HOW DO PELVIC MUSCLES GET WEAK?
The function of pelvic muscles is to help regulate the flow of urine. Subsequently, weak pelvic muscles can contribute to urinary leakage. For women, pregnancy, childbirth and being overweight can help weaken these muscles. For men, prostate surgery may also weaken pelvic muscles. Fortunately, pelvic muscles, like other muscles in the body, can be strengthened by doing specific exercises.
WHAT ARE KEGEL EXERCISES?
A "Kegel" is a pelvic floor exercise, named after Dr. Arnold Kegel, an American gynecologist. Dr. Kegel developed this exercise as a method for controlling incontinence in women following childbirth. These exercises are now recommended for women with stress urinary incontinence, 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?
"Kegeling" provides many benefits:
Conditioned pelvic muscles may make childbirth easier, and the perineum is more likely to remain intact (fewer tears and episiotomies)
Sexual enjoyment can be enhanced for both partners
It can prevent prolapses of pelvic organs
It can help prevent leaking urine when you sneeze or cough (stress incontinence)
HOW TO PERFORM KEGEL EXERCISES
- 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.
- Tighten the pelvic floor muscles and hold for a count of 10.
- Relax the same muscles for a count of 10.
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.
PELVIC MUSCLE EXERCISES TO IMPROVE BLADDER CONTROL AFTER PROSTATE SURGERY
It is recommended that you start doing Kegel exercises six-eight weeks prior to surgery.
Begin by locating the muscles to be exercised:
- 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.
- 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.
HOW OFTEN SHOULD I DO THE EXERCISES?
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. These exercises can be performed standing, sitting, or lying down.
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.
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.
Some people feel that they can speed up their 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.