Pelvic Floor Exercises - Kegel Exercises

DOWNLOAD HANDOUT ON PELVIC FLOOR MUSCLE/KEGEL EXERCISES

 

Introduction

 

Pelvic floor training is often used to strengthen but also relax the pelvic floor. "Uptraining" or strengthening is used for patients with bladder overactivity, prolapse and incontinence. "Downtraining" or pelvic floor relaxation is used for pelvic floor pain, spasms or problems with urinary retention or emptying.

 

The information listed below involves details for STRENGTHENING or uptraining for the pelvic floor.

 

The pelvis is essentially a bowl comprised of 2 components:

  1. Pelvic bones - essentially a ring.
  2. Muscle - this forms the bottom of the bowl and is suspended from the bony ring. Note that these muscles are distinct from the muscles of the abdominal wall or the buttocks.

 

The pelvic floor has 2 functions:

  1. The pelvic floor is important in supporting the structures in the abdomen and pelvis. All of the structures below the chest/diaphragm are supported by the pelvic floor. This amounts to a significant amount of strain on the pelvic floor. Things such as straining, coughing, sneezing, pregnancy and excessive weight all place more stress on the pelvic floor.
  2. Openings withing the pelvic floor are necessary to allow for defecation, urination, sexual and reproductive function. The floor must allow for exit and entry when needed.

 

These 2 functions are often times at odds with one another and a proper balance between being 'closed' and 'open' is required for optimal function. There are many things which can weaken the pelvic floor and compromise both of those functions - especially in terms of failing to support the pelvic structures and inability to remain 'closed' - both of which present as prolapse or leakage (of urine or stool). In women, childbirth and age are the primary causes of weakness. In males, surgery, especially on the prostate, are major causes.

 

Pelvic floor exercises can help strengthen the muscle component of the pelvic floor and improve symptoms related to weaknes.

 

Benefits of Pelvic Floor Exercises

  • Help improve or maintain control of bladder and bowel function.
  • Improve or maintain strength and tone of pelvic floor muscles which support pelvic organs against gravity.
  • Help recover urinary control in men after prostate cancer surgery.

 

Key Points

  • Tighten only pelvic floor muscles.  Do not use abdominal, buttock or inner thigh muscles.
  • Breathe during exercises.
  • Choose a comfortable place and quiet time of day to perform these eg. lying in bed in the morning and evening.

Performing the Excercises

  • Find the right muscles: To contract the pelvic floor muscles, squeeze the same muscles you would use to cut off your urinary stream or prevent passing gas. You should not, however, perform the exercises by trying to stop your stream - use this technique only to identify the muscles.  If you are doing it correctly you will feel your genitals "drawing up and in". Women can place a finger in the vagina and try to squeeze the surrounding muscles.
  • Perfect your technique: Like any exercise, it takes time and repetition for things to get better. It may take 3 or more months of regular exercise. Over-exercising can lead to fatigue. Try to do "10-10-3-3"
    • 10 sets of contractions
    • 10 seconds holding alternating with 10 seconds relaxing 
    • 3 sets, 3 times a day
    • 3 months minimum trial
  • Problems? If you are still having trouble, we have a nurse continence advisor available for instruction - at no charge.
  • See the behavioral therapy for bladder page on how to modify these exercises to prevent urinary urgency and frequency - the "quick flick" technique.

Common Pitfalls

  • Do not hold your breath and bear down.  This strains the pelvic floor and pushes out and down instead of drawing up and in.  This does not contract or strengthen the pelvic floor muscles.
  • Remeber that it will take time to strengthen these muscles, just as it does for other muscles in the body.  Be patient and diligent.
  • Ensure that you are doing the right exercises for you - uptraining or strengthening is appropriate for some patients but other require relaxation techniques with downtraining. Please consult with your urologist, nurse continence advisor or pelvic floor physio to identify the techniques that are appropriate for your problem.

Resources

Soul Physiotherapy & Pelvic Floor Health - an excellent resource for specialized physiotherapy in Richmond

Dayan Physiotherapy and Pelvic Floor Clinic - an excellent resource for specialized physiotherapy in Vancouver