Pelvic Floor Exercises: the What, the Why, and the How.

By Dr Shari Maletsky-Smith

Pregnancy and delivery can negatively affect pelvic floor muscle strength causing symptoms of urinary incontinence.  The prevalence has been noted to be at least 1/3 of all postpartum women in the first three months after delivery, significantly higher after vaginal delivery compared to cesarean section.[i] 

Pelvic floor muscle weakness causes bladder-neck and urethral mobility, leading to urethral sphincter incompetence. When a pregnant woman coughs, sneezes, or laughs, her intra-abdominal pressure increases, and this pressure is then transmitted to the bladder. When pressure inside the bladder is greater than urethral closure pressure, combined with weakness of the urethral sphincter, stress urinary incontinence is the result.[ii] 

Pelvic floor muscle exercises (PFEs) practiced during pregnancy and the postpartum period may increase pelvic floor muscle strength and have been shown to prevent deterioration of urinary symptoms and quality of life during and after pregnancy.

What are pelvic floor exercises (PFEs) or “Kegels”?

Kegel exercises aim to strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. The series of exercises are meant to strengthen muscles known as the levator ani, a group of three muscles that form a hammock or sling at the base of the pelvis connecting the pubic bone, the tail bone and the two ischial tuberosities.

Why are they called “Kegels”?

Dr. Arnold Kegel (1894-1981) was a gynecologist who noted that women’s pelvic floor muscles were weakened by childbirth. Dr. Kegel observed how PFEs affected thousands of women to thereby demonstrate that the pelvic floor muscles could be exercised – just like any other muscle in the body.

After 18 years of research, he published ‘A Nonsurgical Method of Increasing the Tone of Sphincters and their Supporting Structures’ in 1942. The paper noted that diligent patients usually began to notice symptomatic relief from urinary incontinence after 2 to 4 weeks of performing these exercises.[iii]

Why should I take the time to do PFEs?

Strengthening pelvic floor muscles before and after delivery has been shown to decrease the risk of postpartum urinary incontinence[iv] and continuing to do Kegel exercises regularly after giving birth also improves the muscle tone of your vagina, potentially making sex more enjoyable.

How to perform Kegel exercises:

It has been shown that pelvic floor muscle training is most effective when an experienced clinician teaches patients how to perform the exercises properly. But often there is a lack of resources to appropriately teach patients these exercises, given there is no standardized treatment regimen identified.  So here are the basics for in-home training:

Target the precise muscles. To identify your pelvic floor muscles, try and stop urination midstream. If you are able to stop the flow of urine, then you have isolated the correct muscles.  In the future, you shouldn’t perform these exercises during urination – this is just a test to help you identify the correct muscles.

Perfect your technique. Tighten those same muscles, hold the contraction for about five seconds, and then relax. Do it 4-5 times in one sitting. Work up to keeping the muscles contracted for about 10 seconds each time, with 10 seconds between contractions. 

Focus. For best results, focus on tightening only the pelvic floor muscles. Be careful not to flex other muscles in your abdomen, thighs, or gluts. Avoid holding your breath and instead, breathe freely during the exercises.

Repeat. Your goal is to complete at least three sets of ten daily for maximum benefits.[v]

 

The information contained in this article is provided for informational purposes only, and should not be used as a substitute for the advice of your physician or licensed health care provider. You should consult your physician or licensed health care provider before engaging in any exercise activity described in this article to determine if it is right for your needs.

 

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[i] Thom DH1, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010 Dec;89(12):1511-22.

[ii] Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. International Urogynecology Journal. 2013;24(6):901-912.

[iii] https://www.intimina.com/blog/dr-kegel/.  Accessed May 8, 2017.

[iv] Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction.  J Obstet Gynaecol Can. 2003 Jun;25(6):487-98.

[v] http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283.  Kegel exercises: A how-to guide for women.  Accessed May 8, 2017.