PELVIC FLOOR EXERCISE (KEGEL EXERCISE)
What is the pelvic floor?
The pelvic floor is a large sling (or hammock) of muscles and other tissues stretching across the floor of the pelvis. It is attached to the pelvic side walls, the pubic bone in front, and to the coccyx (the tail end of the spine) behind. It forms a kind of "undercarriage". The openings from the bladder (urethra), the bowels (rectum) and the uterus (vagina) all pass through the pelvic floor.
What does it do?
- it supports a woman’s pelvic organs and abdominal contents, especially when she is standing or exerting herself.
- it supports her bladder to help it stay closed. It actively squeezes when she coughs or sneezes, to help avoid leaking. When the muscles are not working effectively she may suffer from leaking ("urinary incontinence"), and/or urgent or frequent need to pass urine.
- it is used to control wind and when "holding on" with the bowels.
- it has an important sexual function, helping to increase sexual satisfaction both for the woman and her partner during sexual intercourse.
How to do pelvic floor muscle exercises
Tighten the muscles around your back passage, vagina and front passage and lift up and squeeze inside as if trying to stop passing wind and urine at the same time. You need to concentrate on using the correct muscles, so don't squeeze your legs together or tighten your buttocks. However, many people find they tighten their lower stomach muscles at the same time, so if you hollow your lower stomach at the same time, that is OK -- the muscles are helping one another.
Try holding them as long and as strong as you can. Rest for 4 seconds and then repeat the contraction as many times as you can up to a maximum of 10 contractions. Gradually increase the time that you can hold each contraction, aiming for 10 second holds.
Try doing these exercises in a slow and controlled way with a rest of 4 seconds between each muscle contraction. Practise your maximum number of held contractions (up to 10) about three or four times each day.
It is important to be able to work these muscles quickly to help them react to sudden stresses from coughing, laughing or exercise that put pressure on the bladder. So you need to practise some quick contractions, drawing in the pelvic floor and holding for just one second before releasing the muscles. Do these in a steady manner: aim for a strong muscle tightening with each contraction up to a maximum of 10 times.
Aim to do one set of slow contractions (exercise 1) followed by one set of quick contractions (exercise 2) three or four times each day.
Get into the habit!
Get into the habit of doing the exercises. Link doing them to some everyday activities; for example, do them after emptying your bladder or whenever you turn on a tap. Or keep a simple exercise diary to help you remember. Practise the exercises when you are lying, sitting and especially standing. It is also important to get into the habit of tightening your pelvic floor muscles before and during activities that are likely to make you leak, such as getting up from a chair, coughing, sneezing or lifting.
How long should I do them for?
Pelvic floor muscle exercises should give optimum results with regular exercise within 3 to 6 months, but you should continue them at least once a day for life to safeguard against problems recurring.
It is strongly recommended to seek help from a health professional, if there is little or no change in the symptoms after trying these exercises on your own for three months.
These are small weights which can be used by women to help with their pelvic floor exercises. The idea is to place an appropriate weight cone in the vagina and use the pelvic floor muscles to hold it there. By using it for 15-20 minutes at a time while walking around at home you will give your pelvic floor muscles some good exercise.
Vaginal weighted cones can be ineffective if they are not in the right position. They will not work if you have anything more than a minor degree of prolapse. Some women find that the cone either slips out of the vagina almost immediately, no matter how good the pelvic floor muscles are, or else stays lodged in the vagina with no muscle work required to keep it in place. In fact, the evidence seems to suggest that using cones does not add any benefit, if you are doing your pelvic floor muscle exercises properly, but they may help you to do the exercises correctly and many women say they have been useful.
Overall it is recommended that you talk to your nurse or physiotherapist before you try to use weighted cones. The nurse/physiotherapist can instruct you in their proper use and make sure you are doing the exercises correctly.
Biofeedback techniques includes anything that increases a woman’s knowledge of her own body by sight, touch, sound etc. It can help as a motivator, give incentive and make pelvic floor muscle exercises more interesting. This is usually used along with pelvic floor exercises for symptoms of stress incontinence and/or overactive bladder.
- a mirror can be used to see if there is any inwards movement of the perineum (the area between the vagina and back passage) when you contract your pelvic floor muscles. If you see any bulging, stop and seek further help from a specialist nurse/physiotherapist, as you may be doing something that could cause problems.
- a sexual partner can give feedback.
- vaginal cones may be used as described above.
- the use of more sophisticated machinery using pressure and other types of equipment. This is usually used as an adjunct to pelvic floor exercises for symptoms of stress and/or urge incontinence to show how your pelvic floor muscles are working - and hopefully improving. The most sophisticated type of biofeedback needs to be used under the supervision of a specialised practitioner, usually a specialist physiotherapist or specialist nurse. It is not directly beneficial in itself, but it does help you (if you need help) to do your pelvic floor exercises properly.