Pelvic Muscle (Kegel) Exercises
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:
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.
Helpful Tips:
1.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.
2. 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.
3. It is easier in the beginning to do these exercises lying down. As you become better able to contract/squeeze the pelvic floor muscles, progress to doing the exercises in a sitting position then a standing position. Doing the exercises while standing is important since many times the “stress” situations occur while you are standing (i.e. sneezing, laughing, lifting, or bending over).
4. Plan on exercising the muscles at least 3 times a day, if not more, and about 15 times each session to begin with. Increase the number of contractions from 15 as you get better at the exercises. Make exercising a habit! Do exercises whenever you stop at a red light, answer the telephone, see a commercial on television, take a shower, or walk the dog. By doing these exercises, soon you will be doing them without consciously thinking about it!
5. Make sure you fully relax the pelvic floor between the “squeeze and hold” exercises for the “slow” twitch muscles. If you do not relax the muscles between contractions, they will tire out much quicker.
How Do I Identify My Pelvic Muscles?
To identify your pelvic muscle:
1. While you are urinating, stop the stream of urine.
2. Tighten the muscles that are used to hold back gas when you don’t want to pass it.
How Do I Know I Am Using The Correct Muscles?
Begin by urinating. While the urine stream is flowing, voluntarily stop the stream and count to five; then begin to urinate again. Repeat the steps twice. Never use your stomach, leg, or buttocks muscles. Exercising these muscles will not help you regain urinary control.
To find out if you are also contracting your stomach muscle, place your hand on your abdomen. Squeeze your pelvic muscle. If you feel your abdomen move, you are using the wrong muscles. If you are having trouble identifying these muscles, contact your doctor or nurse.
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 and eventually 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.
When Will I Notice an Improvement?
You may notice a slight decrease in urinary incontinence after about two weeks of consistent, hourly exercise. You will see an even bigger difference within one month, however, it may take up to six months, if your muscles are very weak to begin with. If these exercises work, you will need to continue to practice them indefinitely. The statement “use it, or lose it!” is particularly true with respect to the pelvic muscles and their role in maintaining continence.
These exercises cannot harm you in any way. You may feel some muscle soreness as your body adjusts to this new activity. In time, you will learn to practice these exercises effortlessly. Eventually, they will become a part of you daily activity. Remember, in order to receive and maintain the maximum benefit from these exercises, it is important that you continue to doing them on a daily basis.
How Often Should I Do The Exercises?
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.
Where Should I Do The Exercise?
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.
When Will I Notice A Change?
Do the exercises every day. After six to eight weeks, you will have fewer accidents. You will notice an even bigger difference after three to four months.
Can These Exercises Harm Me?
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.