Kegels 101

The aim of Kegel exercises is to fortify muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Kegel is a popular prescribed exercise for urinary incontinence and for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and vaginal childbirth. Kegels exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women; and for treating prostate pain and swelling resulting from benign prostatic hyperplasia (BPH) and prostatitis in both men and women. Kegel exercises are also known as pelvic floor exercises, or simply Kegels.

Benefits Factors such as pregnancy, childbirth, aging & being overweight, abdominal surgery such as cesarean section, often result in the weakening of the pelvic muscles. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases.

Urinary incontinence The consequences of weakened pelvic floor muscles may include urinary or bowel incontinence, which may be helped by therapeutic strengthening of these muscles for women with stress, urge, or mixed, urinary incontinence or simple urinary dribble.

Pelvic prolapse The exercises are also often used to help prevent prolapse of pelvic organs.

What do the pelvic floor muscles do?

When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as:

• Incontinence (the involuntary loss of urine or faeces)
• Prolapse (lack of support) of the bladder, uterus and bowel.

The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’until an appropriate time and place.

What causes pelvic floor muscle weakness?

Some of the common causes of pelvic floor muscle weakness are:

• Childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
• Being overweight
• Constipation (excessive straining to empty your bowel)
• Persistent heavy lifting
• Excessive coughing – causing repetitive straining
• Changes in hormonal levels at menopause
• Growing older

How do I strengthen my pelvic floor muscles?

It is recommended that all women exercise their pelvic floor muscles regularly throughout life, to prevent or correct weakness. Exercising weak muscles regularly, over a period of time can strengthen them and make them work effectively again. Regular gentle exercise, such as walking can also have a positive effect on the strength of your pelvic floor muscles.

Exercise 1 (for strength)

Step 1: Sit, stand tall or lie on you back with your knees bent and legs comfortably apart.

Step 2: Close your eyes imagine what muscles you would tighten to stop yourself from passing urine. If you can’t feel a distinct tightening of these muscles, ask for some help from a physiotherapist. She will help you to get started.

Step 3: Now that you can feel your pelvic floor muscles working, tighten them around your front passage, vagina
and back passage as strongly as possible and hold for three to five seconds. By doing this, you should feel your pelvic floor muscles ‘lift up’ inside you and feel a definite ‘let go’ as the muscles relax. If you can hold longer (but no more than a maximum of eight seconds), then do so. Remember, the squeeze must stay strong and you should feel a  definite ‘let go’. Repeat up to ten times or until you feel your pelvic floor muscles fatigue. Rest for a few seconds in between each squeeze. Steps one to three, count as one exercise set. If you can, do three sets per day in different
positions.

Exercise 2 : (quick squeeze for power)

Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction, just squeeze and let go. Rest for a few seconds in between each squeeze. Repeat this 10 to 20 times or until you feel your pelvic floor muscles fatigue.

If you can, do these exercises set one to three times per day.

During both exercises you should: Feel your pelvic floor muscles ‘lift up’ inside you, rather than feel a downward movement Relax your thighs and buttocks Keep breathing normally Stop exercising if your muscles fatigue.

What can I do to prevent damage? To prevent damage to your pelvic floor muscles, avoid:

• Constipation and/or straining with a bowel motion
• Persistent heavy lifting
• Repetitive coughing and straining
• Putting on too much weight

Make training part of your life by tightening your pelvic floor muscles every time you cough, sneeze or lift doing some regular exercise, such as walking. Progress your exercises by doing them during the day in different positions e.g. standing, sitting or on your hands and knees. For many women, it is important to follow a specific exercise program tailored to their individual needs. If you are unsure of whether you are exercising your pelvic floor muscles correctly or you have urinary problems, you should make an appointment with the Fortis Hospital’s Physiotherapy Department.