Pelvic Floor Exercise to Prevent and Treat Incontinence
WHICH MUSCLES CONTROL MY BLADDER?
The muscles that control the bladder are the "pelvic floor muscles" that attach 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.
The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor, thereby improving the urethral sphincter function. The success of Kegel exercises depends on proper technique and adherence to a regular exercise program.
Stronger muscles can help prevent incontinence or dramatically improve leakage for many women.
Even if performing Kegels regularly does not completely resolve your leaking, it will make any other
treatments that much more effective.
HOW DO I DO THEM?
Kegels can be performed anywhere at anytime and in any position, sitting, lying down or standing.
There are two types of muscle fibers that make up the urinary sphincter:
Slow twitch fibers and Fast twitch fibers. Each type is strengthened differently.
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.
PERFORMING PELVIC FLOOR EXERCISES:
Strengthening the "Slow Twitch Fibers" :
1. Begin by emptying your bladder. Remember, do not contract your abdominal, thigh, or buttocks muscles while performing the exercise.
2. Relax you body from head to toe. Concentrate on and isolate the pelvic floor muscles.
2. Tighten the pelvic muscles and hold for a count of 10.
3. Relax the muscles completely for a count of 10.
4. Perform 10 of these contraction exercises, three times a day.
Strengthening the "Fast Twitch Fibers":
Strengthening the faster firing fibers requires a faster contraction exercise.
Here you squeeze and relax in rapid succession 5 to 10 times in a row, taking a 10 second break in between.
Do this in 10 rep blocks 3 times a day.
These exercises can be performed any time and any place. They will work the muscle more if you do the exercises with your knees apart. After 4 to 6 weeks, most people notice some improvement. It may take as long as 3 months to see a significant change.
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.
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!
Do them at the same times everyday and be consistent.
Use a trigger like an alarm on your phone to remember to do them.
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 perineal area. Some therapists place a sensor in the vagina in women, 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 vaginally placed device. 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.