Exercises Specifically for the Pelvic Floor
The second exercise, Type 2, is a quick contraction. The muscles are quickly tightened, lifted up, then released. This works the muscles that quickly shut off the flow of urine (like a faucet) to help prevent accidents.
Now, you are ready to begin:
1. Remember, it is important to exercise only the muscles of your pelvic floor (between your pubic bone and tailbone). Do not tense or contract the legs, buttocks, or belly.
2. You should contract the PFM as you blow out, or exhale, then continue to breathe normally as you do the exercises.
3. Remember to relax the body before and after the exercises.
4. In the beginning, it is best to do the exercises lying down so that there is little stress on the muscles. Bend your knees or elevate your legs on a pillow or stool so you are comfortable and your legs are relaxed.
Each of the exercises explained previously can be done with or without assistive devices. If you are using vaginal weights, it is easier for some women to walk around while doing Kegel exercise contractions.
Suggested Exercise Schedule
Most people try to perform too many exercises and sacrifice the quality of the exercises. It is important to remember to stop and rest when you are no longer performing each contraction properly. To improve muscle function you must challenge the muscles to work harder than they are used to. This is done by exercising the muscles on a regular basis. Start with a set of 10 repetitions of each type of exercise, and do them two to three times per day. It is recommended that you try to do a total of 30-80 repetitions per day. Progress at your own pace. The amount of time needed to show improvement varies from person to person. Increase the exercise periods and/or the number of exercise repetitions as you notice improvement.
Remember, you must continue challenging your PFM to see improvement. Your bladder and bowel control can begin to improve in three to four weeks. However, some people take three to six months to see improvement.
Pelvic muscle exercises require a lifetime commitment. Start your day with a set of pelvic muscle exercises. This is especially important if you have chosen to use vaginal weights. It is easiest to use weights in the morning, as later in the day your muscles tend to become tired.
• Always tighten the pelvic muscles before you lift, cough, or sneeze to help hold back the flow of urine. Remember, learn to squeeze before you sneeze.
• Tighten the muscles before you clear your throat or blow your nose.
• You can also use pelvic muscle exercises to help suppress a strong urge to urinate until you can locate an appropriate place to empty your bladder.
• Pelvic muscle exercises should be incorporated into a regular exercise program.
Assisted Pelvic Muscle Exercises
Various devices and techniques have been developed to help you locate, exercise, and rehabilitate the correct pelvic floor muscles. These include biofeedback training, electrical stimulation, and, for women, vaginal weight training.
As well as basic PFM exercises, Dr. Arnold Kegel also pioneered the biofeedback approach to rehabilitate and exercise the pelvic floor muscles. PFM exercises performed with biofeedback equipment has been demonstrated to be a highly effective treatment procedure for incontinence, because it helps to isolate PFM activity and gives an immediate audio or visual indication of successful exercises. Muscle contraction exercises performed without biofeedback assistance sometimes leads to contractions of other muscles, like the abdominals, and may cause undue fatigue and pressure on the bladder.
These different training aids have also been known to add discipline to a Kegel program – helping people to stick with a routine. Talk to your healthcare provider about these and other ways to assist your pelvic muscle strengthening program.
Working With Your Healthcare Provider
Because these muscles are out of sight, they are frequently out of mind and difficult to isolate. If you have any questions or difficulties, be sure to discuss them with your healthcare provider. If you are considering Kegel exercises, it is wise to get proper instructions from a health professional before you invest the time in the program.
In addition to the techniques mentioned previously, bladder retraining, medications, and surgery are also used to treat incontinence. Sometimes a combination of all or some of these therapies is most helpful in managing and improving your incontinence.
Exercises Specifically for the Pelvic Floor
Pelvic muscle exercises are an important part of the behavioral treatment techniques that help increase bladder control and decrease bladder leakage. These techniques require your conscious effort and consistent participation.
Pelvic muscle exercises, also called pelvic floor muscle or Kegel [Kay-gull] exercises – after the Dr. Arnold Kegel, have been shown to improve mild to moderate urge and stress incontinence. When performed correctly, these exercises help to strengthen the muscles at your bladder outlet. Through regular exercise you can build strength and endurance to help improve, regain, or maintain bladder and bowel control.
