Kegel's Exercise : Females

Original Editor - Venus Pagare

Top Contributors - Venus Pagare, Abbey Wright, Laura Ritchie, Lauren Kwant and Evan Thomas

Introduction

Kegel's exercises, also known as pelvic floor exercises, are named after Dr. Arnold Kegel. [1] He developed a form of exercise to strengthen the pelvic floor muscles.

Dr. Kegel originally proposed his exercise regime in 1948 as an alternative to surgery, which he believed to be inefficient and sometimes unnecessary.

This page is going to look solely at Kegel's theory and terminology, but further information on pelvic floor training can be found on Pelvic floor dysfunction and incontinence. It is important to note that a specialist pelvic floor physiotherapist can advise on the suitability (or otherwise) of Kegel exercises for a particular pelvic floor dysfunction as not all dysfunctions are a result of pelvic floor weakness.

Description

Kegal exercises involve the isometric contraction of the pelvic floor muscles. This can be described as the sensation of stopping urination mid-flow, ideally contracting from back to front. The exercises are necessary to help produce sufficient strength, co-ordination and endurance to deal with life post-partum and the effects of ageing.[2]

[3]

Kegel's Three Steps

Dr.Kegel, in his practice, stated that there were three steps to his method:

  1. "The first step is external observation, with the patient in the lithotomy position (supine with legs in stirrups)."- Kegel first observed the patient's ability to visibly draw up the perineal structures.
  2. "The second step is vaginal examination, performed gently with one finger." - The digital exam served a double purpose: first, it enabled the physician to assess the development of the puboccocygeus muscle at various depths, and second, it enabled the physician to verify that the patient was able to identify the correct muscle and contract it. Thus identification of the muscle, and not its exercise, was the purpose of Kegel's digital exam.
  3. The third stage follows quickly: "after [only] 5 to 10 correct contractions the Perineometer is inserted, and both physician and patient watch the manometer to note the results of her efforts". - In several articles, the insertion of the Perineometer biofeedback device marks the beginning of the third and primary step in Dr. Kegel's exercise program.
It is important to observe that Dr.Kegel defined his exercises "operationally", rather than "formally". That is, rather than specify "how to do the exercises", he specified what would be measured if they were done correctly with his device in place. He invented and used the world's first biofeedback instrument, the perineometer to objectively assess pelvic muscle strength, both in the office and in daily at-home use by the patient.
Kegel's Exercise Diagram

Three steps to an effective Kegel:

  • Learn to tighten the muscles around the vaginal/anal area
  • Contract the vaginal and rectal muscles. Note that when you perform steps 1 and 2 correctly, you should also feel the muscles around the anus tighten slightly. This is normal, but do not consciously try to tighten those muscles.
  • In a quiet, relaxed setting with no distractions, practice your Kegels and determine how long you can hold your contraction and how many you can do before becoming fatigued. Do not do more than 5-10 reps at time with a 3-5 second hold.

Amount of Exercise Prescribed

  • Dr.Kegel routinely prescribed a therapeutic regimen of a full hour a day of practice with his Perineometer device in the vagina.
  • Nowhere does he mention the duration of a single contraction, but he states that "twenty minutes, three times a day, or for a total of 300 contractions daily".
  • In his drawings of "pressure over time" he sketches symmetrical sine waves, and he remarks that in the final, healthy stage contractions become "prolonged", so by simple arithmetic he envisioned six-second contractions.
  • To improve pelvic floor muscle strength the general priniciples of muscle strengthening need to be applied: overload, specificity and reversibility[2].

Benefits

  • Can prevent urinary and faecal incontinence during or post partum[4]
  • Enhanced sexual function
  • Reduce pelvic related pain[5]
  • Conditioned muscles to make childbirth easier
  • Decrease and/or prevent prolapse of pelvic organs[6]
  • Improve the ability of defecation

Presentations

http://www.youtube.com/watch?v=w08iCzxnQBUKegel or not.png
Pelvic Physiotherapy - to Kegel or Not?

This presentation was created by Carolyn Vandyken, a physiotherapist who specializes in the treatment of male and female pelvic dysfunction. She also provides education and mentorship to physiotherapists who are similarly interested in treating these dysfunctions. In the presentation, Carolyn reviews pelvic anatomy, the history of Kegel exercises and what the evidence tells us about when Kegels are and aren't appropriate for our patients.

View the presentation

References

  1. Kegel A. Stress Incontinence and Genital Relaxation: A non-surgical Method of Increasing the Tone of Sphincters and Supporting Structures. CIBA Symposium, 1952, p. 35.
  2. 2.0 2.1 Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women. Canadian Urological Association Journal. 2010 Dec;4(6):419.
  3. The Rotherham NHS Foundation Trust. Pelvic floor muscle exercises: How to do them. Available from: https://www.youtube.com/watch?v=b3LaDSWBJW0 [Last accessed 11.07.2017]
  4. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay‐Smith EJ. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane Library. 2017 Jan 1.
  5. Rosenbaum TY, Owens A. Continuing medical education: the role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). The Journal of Sexual Medicine. 2008 Mar 1;5(3):513-23.
  6. Burgio KL. Pelvic floor muscle training for pelvic organ prolapse. The Lancet. 2014 Mar 1;383(9919):760-2.