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How to do pelvic floor exercises

by Diane K. Newman, DNP, FAAN, BCB-PMD

Pelvic floor exercises or Kegels as part of a pelvic muscle rehabilitation program can benefit both men and women.

How to do pelvic floor exercises correctly

Kegel exercises for men may help in the recovery of urinary continence after prostate cancer surgery. Kegels often help women to achieve continence after childbirth. In either case, they must be done correctly to help at all.

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Kegel exercises involve improving the urethral resistance (increasing support to the urethra) and urinary control through active exercise of the pubococcygeus muscle. Weakness of the pelvic floor in woman can be caused by childbirth where descent of the pelvis causes pudendal nerve neuropathy (decreased sensation and function of nerve endings) and stress urinary incontinence.

Age and an accompanying decrease in physical activity can decrease fast twitch muscle fibers which are part of the pelvic floor causing urinary incontinence, urgency and frequency. The pelvic floor surrounds the prostate in men and surgery of the prostate can damage this muscle group causing stress urinary incontinence.

To counter these effects, Dr. Arnold Kegel, a gynecologist, advocated in the 1940's for teaching women of childbearing years how to do these exercises. He reported 86% success rate with young, as well as elderly, women with stress urinary incontinence. The premise for Kegel's exercises was that women need to first gain awareness of the function of the pelvic muscles.

Weakness in the pelvic floor can lead to problems with both bladder and rectal support. Urinary continence is difficult to maintain without the strength and support of the pelvic muscle. Correcting pelvic floor weakness through rehabilitation of pelvic muscles is helpful in both fecal and urinary incontinence where lack of pelvic support is a causative factor. The pelvic floor muscle consists of a mixture of slow and fast twitch muscle cells controlled by the pudendal nerve. An increase in the tone of the pelvic floor muscles is said to provide support to the bladder and there may be a decrease in frequency and urgency following pelvic floor exercises. Today success is seen in 80% of persons practicing these exercises.

Many women were taught how to do Kegel exercises in the past and felt they were not effective. Such women were taught incorrectly. The key to learning the exercises is in the proper identification of the muscle.

What is the pelvic floor muscle?

The Bathroom KeyYour pelvic floor muscle provides support to your bladder, and rectum and, in women, the vagina and the uterus. If it weakens, it cannot support these organs and also their position changes. This change in position can cause problems with normal function. Keeping the muscle strong can prevent urine from leaking from your bladder.

How to find the pelvic muscle for Kegels

Without tensing the muscles of your leg, buttocks or abdomen, imagine that you are trying to control the passing of gas or pinching off a stool. Or imagine you are in an elevator full of people and you feel the urge to pas gas. What do you do? You tighten or pull in the ring of muscle around your rectum - your pelvic muscle. You should feel a lifting sensation in the area around the vagina or a pulling in of your rectum.

Pelvic exercise regimen

One Kegel exercise consists of both "tightening and relaxing". It is equally important to control when your muscle tightens and relaxes. Therefore, you should relax for the same amount of time you tighten. Be sure to relax completely between each muscle tightening. Tighten your pelvic muscle and hold for a count of 3 seconds, then relax the muscle completely for a count of 3 seconds. Over time you will increase tightening the muscle to 5 - 10 seconds and even longer.

Where to practice pelvic muscle exercises

You can practice pelvic exercises anywhere and anytime. You should do pelvic muscle exercises in these positions:

  • Sitting.
    Sit upright in a firm seat and straight-back chair, knees slightly apart, feet flat on the floor or legs stretched out in front and crossed at the ankles.
     
  • Lying Down.
    Lie on your back, flat or with your head on a pillow, knees bent and feet slightly apart. It is helpful to support your knees with a pillow.
     
  • Standing.
    Stand by a chair, knees slightly bent with feet shoulder width apart and toes slightly pointed outward. You can also lean on the kitchen counter with your hips flexed.

When to use the pelvic floor muscle

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If you experience urine loss in one specific position only, like when you stand, then follow these steps:

  • Increase the number of exercises for that position only, or
  • Add an additional set of exercises per day with the focus on doing all the exercises in that position only.

Common mistakes in doing Kegel exercises

  • Concentrate and tighten (lift) only the pelvic floor muscle. DO NOT tighten leg muscles (thighs), buttocks or abdomen. If you feel your stomach move, then you are also using these muscles.
  • DO NOT hold your breath. Breathe normally and/or count out loud.

Can pelvic exercises be harmful?

No, Kegel exercises cannot harm you in any way. You should find them easy and relaxing. If you get back pain or stomach pain after you exercise, you are probably trying too hard and using your stomach muscles. If you experience headaches, then you are also tensing your chest muscles and probably holding your breath.

When will a change be seen?

After 4 to 6 weeks of daily Kegel exercises, you will begin to notice less urine leakage. Make the exercises part of your daily lifestyle. Tighten the muscle when you walk, as you stand up, and on the way to the bathroom.

Exercise your pelvic muscles during activities of daily living

In addition to doing your sets of pelvic muscle exercises, you should start doing your exercises during activities of daily living (activities you do on a daily basis).

  1. Any activity that increases pressure in your abdomen may cause you to lose urine. Examples of such activities are: coughing, sneezing, laughing, bending/lifting, carrying objects, sitting down, standing up, going up/down stairs. During these activities, pressure is placed on the bladder, forcing it to empty.

    • To prevent urine loss, tighten your pelvic muscles just before these activities.

    • For short activities like a cough, tighten your muscles until you finish, then relax.

    • For prolonged activities, tighten during the most stressful moments, or tighten them on and off during the entire activity.

    • Contract your pelvic muscle prior to rising and keep muscles contracted till you are in an upright position. 
       
  2. Do your exercises when:

    • standing at the sink and brushing your teeth
    • washing dishes
    • putting on your make-up
    • sitting in the car at a stop light
    • sitting and having dinner
    • reading a book in bed
    • going for a walk
    • talking on the phone 
       
  3. Try to always tighten your pelvic muscle when you get a strong urge that you cannot control. 

  4. Tighten your pelvic muscle on the way to the bathroom.

  5. Do both types of Kegel exercises, short and long holds, during your activities of daily living. You do not have to keep a formal count of the number of times you do each exercise—just do it several times in a row. Do them often enough to make them a habit.

Remember, the more Kegel exercising you do:

  • the stronger your pelvic muscles will get
  • the faster they will get stronger
  • the easier it will be to maintain muscle strength

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Posted April 2003
Updated March 2013

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