The muscles of the pelvic floor are located in the base of your pelvis between your pubic bone and tailbone. These muscles have three main functions:
(1) They help support the abdominal and pelvic contents from below,
(2) They are responsible for helping to control bowel and bladder function, and
(3) They are involved in sexual response. Like other muscles in the body, if these muscles get weak they are no longer efficient at doing their job.
How to Find and Recognize the Muscles
As you can see from Diagram 1, it can be difficult to find these pelvic muscles. The pelvic floor muscles (PFM) are the ones you use to hold back gas or to stop a urine stream. For instance, imagine that you need to hold back gas. Squeeze and lift the rectal area, and for women also the vaginal area, without tightening the buttocks or belly (abdomen).
Another technique used only to help you identify the PFM is to attempt to stop or slow the flow of urine. While urinating, partially empty your bladder then try to stop or slow the stream of urine. Remember to relax and completely empty your bladder when you have finished this test. Do not do this start-and-stop test on a regular basis (no more than twice a month). It is not a helpful way to exercise the pelvic floor muscles.
Locating these muscles may also require you to use a mirror or one of the variety of training aids such as biofeedback, muscle electrical stimulation, or for women, vaginal weights.
This informational brochure, based on the proven PFM exercises developed by Dr. Arnold Kegel, is designed to describe a variety of techniques to help you exercise your pelvic muscles.
There are two types of exercises that you should perform to improve continence.
The first exercise, Type 1, works on the holding ability of the muscles (building a strong dam to hold back urine). It is done by slowly tightening, lifting, and drawing in the PFM and holding them to a count of five. At first, you will probably notice that the muscles do not want to stay contracted or tightened very long. You may only be able to hold the contraction for 1-2 seconds. Progress slowly over a period of weeks to a goal of 10-second holds. Rest for 10 seconds between each contraction.
Whether you experience urge incontinence or stress incontinence, Kegel exercises — performed cor-rectly — can offer relief. By strengthening the muscles that hold urine in the bladder, you can either decrease or possibly eliminate incidences of urinary incontinence. The key to Kegal exercises is iden-tifying the pelvic floor muscles and performing the prescribed routine properly.
WHO SHOULD DO MUSCLE TRAINING EXERCISES?
Anyone who experiences either urge inconti-nence (an intense urge to urinate that develops suddenly and makes it difficult to get to the bath-room in time) or stress incontinence (loss of urine during activities that increase intra-abdom-inal pressure like coughing, sneezing or straining) can benefit from Kegel exercises.
HOW DO KEGEL EXERCISES HELP URINARY INCONTINENCE?
Kegel exercises can strengthen the periurethral (in men and women) and perivaginal (in women) muscles that make up the muscles that help you hold urine in your bladder so you can get to the bathroom before urinating. Doing these exercises regularly can decrease the incidences of urinary incontinence you experience, and in a smaller percentage of individuals (10-15 percent) will even totally resolve the incontinence. You need to per-sist with the exercises, however, to continue to benefit from them.
If you have stress incontinence, once you learn the exercise you will be able to contract your pel-vic muscles during sneezing or coughing and de-crease the frequency and quantity of urine loss. It will take at least 4-6 weeks for your muscles to get stronger and for you to see the benefit of these exercises. For individuals who are 65 years of age and older, it may take 8 weeks to see the benefit.
HOW TO DO KEGEL EXERCISES
STEP I: Get to know where your pelvic floor muscles are by trying to stop your urine stream while paying attention to the muscles that do this. Place your hand on your lower abdomen to feel if any tightening occurs. You want to avoid tightening your thigh muscles, your buttocks or your abdomen. Do not hold your breath. You should feel a sensation of closing and lifting in as you squeeze the pelvic floor muscles.
STEP II: Perform muscle-training exercises. Al-though these exercises can be done in any posi-tion, it may be easiest to perform them when lying on your back with your knees bent and feet flat. Squeeze or tighten the pelvic muscles (as if you were stopping the flow of urine or the passage of gas) for 10 seconds. Then relax this muscle for 10 seconds. Repeat this process 25 times. Do a set of 25 contractions twice a day.
