HOW DO PELVIC MUSCLES GET WEAK?
Pelvic muscles help stop the flow of urine. For women, pregnancy, childbirth and being overweight can weaken muscles. For men, prostate surgery can weaken pelvic muscles. Weak pelvic muscles can cause you to leak urine. Fortunately pelvic muscles are like other muscles-exercises can make them stronger.
WHICH MUSCLES CONTROL MY BLADDER?
The muscles attached to the front, back and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock (puboccocygeus muscle). The other is shaped like a triangle( illiococcygeus muscle). These are the same muscles that you would use to try to stop the flow of urine. They are the muscles you will exercise and strengthen.
WHAT ARE KEGEL EXERCISES?
A kegel is the name of a pelvic floor exercise, named after Dr. Kegel, who in 1948 discovered the exercise as a method of controlling incontinence in women following childbirth. These exercises are now recommended for women with stress urinary 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.
WHY DO I NEED TO DO KEGEL EXERCISES?
Often the pelvic floor muscles are weak which contributes to problems with losing urine. Doing the exercises correctly and regularly can strengthen the muscles. Stronger muscles lead to little or no urine loss for many women and men. It is also risk-free, low cost and painless!
Kegeling provides many benefits:
Conditioned muscles will make birth easier, and your perineum will more likely be intact (fewer tears and episiotomies)
Sexual enjoyment is enhanced for both partners
It can prevent prolapses of pelvic organs
It can help prevent leaking urine when you sneeze or cough
HOW DO I DO THEM?
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.
Over one-third of women and men start out squeezing the wrong muscles. Therefore, it is helpful to work with a doctor or nurse who can teach you the correct technique.
Several techniques help the incontinent person identify the correct muscles.
PERFORMING PELVIC FLOOR EXERCISES
1. Begin by emptying your bladder. 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.
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.
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. When properly performed, Kegel exercises have been shown to be 50-80% effective in improving urinary continence.
FOR MEN WHO HAVE HAD PROSTATE SURGERY
PELVIC MUSCLE EXERCISES TO IMPROVE BLADDER CONTROL
It is recommended that you start doing Kegel exercises six-eight weeks prior to surgery.
Begin by locating the muscles to be exercised:
1. As you begin urinating, try to stop or slow the urine WITHOUT tensing the muscles of your legs, buttocks, or abdomen. This is very important. Using other muscles will defeat the purpose of the exercise.
2. When you are able to stop or slow the stream of urine, you know that you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.
You may squeeze the area of the rectum to tighten the anus as if trying not to pass gas and that will be using the correct muscles.
Remember NOT to tense the abdominal, buttock, or thigh muscles.
Now you are ready to exercise regularly:
1. After you have located the correct muscles, set aside time each day for three to four exercise sessions (morning, midday, and evening).
2. Squeeze your muscles to the slow count of 10. Then, relax the muscle completely to the slow count of 10. The 10 second contraction and the 10 second relations make one "set."
When your pelvic floor muscles are very weak, you should begin by contracting the muscles for only three to five seconds. Begin doing what you can and continue faithfully. In a few weeks, you should be able to increase the amount of time you are able to hold the contraction and the number of exercise sets you are able to do. Your goal is to hold each contraction for ten seconds, to relax for ten seconds, and to complete 25 to 30 sets in each of the three to four exercise sessions per day.
In the beginning, check yourself frequently by looking in the mirror and placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh, or buttock muscles move. If there s movement, continue to experiment until you have isolated just the muscles of the pelvic floor.
If you are unsure that you are contracting the correct muscles, at your next exam, ask your urologist to help you identify the proper muscle contraction.
Your bladder control should begin to improve in three to four weeks. If you keep a record of urine leakage each day, you should begin to notice fewer instances of bladder leakage.
Exercise your pelvic muscles regularly for a lifetime to improve and maintain bladder control.
Pelvic muscle exercises also improve orgasmic function. Whether you are doing pelvic muscle exercise to improve or maintain bladder control or improve orgasmic function, or both, they must be done faithfully. Make them part of your routine.
Use daily activities such as eating meals, watching the news, stopping at traffic lights, and waiting in lines as clues to do a few pelvic muscle exercises
If you are not finding the improvement in control we typically expect over the first 8 weeks you may benefit from bio-feed back or pelvic floor rehabilitation. This is essentially a physical therapist that can act as a personal trainer to work on the muscles you need to regain your urinary control.
HOW OFTEN SHOULD I DO THE EXERCISES?
Be sure you are doing them correctly before you start. We recommend doing the exercises for five minutes twice a day. You should squeeze the muscle for a count of 10 and relax for a count of 10. At first, you may not be able to do the exercises for a whole five minutes or hold the squeeze for a count of 10. With practice it will become easier as the muscles get stronger.
WHEN SHOULD I EXPECT IMPROVEMENT IN MY SYMPTOMS?
It takes from six to twelve weeks for most women to notice a change in urine loss. Remember, if you do the exercises regularly you could cure yourself and avoid surgery!
HOW SHOULD I DO THE EXERCISES?
If you read that these exercises can be done anywhere, anytime - that is not necessarily true. We have studied different ways of doing the exercises to see what works best to decrease urine loss. What we found worked best was five minute sessions done twice or three times a day. So doing them while watching television or wherever you think of it usually will not work as well. Many women report that five minutes before they get up in the morning and five minutes before they sleep is a helpful routine.
IS THERE ANYTHING I SHOULD CHANGE ONCE THE EXERCISES BECOME EASY?
Once the exercises become easy, you can further strengthen the muscles by squeezing to a count of 10 and relaxing to a count of 10. Repeat this for five minutes two times a day. It will also work the muscle more to do the exercises with your knees apart.
HOW LONG DO I HAVE TO DO THE EXERCISES?
Once you have attained your goal, you can do the exercises for five minutes three times a week. If you start having problems again with urine loss, you may need to go back to five minutes two or three times a day.
Listen to music when you do the exercises - this can make it more fun! Keep a calendar and give yourself a check mark or star each time you do the exercises. This will help you keep track of when you started and keep you motivated. If you stop doing the exercises, start again! Just remember it takes regular practice to see results.
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.
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.