Pelvic floor exercises (PFEs)

Alternative names
Pelvic muscle strengthening exercises; Kegel exercises

Definition
Kegel exercises are a series of pelvic muscle exercises designed to strengthen the muscles of the pelvic floor.

Information

Kegel exercises were originally developed by Dr. Arnold Kegel in 1948 as a method of controlling incontinence in women following childbirth. These exercises are now recommended for women with urinary stress incontinence, some men who have urinary incontinence after prostate surgery, and people who have fecal (stool) incontinence.

The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor, thereby improving the urethral and rectal sphincter function. The success of Kegel exercises depends on proper technique and adherence to a regular exercise program.

Some people have difficulty identifying and isolating the muscles of the pelvic floor. Care must be taken to learn to contract the correct muscles. Typically, most people contract the abdominal or thigh muscles, while not even working the pelvic floor muscles. These incorrect contractions may even worsen pelvic floor tone and incontinence.

Several techniques help the incontinent person identify the correct muscles. One approach is to sit on the toilet and start to urinate. Try to stop the flow of urine midstream by contracting your pelvic floor muscles. Repeat this action several times until you become familiar with the feel of contracting the correct group of muscles. Do not contract your abdominal, thigh, or buttocks muscles while performing the exercise.

Another approach to help you identify the correct muscle group is to insert a finger into the vagina (in women), or rectum (in men). Try to tighten the muscles around your finger as if holding back urine. The abdominal and thigh muscles should remain relaxed.

A woman may also strengthen these muscles by using a vaginal cone, which is a weighted device that is inserted into the vagina. She then tries to contract the pelvic floor muscles in an effort to hold the device the place.

For those people who are unsure if they are performing the procedure correctly, biofeedback and electrical stimulation may be used to help identify the correct muscle group to work.

Biofeedback is a method of positive reinforcement. Electrodes are placed on the abdomen and along the anal area. Some therapists place a sensor in the vagina in women or anus in men, to monitor contraction of the pelvic floor muscles.

A monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help identify the correct muscles for performing Kegel exercises.

Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy may be performed in the clinic or at home.

Treatment sessions usually last 20 minutes and may be performed every 1 to 4 days. Some clinical studies have shown promising results in treating stress and urge incontinence with electrical stimulation.

PERFORMING PELVIC FLOOR EXERCISES:
1. Begin by emptying your bladder.
2. Tighten the pelvic floor muscles and hold for a count of 10.
3. Relax the muscle completely for a count of 10.
4. Perform 10 exercises, three times a day (morning, afternoon, and night).

These exercises can be performed any time and any place. Most people prefer to perform the exercises while lying down or sitting in a chair. After 4 to 6 weeks, most people notice some improvement. It may take as long as 3 months to see a significant change.

A word of caution: some people feel that they can speed up the progress by increasing the number of repetitions and the frequency of exercises. However, this over-exercising may instead cause muscle fatigue and increase leakage of urine.

If you feel any discomfort in your abdomen or back while performing these exercises, you are probably performing them incorrectly. Some people have a tendency to hold their breath or tighten their chest while trying to contract the pelvic floor muscles. Relax and concentrate on contracting just the pelvic floor muscles.

When properly performed, Kegel exercises have been shown to be 50-80% effective in improving urinary continence.

The Help for Incontinent People Organization offers an audio cassette tape and booklet to help coach you in performing Kegel exercise properly. To order this information write to:

HIP PME
P.O. Box 544
Union, SC 29379

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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