Kegel Exercise

Kegel, or pelvic muscle exercises are done to strengthen the muscles that support
the bladder, urethra and vagina. Often the pelvic floor muscles are weak which
contributes to problems with losing urine. Learning how to “activate” or contract these
muscles properly can help prevent urine loss from occurring. It takes time and effort to
strengthen these muscles. This means that it may take several weeks to months before
you will see an improvement.

How to Identify the Correct Muscles
To find the muscles you need to exercise, place your index finger into your vagina
and try to lift your finger upward with the muscles of your vagina. Alternatively,
imagine that you have a tampon in your vagina that is falling out and you must tighten
you muscles in order to hold it in.
Do not be discouraged if you do not feel a strong lift at first. We want to first
make sure you are doing the exercises correctly. Your muscles will become stronger as
you do more exercises. Remember, it is very important that you never use your stomach,
legs or buttocks muscles or hold your breath when you contract your muscles. The most
common mistake is using too many muscles.

Doing the Exercise
Pelvic exercises can be done in many different ways. We will give you instructions on
how to do two types of exercises.
1. LIFT the pelvic floor muscles and hold for a count of 5 seconds. Then relax for a
count of 10 seconds. This is called a holding contraction. Repeat this lift five times
hourly during your waking hours.
2. Next, activate the pelvic muscles and hold for 1 to 2 seconds in an on and off
sequence three times. This is called a flick contraction. Perform these types of
exercises after you have finished performing the holding contractions.
3. Do not be discouraged if you cannot hold the lift for more than a few seconds at a
time initially or if your efforts is very weak. This is quite typical. This muscle is not
one that we regularly use, so be patient with yourself. With practice, your ability to
hold a contraction will improve.
4. Start by practicing these exercises lying down. Maintain normal breathing at all
times. When you feel more comfortable with them, you can do them in a sitting andeventually a standing position.
5. If your muscles get tired during your initial practice sessions, continue to do the
holding contraction for 5 seconds and do three contractions at a time. Gradually, as
you gain endurance, you will be able to do this five times an hour.
6. You should also perform a pelvic muscle contraction during sneezing, coughing,
lifting or bending to help prevent urine leakage. Start the contraction immediately
prior to exertion, and hold it steady throughout the exertion. Although you may not
be able to prevent urine loss completely, you may greatly reduce the amount of
leakage.
7. If you feel a strong urge to empty your bladder, relax and begin contracting slowly –
do a holding contraction for 5 seconds, relax for 5 seconds and repeat 4 more times.
Your first few efforts may increase the urge momentarily, but eventually it will
decrease the urge. Then, if you need to empty your bladder, walk calmly at a normal
pace to the bathroom.

Pelvic floor exercises, or Kegels, strengthen the muscles of the pelvic floor.
These muscles contract and relax to help control the opening and closing of the
bladder. There are two types of muscle fibers in the pelvic floor. The “fast” twitch
muscles help to prevent leakage of urine with coughing, sneezing or laughing. The
“slow” twitch fibers help to keep the sphincter or valve closed at the end of your
urethra or the opening to the outside of your body. You need to exercise both of
these muscle groups to control urinary leakage.
The pelvic floor muscles create a type of “hammock” that supports the
pelvic organs, such as the bladder and uterus. If the “hammock” is weak, the
support is not there and leakage of urine may result when there is pressure put on
the bladder. This increased pressure can occur suddenly with coughing, sneezing,
laughing or exercising. By strengthening this muscle group, the “hammock” is
stronger and the bladder does not descend and leak urine with the increased
pressure.
Pelvic floor exercises must be done every day to maintain effectiveness. If
you stop, the muscles will weaken again, much the same as if you stop exercising
any muscle in your body. Often, patients will not see much improvement for 3 to 4
months so you need to be faithful to doing the exercises and patient!
These exercises are easy to do once you learn them properly. In fact, you
can do these exercises anywhere and no one will know that you are doing them!
So, do the exercises when driving the car, in line at the store or stopped at red
lights. Develop a routine that you will be able to stick with. Soon the exercises
will become second nature and you will be able to contract the muscles as a reflex
whenever a “stress” occurs such as sneezing, coughing or laughing, lifting or
bending.

Begin by locating the muscles to be exercised:
1. As you begin urinating, try to stop the flow of urine. This small
upward, lifting inward movement is the pelvic floor muscle. Do not
exercise these muscles by stopping and starting urination. Only
do this to help identify the muscle.
Another way of identifying the muscle is to imagine that you are in a
room full of friends at a party and feel like you are going to pass gas.
Try squeezing the anus/rectal area as if trying not to pass gas.
This should create a feeling of upward and inward motion as above.
You should not bear down while exercising these muscles. Also you
should not be holding your breath. Your buttocks, abdomen and leg
muscles should not be moving. If you are doing any of these, you are
probably trying too hard and not exercising the correct muscle, If
you continue to have problems, contact us at (334-262-4418).
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Helpful Tips:
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In the beginning, your muscles may be weak arid you may not be able to
hold the contractions for longer than 2-4 seconds. It takes a lot of time to
build up this endurance. For example, if you have never run a race before,
you certainly would not be able to run the Boston Marathon! The same
applies here; your pelvic floor muscles need time to build up endurance
and strength.
You need to relax the muscles for twice the amount of time that you
contract them. For example, if you contract the muscles for 3 seconds,
relax them for 6 seconds. This is one set. You should do as many sets as
you can until you cannot maintain the contraction for the amount of time
set aside. This means that your muscles are getting tired. Please rest at this
point. You should then add two to this number and try that amount the next
time you exercise, Over-exercising the muscle when it is tired does not
help you at all and may cause some discomfort.

These exercises cannot harm you in any way. Most people find them relaxing and easy. If you get back pain or
stomach pain after you exercise, you are probably trying too hard and using stomach or back muscles. If you have
headaches, you are also tensing your chest muscles and probably holding your breath.

Most people prefer exercising lying down on the bed or sitting in a chair. However, you should be able to do them
in any position. To avoid urine leakage, tighten the muscle:
• Before you walk.
• Before you sneeze.
• On the way to the bathroom.
• During urination.
• When you stand up.

Exercise these muscles throughout the day, not just when you urinate. Do five to ten exercises at least five times a day.
Tighten the pelvic muscle and hold for five to ten seconds; then relax the muscle completely for ten seconds. The muscle
may start to tire. If this happens, stop and resume exercising later.