So maybe you’ve decided to do pelvic floor muscle exercises on your own because you aren’t quite ready to see a physical therapist. This decision feels good but you are a little uncertain about how to get the best results. Do you have questions about how to do the exercises correctly and how to best track your progress? Are you not sure where to start? Do you need special vaginal gear to do kegels? You’ve seen LOTS of things advertised….
The short answer is only if you want it. Honestly, totally up to you. There are lots of different ways to strengthen the pelvic floor and you can pick the way that suits you. But let’s discuss kegels first and some considerations before you buy anything.
Kegels
To do a kegel, pretend that you are tightening the vagina around a tampon. DO NOT try to stop your urine flow. While stopping your flow once doesn’t really matter, doing it repetitively can confuse your bladder and lead to other bladder issues. If you want to see if you are contracting correctly, put a finger in the vagina and squeeze (why not?). The muscle will tighten and pull in and up. You should be able to feel a muscle on the right and one on the left. Just know that one side may be stronger than the other.
Want more information? Check out the IUGA education information.
You should work up to 30 slow contractions per day and 30 fast contractions per day. The slow contractions should eventually held for 10 seconds.
Considerations
While improving your muscle strength is not hard , it takes time, dedication, and commitment. You have to have a plan and stick with it. For some women, having vaginal gear can provide the right feedback and help with motivation. The right vaginal gear can help you to do kegels. But before buying anything, take a minute to think about what you want and answer the following questions:
- Do you want feedback to tell you how you well are contracting and if you are getting stronger?
- Will you take the time to insert something into the vagina to give you this feedback?
- What will motivate you to do these exercises and keep doing them?
If you want the feedback, don’t mind taking the time to insert a device and think it will keep you motivated, you want vaginal gear to do your kegels. No one device is better than another, it just depends on what you want and like. Each picture links to the corresponding website if you want more information. And if you are just thinking about incontinence pads and underwear, I have another post on that.
Vaginal gear options
Vaginal cones
Weights that you put in the vagina are called vaginal cones. When you use them, you are lifting a weight and making the exercise a little harder. They are not connected to any feedback device. The smallest weight is often 30g and then each bigger weight is 20g heavier. This can make it easier to feel the muscles working. There is some data suggesting that these weights may help improve your ability to do pelvic floor exercises. But (not to sound like a broken record), you have to take the time to insert them in the vagina and use them. If they are going to stay in your drawer, don’t get them. And there is no reason to buy anything fancy like a jade egg.
Kegel trainers
There are a slew of kegel coachs and trainers. These are vaginal devices with an app. Some are available over the counter (I just saw one at Target) and some require a prescription (like the leva from Renovia). The device goes in the vagina to measure your strength while you are doing the exercises. The app is usually on your phone. They can give you different “routines” and tell you how you are doing. Some are made to look like games so no one can tell what you are doing (unless you are making faces while you do them). This biofeedback does not clearly help improve muscle strength more than exercising without it.
Some women really like the varied routines and the progress reports. But again, you have to get it out and put it in the vagina. Get it if you like this idea and will use it. The price range is ~ 139-200+ dollars for the over the counter trainers. The trainers that are available with prescriptions generally have more data behind them and offer more support- programs to keep you engaged. And, a little disclaimer, I am on the medical board of Renovia. The trainers are all a little different and if you want one, do a little research and get the one that suits you best in the right price point. I’ve just highlighted a few of the devices out there, there are many more.
electrical stimulation shorts
I think the holy grail is something that can test your muscle strength and not be placed in the vagina. This does not exist. There are the innovo shorts- these use electrical stimulation to improve pelvic floor strength and leakage. There is some clinical data to show that they improve leakage but the available published data is limited.
Lucacz ES et al. JAMA (2017);318(16):1592-1604.
Dumoulin C et al Neurourol Urodyn (2016);35:15-20
Maher Rm et al Neuromodulation 2013;16(6):590-4.
