It is unlikely that you’ve heard of their opposite: reverse kegels.
Sometimes this movement is also referred to as a “perineal bulge” or a lengthening/elongating of the pelvic floor. But, what exactly is it? It is using the same exact pelvic floor muscles as when you kegel, but just in a different way. In fact, all of our muscles need to be able to shorten (called a concentric contraction) and lengthen (called an eccentric contraction.)
I’ve found this motion to be less intuitive than a regular old kegel. A common analogy I give to my patients is this: imagine that you want to take a drink from a glass of water on the counter. In order to pick up that glass and raise it to your mouth, your biceps muscle needs to contract by shortening. However, you don’t want to carry the glass around all day long. Thus, in order to put it down, your biceps will contract again, but this time by lengthening.
While some people may have genuine loss of muscle strength or overactivity that is causing their symptoms, for many it is this coordination of shortening and lengthening that becomes disorganized and needs to be retrained. So, let’s get to reverse kegeling!
A note about terminology: In this blog post, I will be using certain anatomical terms including vagina, penis, scrotum, clitoris, etc. These words are often heavily gendered, including in the medical field. The intention of using these terms here is only for clarity of explanation and by no means an indication of gender or sex based on genitals. Please read with caution and feel free to substitute your own terms that feel more authentic for you. For example, many of my patients like to refer to their anatomy with words like canal, shaft, interior, exterior, etc.
Movement cues for how to reverse kegel:
- Gently bear down as though you were trying to pass gas or have a bowel movement
- Gently push down as though you are laying an egg
- Imagine that you are passing a lime through your vagina or anus
- Imagine that your pelvic floor muscles are contracting to hold a marble inside; now release and let go of the marble
- Visualize your pelvic floor as an elevator. A kegel would be closing the elevator doors and going up. A reverse kegel would be descending the elevator all the way down to the basement and opening those doors.
Positions to encourage relaxation:
Why do reverse kegels?
Performing this movement can help to stretch, elongate, and “downtrain” the pelvic floor. Some people with pelvic floor dysfunction actually have a hypertonic or overactive pelvic floor. This is sometimes referred to as “tight and weak” but I don’t love this phrasing because of the patriarchal descriptions of a “tight” or “loose” vagina. Nor do I like to refer to muscles as weak because the last thing I want is for patients to leave my care feeling like I gave them a list of things that are ‘wrong with them.’ In the case of a hypertonic pelvic floor, doing a bunch of kegels will likely worsen their symptoms and not help to make them stronger.
Another common presentation is that a patient may be able to do a kegel (contraction) just fine, but can’t elongate the muscles. This is an issue because all of our muscles in our body are only good at doing their jobs if they are coordinated. As mentioned in the previous article, this coordination is crucial for managing the pressure in the “canister” of our abdomens.
Who may benefit from reverse kegels?
Those with:
- Interstitial cystitis or bladder pain syndrome
- Dyspareunia (pain with sex)
- Vaginismus and vestibulodynia
- Other forms of pelvic pain
- High urinary urgency and frequency (overactive bladder)
- Constipation
Who should avoid reverse kegels until they’ve had proper evaluation/guidance:
- Patients who have undergone pelvic surgery
- Those experiencing tailbone pain
- If you have an active UTI or yeast infection
- Patients with any type of incontinence
- Folx with pelvic organ prolapse (can feel like a heaviness in the vagina or rectum or as though something is stuck inside the canals)
Similar to kegels, if doing reverse kegels makes your symptoms worse, don’t do them. And it is always best to have an evaluation by a pelvic floor specialist to ensure that the exercises you’re doing are tailored to your specific needs.
Brianna earned her Doctor of Physical Therapy at Texas Woman’s University in Houston, TX and her Bachelor’s of Athletic Medicine at University of Texas San Antonio. During and after graduate school, she received training on pelvic floor physical therapy in addition to her orthopedic manual skillset. As a competitive powerlifter, Brianna enjoys working with female athletes who experience stress urinary incontinence. She is passionate about providing care to individuals in the LGBTQ+ community, especially those undergoing hormonal/surgical transition. Additional clinical interests of her’s include: prenatal/postpartum care, vestibular and balance rehab, and sports-related injuries. In her spare time, Brianna enjoys playing board games, lifting heavy, and watching stand-up comedy.
