Kegel Exercises

Kegel exercises are strengthening exercises for muscles in the pelvis, called the pelvic floor muscles.

Many factors, such as pregnancy, childbirth, obesity, abdominal surgeries, prostate cancer or surgery can weaken the pelvic floor muscles. This can lead to bladder or bowel control problems. But like other muscles, they can be strengthened, and this can help both women and men regain control. Both sexes may also experience improvements in sexual sensation by strengthening the pelvic muscles.

Image of the pelvic bowl region showing the relationship of pertaining organs. Source: NKUDIC

Anatomy

The part of the body within the hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between the legs. The muscles attach to the front, back, and sides of the pelvis bone. They provide support for organs like the uterus, bladder, and intestines, and prevent incontinence (leaking of urine and stool).

Two pelvic muscles do much of the work to prevent incontinence. The biggest one stretches like a hammock. The other is shaped like a triangle.

Why Kegel Exercises Are Done

Kegel exercises are done in patients with pelvic floor disorders to strengthen pelvic floor muscles, which can help improve conditions related to urinary and sexual function.

Image of organs discussed as seen looking up between the legs. Source: NKUDIC

How Kegel Exercises Are Done

Find the right muscles. This is very important. The two major muscles that stretch across the pelvic floor should be tightened. They are the "hammock" muscle and the "triangle" muscle. Here are three methods to check for the correct muscles.

1. Try to stop the flow of urine while sitting on the toilet. These are the right muscles.
2. Squeeze as if trying to stop passing gas. A "pulling" feeling is normal.
3. Women can lie down and place a finger inside the vagina. Squeezing as if trying to stop urine from coming out should produce a feeling of tightness on the finger.

Don't squeeze other muscles at the same time. One should not tighten stomach, leg, or other muscles. Squeezing the wrong muscles can put more pressure on the bladder control muscles. Only the pelvic muscles should be squeezed. The breath should not be held.

Repeat, but don't overdo it. When beginning, recommendations are to find a quiet spot to practice and concentrate, lie on the floor, and pull in the pelvic muscles and hold for a count of three then relax for a count of three. The eventual goal should be 10 to 15 repeats each time.

Do pelvic exercises at least three times a day. Every day, use three positions: lying down, sitting, and standing. These muscles can be exercised while lying on the floor, sitting at a desk, or standing in the kitchen. Using all three positions makes the muscles strongest.

Be patient. Bladder control may not improve until after three to six weeks. Still, most women do notice an improvement after a few weeks.

Exercise aids. Special weights and biofeedback may also be helpful.

Image of the bladder and the related muscles used for urination. Source: NKUDIC

Bracing

The pelvic muscles can be protected from more damage by bracing.

Sudden pressure from sneezing, lifting, or jumping can hurt the pelvic muscles. Squeezing the pelvic muscles tightly and holding until after sneezing, lifting, or jumping may be protective.

Women who tighten the pelvic muscles for these moments may have fewer accidents.

Benefits

Exercising the pelvic floor muscles for just five minutes three times a day can make a big difference in bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

Studies have shown a benefit of Kegel exercises in reducing urinary incontinence and urinary tract infection in children with voiding dysfunction,^[1] urinary incontinence after removal of the prostate,^[2] stress urinary incontinence in women,^[3] postpregnancy incontinence,^[4] and sexual dysfunction in both women^[5] and men^[6]

Risks

There are no known risks associated with Kegel exercises.

Effectiveness

Dr. Kegel reported a 93% cure rate in over 300 women using his method, which included biofeedback and an intensive exercise regime.^[7]

Statistics

Urinary incontinence affects an estimated 38% of women aged 60 or older. Urinary incontinence affects an estimated 17% of men aged 60 or older.^[8]

Alternatives

Alternatives to Kegel exercises depend on the condition being treated. Urinary incontinence can be treated with medications or surgery, depending on the severity and type of incontinence.

Controversy

Two writers contend that there have been unfortunate changes in the way the exercises are taught today compared with the way they were originally prescribed by their originator, Dr. Arnold Kegel, and that these changes have led to misunderstandings and in some cases unnecessary surgery. His method included biofeedback and digital exams, as well as a device to measure the strength of muscle squeeze called a perineometer.^[7]

History

How Kegel exercises were developed

Kegel exercises were first developed in the 1950s by Dr. Arnold H. Kegel, who published several papers on the use of exercises for stress incontinence.^[9]

References

1. ↑ Vasconcelos M, Lima E, Caiafa L, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol. 2006 Dec;21(12):1858-64. Epub 2006 Sep 12. Abstract
2. ↑ Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005 Nov;48(5):734-8. Epub 2005 Jun 22. Abstract
3. ↑ Turkan A, Inci Y, Fazli D. The short-term effects of physical therapy in different intensities of urodynamic stress incontinence. Gynecol Obstet Invest. 2005;59(1):43-8. Epub 2004 Sep 29. Abstract
4. ↑ Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can. 2003 Jun;25(6):487-98. Abstract
5. ↑ Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978 Jul 15;131(6):633-6. Abstract.
6. ↑ La Pera G, Nicastro A. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor. J Sex Marital Ther. 1996 Spring;22(1):22-6. Abstract
7. ↑ ^{7.0 7.1} Perry JD and Hullet LT. The Bastardization Of Dr. Kegel's Exercises. Presented to Northeastern Gerontological Society, New Brunswick, New Jersey, May 20, 1988. Full Text
8. ↑ National Kidney and Urologic Disease Clearinghouse Web site. Kidney and Urologic Diseases Statistics for the United States
9. ↑ Jones E.G. and Kegel A.H. Treatment of urinary stress incontinence with results in 117 patients treated by active exercise of pubococcygeal. Surg Gynecol Obstet. 1952 Feb;94(2):179-88. Abstract

External Links

• American Urological Association: Pelvic Floor Muscle ("Kegel") Exercises
• National Kidney and Urologic Diseases Information Clearinghouse: Exercising Your Pelvic Muscles