Pelvic Floor Exercises (Kegel)
The pelvic floor muscles lie at the base of the pelvis and are an integral part of support to the pelvic floor.
One does not usually think about the pelvic floor muscles unless you are pregnant, have had a baby or present with symptoms such as urinary incontinence, faecal incontinence, vaginal prolapse or rectal prolapse.
Perhaps you have read or have been told by your health professional to ‘just do your pelvic floor muscle exercises’? Perhaps you have tried to do pelvic floor muscle exercises after googling how to but you are not sure if you are doing them correctly or feel that they don’t work! Perhaps you are male and did not realise that pelvic floor muscles are important for you too!
Kegel Exercises
Pelvic floor muscle exercises and kegel exercises are essentially referring to the same thing. Dr Arnold Kegel (1894-1972) was an American gynaecologist who invented a device for measuring the strength of a pelvic floor muscle contraction.
How do the pelvic floor muscles support the pelvic floor?
The pelvic floor muscles, the connective tissue of the pelvis and associated nerves provide the following:
Structural support at rest: what level the pelvic floor rests when not contracting or squeezing
Active support: how strong they contract – squeeze and lift
Structural support on straining or bearing down: what level the pelvic floor descends to
When these three components of the pelvic floor are working well, this helps to:
Support the pelvic organs from underneath: rectum, vagina, bladder, uterus (female) or rectum, prostate, bladder (male)
Aid continence – bladder and bowel.
Aid emptying – bladder and bowel.
Assist in sexual response.
Assist in pelvic stability: they work with the deep abdominal and back muscles to support your pelvis, and spine.
What is the correct way to do pelvic floor muscle exercises?
To answer this question, it is helpful to understand that there are two main groups of pelvic floor muscles; the superficial or perineal muscles and the deep muscles sometimes called the levator muscles. The superficial muscles squeeze around the openings and the deep muscles lift up and forwards. The combination of squeeze and lift:
Tension the connective tissue between pelvic organs,
Compress the openings.
The net result? Pelvic organ support and continence.
Depending on what description is used to contract or tighten the pelvic floor muscles will depend on how effective the overall contraction is. For example, a common phrase to contract your pelvic floor muscles is to imagine you are stopping urine flow. However, this has the effect of contracting more the superficial muscles and not the deep pelvic floor muscles. This may have benefit in some cases such as for men post-prostatectomy but it is not optimising the whole function of the pelvic floor muscles and in most cases, all of the pelvic floor muscles need to be working well. In general, to contract your pelvic floor muscles, you need to think of squeezing around the openings and lifting from the back passage up towards the pubic bone in the front.
What affects good pelvic floor muscle function?
The ability to have good pelvic floor muscle function relies on:
Intact pelvic floor muscles. Sometimes the muscles are stretched or torn from childbirth or trauma.
Intact nerve supply. If nerves to the muscles have been stretched or torn from childbirth or trauma, the muscles cannot contract properly.
Correct breathing technique. Some people struggle to breathe in to their diaphragms (tummy) and instead breathe in to the upper chest or hold their breath. This can affect how well the pelvic floor muscles function.
Good coordination between the pelvic floor muscles and abdominal muscles. A common mistake with contracting the pelvic floor muscles, is to pull your navel in strongly or lift up under your ribs. The net result is minimal lift with the pelvic floor muscles or bearing down in to the pelvic floor.
Normal resting tone. This refers to what a muscle feels like. Sometimes a muscle is overactive or hypertonic meaning that if feels firm or is too tight. This affects how well a muscle can contract and relax. In these cases, the pelvic floor muscles need help to stretch and relax before they can function properly.
How do you know that pelvic floor muscle exercises are working for you?
If you have been doing pelvic floor muscle exercises from guidelines given from a health professional or from the internet, you should start to notice improvement in your symptoms over 6-12 weeks of regular exercising.
For example:
If you leaked with coughing or sneezing before, now you can control leakage by contracting your pelvic floor muscles first.
If you leaked faecal matter as you rushed to the toilet or after passing a bowel motion before, now you have control getting to the toilet and have no further faecal smearing afterwards.
If you had symptoms of vaginal bulging or dragging from a prolapse before, now it feels comfortable.
Perhaps you have made some improvement or no improvement at all. The reasons for this may be:
Incorrect technique when contracting your pelvic floor muscles,
You need a specific exercise programme to suit your physical needs,
There are other factors that are contributing to your symptoms.
If you are still struggling with symptoms or are not sure if you are working your pelvic floor muscles correctly, we recommend you see our pelvic floor physiotherapist. Maree will assess you and determine what is right for you. She will give you a specific programme or advice to suit your needs and goals.