Women’s Health Questions- Are You Doing Kegels Properly?

It can be hard to tell… One study shows about 25% of us perform pelvic floor muscle exercises (Kegels) improperly following purely verbal cues (Bump et al, 1991). A good pelvic floor muscle contraction should feel like you are bringing together the ischial tuberosities (sitz bones) while also drawing together the pubic bone and tailbone. It should not feel you are bearing done or pushing out in any way. And muscles need oxygen! Calm, steady, abdominal breathing should be maintained throughout the contraction.

Linda Anzalone, WHNP
Are you doing your Pelvic Floor Exercise (Kegels) properly?

Another important consideration is that the muscles of the pelvic floor consist of both slow and fast switch muscle fibers. Slow twitch fibers maintain the structure and stability whereas fast twitch take care of the sphincters and orgasms. All pretty important stuff! Slow twitch muscles benefit from endurance training while fast twitch muscle fibers are strengthened by quick repetitions.


There are several products on the market for strengthening the pelvic floor muscles, with a whole range of prices. Prior to purchase, it can be very helpful to have your own personal trainer (Pelvic Rehabilitation Specialist) to learn how to access and strengthen your pelvic floor, as well as to assign appropriate exercises with an eye toward progression of intensity.

Linda Anzalone, WHNP
Pelvic Floor Rehabilitation Exercises

Sometimes, Kegels aren’t really what is needed for improved function. Like every other muscle in our bodies, the muscles of the pelvic floor can be strengthened or lengthened, can become weak or spasm, can get too tight and cause pain or be too lax to do the job properly. Pelvic floor dysfunction manifests in a multitude of different ways: urinary or fecal incontinence, dyspareunia (painful sex), other pelvic pain, anterior or posterior vaginal wall prolapse, low back or hip pain….


To find out if we can help you, we invite you for a free consultation. Call us at 503-287-4970.

Urinary Incontinence

incontinence, pelvic floor rehab, pelvic floor physical therapy, Women's health Portland Oregon
Diagnosis: urinary incontinence

Perhaps it’s a little leak when you sneeze, or you need to change your outfit after the “key in the door” urgency has overtaken you. You might think it’s a normal part of growing older, or the price to pay for those adorable children, or something to quietly ignore and hope it goes away. Current research indicates 1 in 4 women over 18 experiences some leakage. Please know that help is available, and you don’t need to suffer quietly!

The Almighty Pelvic Floor is responsible for the structural support of the bladder in addition to the other pelvic organs. Typically, these muscles contract with storage and relax with emptying.  The muscles and fascia of the pelvic floor can be too tight, too loose or be contracting in a discordant fashion. Reestablishing appropriate support of this little “hammock” can result in great improvements with both urinary and fecal continence.

Another consideration is the network of neural pathways involved in urination. Our sympathetic nervous system (fight, flight or freeze) impulses “stop and store” while the parasympathetic (rest and digest) impulses are necessary for emptying the bladder. Neurological control of urination falls under the heading of Bradley’s Loops- 1, 2, 3 and 4. Disruption of these loops by certain neurological conditions or local trauma can influence our ability to hold urine.  Unopposed parasympathetic impulses of the pelvic nerve in Loop 3 results in the symptoms of urge incontinence (key in the door leakage). Check out this link for answers to some frequently asked questions: https://www.womenshealth.gov/a-z-topics/urinary-incontinence

Bladder retraining, pelvic floor physical therapy and behavioral modification are first line treatments for urinary incontinence. Urge incontinence may also be treated with medication or electrical stimulation of the bladder nerves. Further on down the line, there are other more aggressive treatments such as surgery, pessaries or indwelling catheters but I’d say pretty much everyone prefer the more conservative treatments!

As a Holistic Women’s Healthcare Provider, I always consider the whole person when assessing my patient’s concerns. Incontinence is typically multifactorial and there are many angles to address it. We consider the history of symptoms, any known triggers, anything that seems to make it better or worse, and a physical exam to consider any physical causes. Together we will set goals and work our way towards them, celebrating your successes along the way and changing up anything that does not seem to be helping. And there will be homework! Yes, homework…. but I promise to work as hard as you do!

If incontinence is impacting your quality of life, I invite you to schedule an office visit today.


Linda Anzalone, WHNP

Linda Anzalone WHNP
Linda Anzalone, WHNP-BC, in Nature Cures Clinic Downtown Portland, OR