to increase tone and strength—rather it is to instill pelvic muscle awareness and enable the capacity for maximal pelvic relaxation, which is considered to be a “meditative” state between pelvic muscle contractions. Those suffering with this problem need to learn to unclench and release the pelvic floor muscles.

Focused therapies include the application of heat and pelvic massage. Pelvic floor physical therapists can be of great benefit to those suffering with pelvic tension myalgia. They use a number of physical interventions that provide pelvic muscle stretching and lengthening to increase muscle flexibility including trigger point therapy, which compresses and massages the knotted and spastic muscles. Those afflicted that are so motivated can pursue self-treatment regimens using internal, manually guided trigger point release wands that aim to relieve or eliminate the knots by self-directed manipulation and massage. These devices may be obtained without a prescription and are available online. Pelvic muscle tension myalgia sometimes requires injections of medication—including anesthetics, steroids or Botox—into the offending trigger points.

Bottom Line: In people afflicted with pelvic pain, the diagnosis of pelvic floor muscle tension myalgia should be a primary consideration. Physical interventions can be extremely helpful in alleviating the pain and untying the “knots” within the over-tensioned pelvic muscles. By making the proper diagnosis and providing pain relief and fostering muscle relaxation, the vicious cycle of anxiety/pain can be broken.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at

Author page on Amazon:

Apple iBook:

Trailer for The Kegel Fix: 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

10 Myths About Kegel Exercises: What You Need to Know

November 14, 2014

Andrew Siegel, M.D.


shutterstock_orange gu tract closeup




Myth: Kegels are just for the ladies.

Truth: Au contraire…men have essentially the same pelvic floor muscles as do women and can derive similar benefits to sexual, urinary, and bowel health.


Myth: The best way to do Kegels is to stop the flow of urine.

Truth: If you can stop your stream, it is indeed proof that you are contracting the proper set of muscles. However, this is just a means of feedback to reinforce that you are employing the right muscles, but the bathroom should not be your Kegel muscle gymnasium.


Myth: You should do Kegel exercises as often as possible.

Truth: Pelvic floor muscle exercises strengthen and tone the pelvic floor muscles and like other muscle-strengthening routines, should not be performed every day. Pelvic exercises should be done in accordance with an intelligently designed plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.


Myth: You can and should do Kegels anywhere (while stopped in your car at a red light, waiting in line at the check out, while watching television, etc.)

Truth: Exercises of the pelvic floor muscles, like any other form of exercise, demand gravitas, focus, and isolation of the muscle group at hand. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you cannot integrate the exercises into the activities of daily living.


Myth: Holding the pelvic floor muscles tight all the time is desirable.

Truth: Not a good idea…the pelvic floor muscles have natural tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. There exists a condition—tension myalgia of the pelvic floor muscles—in which there is spasticity, tightness and pain due to excessive tension of these muscles. Pelvic floor training in this circumstance must be done with caution in order to avoid aggravating the pain, but maximal muscle contraction can induce maximal muscle relaxation, a meditative state between muscle contractions.


Myth: Focusing on your core is enough to ensure pelvic floor muscle fitness.

Truth: The pelvic floor muscles do form the floor of the “core” group of muscles and get some workout whenever the core muscles are exercised. However, for maximum benefit, specific focus needs to be made on the pelvic floor muscles. In Pilates and yoga, there is an emphasis on the core group of muscles and a collateral benefit to the pelvic floor muscles, but this is not enough to achieve the full potential fitness of a regimen that focuses exclusively on the pelvic muscles.


Myth: Kegel exercises do not help.

Truth: Au contraire…pelvic floor muscles have proven to help a variety of pelvic maladies in each gender. In females, pelvic floor muscle training can help urinary and bowel incontinence, pelvic relaxation, and sexual dysfunction. In males, pelvic floor muscle training can help incontinence (stress incontinence that follows prostate surgery, overactive bladder, and post void dribbling), erectile dysfunction, premature ejaculation and other forms of ejaculatory dysfunction as well as help bowel incontinence and tension myalgia of the pelvic floor.


Myth: Kegels are only helpful after a problem surfaces.

Truth: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive in order to maintain muscle mass and strength in order to prevent problems from arising before they have an opportunity to do so. Pelvic floor muscle training done during pregnancy can help prevent pelvic issues from arising in females and pelvic muscle training in males can likewise help prevent the onset of a variety of sexual and urinary maladies. There is no better time than the present to start pelvic exercises to delay or prevent symptoms.


Myth: You can stop doing Kegels once your muscles strengthen.

Truth: No, “use it or lose it” applies here as it does in any muscle-training regimen. Muscles adapt positively to the stresses and resistances placed upon them and so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the pelvic floor muscles.


Myth: It is easy to learn how to isolate and exercise the pelvic floor muscles.

Truth: No, not the case at all. Studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually contracting other muscles, typically the rectus, the gluteal muscles, and the adductor muscles of the thigh. One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs…UNTIL NOW! The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-training program could be made accessible and available in the home setting. This comprehensive, interactive, follow-along exercise program is available on DVD…


Myth: Kegels can adversely affect your sex life.

Truth: Absolutely not… In both genders, pelvic floor muscle training has been found to improve sexual function. The pelvic floor muscles play a critical role in both female and male sexuality, supporting clitoral and penile erections as well as ejaculation in males and orgasm in both genders.


Wishing you the best of health,

2014-04-23 20:16:29


A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym: – now available on Amazon