If you find that your muscles get tired doing 25, you can do a smaller number of contractions at a time. Try to work up to a total of 50 per day.
Try to use this muscle contraction technique to decrease the passage of urine when you cough or sneeze.
After a 6-8 week period you may cut down to 25 contractions daily to maintain the benefits you have gained (decreased episodes of urinary incontinence).
COMMON MISTAKES WHEN DOING KEGEL EXERCISES
It is important to do the exercises correctly; improper or poor form may make the inconti-nence worse. Common mistakes include contract-ing the stomach muscles, thigh muscles and mus-cles of the buttocks, or holding your breath. Focus on keeping your stomach, buttocks and thigh muscles relaxed. The muscle you want to work on is your pelvic muscle.
Pelvic muscle exercises, also called Kegel (kay-gull) are named after Dr. Arnold Kegel, who developed them to strengthen the pelvic floor muscles. The actual name of the muscles is the “pubococcygeus” muscles. These muscles contract and relax under your command to control the opening and closing of your urethral sphincters, or the muscles that give you urinary control. Through regular exercise, you may be able to build up their strength and endurance to gain better bladder control.
Begin by locating the muscles to be exercised:
1.As you begin urinating, try to stop or slow the urine without tensing the muscles of your legs, buttocks or abdomen. It is very important not to use these muscles because only the pelvic floor muscles help with bladder control.
2.When you are able to slow or stop the stream of urine, you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.
Squeeze in rectal area to tighten anus as if trying not to pass gas. You will be using the correct muscles.
YOU should aim to perform ten sets of each of the following exercises ten times each day:
Set # 1
Quick Contractions (QC) -Tighten and relax the sphincter steadily without a break between (Squeeze-release, Squeeze-release, Squeeze-release, etc.)
Slow Contractions (SC) -Tighten the sphincter and hold for a count of 3, then relax for a count of 3 (Squeeze, 2, 3, Release 2, 3; Squeeze 2, 3, Release 2, 3). Gradually increase the count to 10: squeeze 2,3,4,5,6,7,8,9, 10, release 2,3,4,5…10)
In the beginning, check your self frequently by looking in the mirror or by placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh or buttocks muscles move. It there is movement, continue to experiment until you have isolated just the muscles of the pelvic floor.
Your bladder control should begin to see some improvement in 3 to 6 weeks. Make pelvic exercises apart of your daily routine. Whether you are doing pelvic muscle exercises to improve or maintain bladder control, you must do them regularly, and habitually. Use daily occurrences such as watching 1V, reading stopping at traffic lights and waiting in line at the store as cues to perform a few exercises.
Use the toilet regularly. Make toilet facilities convenient -this may mean a bedside commode, bedpan or urinal placed within reach.
Wear clothes that are easy to remove when it is time to use the toilet.
Train your bladder. Use a clock to schedule times to toilet. Every hour, then every 1-1/2 hours, etc. , until you achieve a satisfactory schedule. Avoid frequent trips to the toilet “just in case.”
Remain at the toilet until you feel your bladder is empty. Do not rush. If you feel there is still some urine in the bladder, move around or stand up if you were sitting, sit back down and lean forward slightly over the knees.
Empty your bladder before you start on a trip of an hour or more. Do not try to wait until you get home or until it’s more convenient.
Learn to squeeze before you sneeze -and before you cough, laugh, get out of a chair, or pick up something heavy.
Establish regular bowel habits. Constipation affects bladder control.
Consider avoiding foods that are known to affect the bladder, such as tomatoes, chocolate, spicy foods and beverages, including alcohol, and those containing caffeine. These make the bladder more irritable and therefore increase the chance of incontinence.
Watch your weight. Obesity makes bladder control more difficult. Ask your regular doctor about a sensible diet if you are overweight.
Stop smoking. Smoking has been listed as a risk factor for bladder cancer, and it is irritating to the bladder. Also, a smoker’s cough may cause bladder leakage.