Kegel Exercises

For many years I too had advised that the proper way to perform Kegel exercises was to activate those pelvic floor muscles that would allow the patient to stop and then start the urinary stream. A dear colleague and world renowned urogynecologist, Dr. Jack Robertson, set me straight with instructing patients the proper way to perform Kegel exercises.

1) Imagine that rather abruptly you are experiencing a strong need to either pass gas or have a bowel movement; however the rest room is occupied and you will have to wait a few minutes. What do you do to avoid an accidental stool loss??? As you tighten the muscles in your pelvic diaphragm that will prevent that loss of gas/stool, and hold it, imagine that NOW you perceive a strong desire to void urine...

2) BUT the restroom is still occupied!! OOPS.. you now have to hold tight both these muscle groups (stool and urine). Do this for 10 seconds, then relax for 10 seconds. Repeat 10 times in a row, ( rectal then vaginal). This is called a set. Perform 3 sets a day for at least 6 weeks.

Properly performed, and diligently performed, there are studies indicating as much as a 75% reduction in the need for surgery for stress incontinence, after 6 weeks. The beauty about Kegel Exercises is that one needs no special equipment, there are no training fees, and you can do them anywhere!! Sometimes the patient may not 'know' how to activate these unused muscles so during a pelvic exam your doctor can help focus you on the muscles needed during that examination, by asking you to tighten here (rectally) and then here (vaginally). I am always amazed that with careful coaching and instruction, a patient may begin the attempts and not be able to contract any muscle to any significant degree, but by digitally helping her identify this muscle group or that she most often make the proper neuromuscular connection very quickly. I would add that some patients cannot make the neuromuscular connection in the pelvic diaphragm, and for these folks biofeedback or vaginal cones may be of benefit.

Kegel exercises are really worthwhile doing IMHO.

J. Glenn Bradley, MD
OBGYN.net Editorial Advisor

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