By: Kim Osier, PT, DPT
Cathy Konkler, PT
For years, health care practitioners have been prescribing the Kegel exercise as a first treatment for patients suffering from pelvic floor muscle weakness. The Kegel exercise was developed by Arnold Kegel, an American obstetrician/gynecologist. It was a method for women to exercise the pelvic floor musculature, to help treat and prevent urinary incontinence. Unfortunately, pelvic floor muscle exercise instruction in the past has commonly consisted of a handout or a quick mention during a patient’s doctor visit.
Indeed, many people do not understand that proper and thorough Kegel instruction is just as, if not more, important than the mention of the Kegel exercise alone. It is not uncommon to see women who have been verbally instructed in the Kegel exercise, but have no idea of how to properly do it. Because they have not been successful, their compliance with the prescribed exercise is low. It is also common to see women who report doing 100 or more repetitions of the Kegel daily with no results, and who therefore have stopped exercising. Both individuals have one thing in common. Ignorance of how to properly perform a Kegel exercise has led to ineffective results in strengthening the pelvic floor muscles. The increased confusion has led to frustration and a feeling of helplessness.
A Kegel exercise, if done incorrectly, is often ineffective in changing symptoms of incontinence. Following is a list of common mistakes:
- Isolation of the pelvic floor musculature is important. Because many people are unaware of where the pelvic muscles are located, and how they work, muscle substitution is common. Women who are instructed to “hold back gas” often squeeze their buttocks, thighs, or use their abdominal muscles to assist. This substitution and inappropriate muscle use leads to decreased activation of the pelvic floor musculature. In a sense, when muscle substitution is present, the pelvic floor muscles are merely “going along for the ride” rather than being in the drivers seat. Depending on the amount of substitution, the pelvic floor muscles will be strengthened very little.
- Quality is often more important than quantity. Some individuals are instructed to perform up to 100 Kegels a day for effective results. This large, often time consuming number of repetitions leads to decreased compliance. Even 20 Kegel repetitions, done correctly, can have a more dramatic effect than 100 or more repetitions done poorly.
- When given instruction in the Kegel exercise, there is usually no distinction between “hold” Kegels and “quick” Kegels. Women often perform many repetitions per day, contracting only for a few seconds at a time. For Kegel exercises to be most effective, the muscle must be challenged. Because the muscle has both fast and slow twitch fibers, exercises that involve both types of muscle fibers should be included in the exercise program. Perhaps the most important is the “hold” Kegel, which challenges the endurance of the pelvic floor muscle. To work the slow twitch fibers, the contraction must be held at least 5 seconds. The fast twitch fibers fatigue after 5 seconds, and the slow twitch fibers are left. In individuals who are unable to hold for 5 seconds, the goal is to build up to at least a 5 second hold, with a 10 second hold being optimum.
Lastly, most women are not instructed in functional use of the pelvic floor muscles. Often the pelvic floor muscle contraction is not practiced during functional activities like lifting, coughing, sneezing, and exercising. These activities increase intra-abdominal pressure, which often causes urine leakage. If these activities are not practiced with a Kegel exercise, often is it too difficult when the increase in intra-abdominal pressure happens suddenly, to quickly contract the pelvic floor. If the Kegel is practiced during increases in abdominal pressure, it is easier for the woman to contract the pelvic floor muscles during sudden increases in intra-abdominal pressure.
Conservative methods of treating urinary incontinence or pelvic floor muscle weakness are usually preferred to more invasive methods as a first intervention. Even if more invasive techniques are needed, teaching correct use of the pelvic floor muscles will only enhance surgical results. Physical therapy can be effective in teaching correct use of the pelvic floor, as well as abdominal strengthening and control of intra-abdominal pressures. The skills of the physical therapist in assessing and teaching correct muscle use can be especially helpful as part of the comprehensive treatment of pelvic floor muscle weakness or incontinence.
*Please feel free to comment with any questions or comments below.
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