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Kegel / Pelvic Floor Exercise

By Dr Liji Thomas, MD

Kegel exercises are special exercises meant to tone up the pelvic floor muscles. These muscles support your pelvic organs firmly in place, while allowing urine, feces and other substances to be excreted at will, but under your control.

Female pelvic floor labeled - Image Copyright: Alila Medical Media / Shutterstock
Female pelvic floor labeled - Image Copyright: Alila Medical Media / Shutterstock

Weakness of these muscles causes health conditions such as laxity of the vaginal opening and urinary incontinence, as well as pelvic organ prolapse. The pelvic floor can be made and kept stronger by using Kegel exercises to keep the muscles in shape. These exercises are also called pelvic floor muscle training, and are most commonly prescribed to treat stress incontinence in women, or as preventive measures to prevent weakening of the floor after childbirth.

How to feel the pelvic floor muscles

The pelvic floor muscles are the ones which control the flow of urine, as well as the escape of gas from the rectum. In order to know which ones you need to exercise, try to stop your urine while you are in the toilet. This will help you to feel the muscles being squeezed, and to learn to squeeze and relax them at will. However, it is not good for your bladder when you repeatedly try to stop your urine flow. The detrusor muscle of the bladder contracts during urination, increasing intra-bladder pressure. Squeezing the urethra shut increases the bladder pressure still higher. It also sends mixed signals to the brain. If the pressure in the bladder rises too high the urine may flow back into the ureters.

Other ways of identifying the right muscles to squeeze have been suggested, as follows:

  • Inserting a finger into the vagina in the lying down position, and then squeezing as if you wanted to keep back urine. If the finger is squeezed, you are doing it right.
  • Squeezing as if you wanted to keep gas from escaping
  • Imagining that you are picking up a small smooth marble with only your vaginal muscles

Kegel exercises are of greatest effectiveness only if they are done using the right muscles and with the right technique. For this reason, many healthcare providers recommend that you learn how to do these exercises under the supervision of a trained physiotherapist or other professional. Once you have become familiar with performing them right, you can continue to do them at home.

How to do pelvic floor muscle exercises

Lie or sit in a comfortable position and squeeze the muscles that you have identified as pelvic floor muscles to a count of 3. Now relax them and count to 3. Repeat the squeeze-relax cycle 10-15 times consecutively.

An important precaution here is to make sure you do not squeeze or tighten your abdominal, buttock or thigh muscles at this time, as this may lead to muscle fatigue. Breathe normally while you squeeze and relax. Place your hand on your stomach, your back, your thighs and your buttocks to make sure you are not contracting any of them by mistake. If you are, relax and try again.

Once you have got the hang of it, you can increase the time you hold the squeeze little by little till you can hold for a count of 8. You can also increase the number of sets you do at a time. Once you finish one set, rest for a few minutes before you do the next set of reps. Do them for at least 15 sets of 10 reps each, three times a day, from the beginning.

The best part of Kegel exercises is that nobody knows that you are doing them, so you can do them in any position – while lying down, sitting at your desk or standing up, waiting in a line or working in your home. In fact, doing them in different positions strengthens them more evenly, and is highly beneficial. Your daily workout should include these three primary positions. You should try to do them as often as you can during the first three months, and once your pelvic floor shows signs of being strong, such as the cessation of stress incontinence, you can continue them, but reduce the number of reps/sets slowly to a maintenance level.

Pilates woman pelvic lift fitball exercise - Image Copyright: holbox / Shutterstock
Pilates woman pelvic lift fitball exercise - Image Copyright: holbox / Shutterstock

Results of pelvic floor exercises

These exercises are meant to use very small muscles, and so the effect builds up slowly over a few weeks to months. However, within a month you should be able to see some effect on the control of your urine flow. Even if the incontinence does not disappear, it should be significantly less than before. In addition, you may find that intercourse becomes more enjoyable and climaxes are more intense, as the vagina is supported better by the toned pelvic floor muscles. These exercises improve the woman’s overall quality of life.

These may also be of benefit for men who are suffering from erectile dysfunction or urinary incontinence. When the pelvic muscles are correctly used, in fact, they may discourage bladder irritability and further reduce urinary incontinence.

It is important not to stop doing the Kegel exercises when you begin to see the results, as they must be continued for a long time, preferably life-long, at a maintenance level. They can help you prevent the weakening effects of age on your pelvic musculature, and stave off obvious prolapse.

Kegel’s exercises are safe during pregnancy, as they use no part of the body but the pelvic floor. The earlier you do them, the more insurance you have against the risk of a weak pelvic floor following childbirth.

Biofeedback in pelvic floor muscle training

These exercises are sometimes done using biofeedback to help the woman identify if she is contracting the right muscles, and to motivate her to continue. Biofeedback may be obtained via electronic recorders that tell you when the right muscles are being squeezed. There are other techniques as well, such as written diaries.

There are several ways to apply biofeedback:

  • Using a vaginal or anal probe which senses pelvic muscle contractions and sends them to a monitor
  • Using a skin electrode which picks up muscle contractions and sends a signal to a monitor

While the objective benefits of biofeedback in pelvic muscle training has not been demonstrated, it may offer some people a visual stimulus and motivation to continue with the exercises.

References

Further Reading

Last Updated: Aug 11, 2016

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