Kegel Exercises Health Article

Definition

Kegel exercises (Kegels) are exercises designed to strengthen the muscles of the lower pelvic girdle, or pelvic floor—the pubococcygeal (PC) muscles. The PC muscles support the bladder, urethra, and urethral sphincter—the muscle group at the neck of the bladder that acts as a spigot for controlling urine flow into the urethra—and the vagina, uterus, and rectum. Anything that puts pressure on the abdomen can weaken or damage these pelvic muscles. Such conditions include pregnancy, childbirth, excess weight, hormonal changes, and aging. Kegel exercises enable the PC muscles to better withstand increases in intra-abdominal pressure (pressure inside the abdomen). They make the bladder, urethra, and vagina more resilient, and improve bladder control and sexual relations.

Thirteen to 20 million American women suffer from urinary incontinence, primarily stress urinary incontinence (SUI)—urine leakage while laughing, coughing, sneezing, standing up suddenly, or exercising. SUI occurs when intra-abdominal pressure increases and the urethral sphincter opens inappropriately. During pregnancy, the fetus puts pressure on the bladder and the sphincter may relax and leak. Postpartum incontinence may result from muscle and nerve damage during childbirth due to delivery of a large baby, prolonged labor, excessive pushing, a forceps delivery, or an episiotomy (an incision made during delivery to prevent tearing of maternal tissue). About 40% of American women suffer from incontinence after childbirth, and the incidence increases by about 12% following each birth. Childbirth also increases the risk for incontinence later in life. During menopause, as a result of lower levels of estrogen, women with SUI may have thinning of the lining of the outer urethra, a sensation of having to urinate often, and recurrent urinary tract infections (UTIs). Beginning Kegels in midlife can help prevent urinary incontinence later.

Origins

In the 1930s, Dr. Joshua W. Davies hypothesized that strengthening the PC muscles could improve bladder control by assisting the closure of the urethral sphincter. By 1948, Dr. Arnold M. Kegel, a Los Angeles-area obstetrician and gynecologist, was having his patients practice vaginal contractions in preparation for childbirth. That same year he invented the Kegel perineometer, or pelvic-muscle sensor, to help prevent urinary incontinence (leakage) following childbirth.

Kegel's perineometer was the first biofeedback machine designed for clinical use. Employing a vaginal sensor, an air-pressure balloon, and a tire gauge, it enabled patients to verify that they were performing Kegel's correctly and to monitor their progress. The patients continued their practice at home. Kegel published numerous papers on his work and claimed to have cured incontinence in 93% of 3,000 patients. He produced a documentary movie to teach the procedure to other physicians. However, his perineometer was never marketed effectively and there was a widespread misconception that Kegels could not be performed without it. In the 1970s, more sensitive electromyography (EMG) perineometers became available for those with severely debilitated pelvic muscles.

Benefits

Kegel exercises strengthen the PC muscles and increase blood flow and nerve supply to the pelvic region, promoting or resulting in:

• increased pelvic support
• restoration of vaginal muscle tone and improved vaginal health
• protection from the physical stresses of childbirth
• restoration of sexual function and improved sexual response and pleasure
• increased vaginal-wall thickness and lubrication after menopause (cessation of menstruation)
• prevention or reversal of urinary leakage and rectal incontinence
• relief from pelvic pain or pain of vulvar vestibulitis (inflammation of the vaginal opening)

Locating the PC muscles

The PC muscles can be felt by:

• stopping and starting urine flow to identify the forward PCs
• squeezing the vagina to identify the back of the PCs
• squeezing around two fingers placed in the vagina
• imagining sucking a marble up the vagina
• preventing a bowel movement or the passing of gas by tightening the muscles around the anus

There is a pulling sensation when the correct muscles are contracted. Weaker and stronger contractions are practiced until the PC muscles can be squeezed at will.