kegel or pelvic muscle exercises

by Diane K. Newman, RNC, MSN, CRNP, FAAN

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 incontinence.

Age and an accompanying decrease in physical activity can decrease fast twitch muscle fibers which are part of the pelvic floor causing incontinence, urgency and frequency. The pelvic floor surrounds the prostate in men and surgery of the prostate can damage this muscle group causing stress 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 incontinence. The premise for Kegel's exercises was that women need to first gain awareness of the function of the pelvic muscles.

Weakness in pelvic muscles 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 muscle weakness through rehabilitation of pelvic muscles is helpful in both fecal and urinary incontinence where lack of pelvic support is a causative factor. This 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 exercises. Today success is seen in 80% of persons practicing these exercises.

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

Identifying your pelvic muscle

What Is The Pelvic Muscle?

Your pelvic 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.

Finding The Pelvic Muscle

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 pass 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.

Exercise Regimen

One exercise consists of both "tightening and relaxing" the muscle. 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. There are 2 type of muscle contraction you will need to practice - Short ( 2 second) Quick contractions and long (3 or 5 or 10 second) contractions. To do the quick muscle contractions, contract or tighten your pelvic muscle quickly and hard, and immediately relax it. For the long or sustained contractions which tightening your pelvic muscle and holding 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- These exercises can be practiced anywhere and anytime. You should do the 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 stretchedout in front and crossed at the ankles.
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.
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.

Times to use the Muscle

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 additional exercises per day with focus on doing all the exercises in that position only.

Common Mistakes

Concentrate and tighten 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 They Be Harmful?

No, these 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 I See a change?

After 4 to 6 weeks of daily exercise, 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.