Kegel exercise

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Kegel exercise
Kegel exercises diagram.png
Kegel exercises diagram
PronunciationKegel: /ˈkeɪɡəl,kiː-/
Other namespelvic muscles exercise

Kegel exercise, also known as pelvic floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many times a day, for several minutes at a time but takes one to three months to begin to have an effect. [1]

Contents

Kegel exercises aim to strengthen the pelvic floor muscles. [2] These muscles have many functions within the human body. In women, they are responsible for holding up the bladder, preventing urinary stress incontinence (especially after childbirth), vaginal and uterine prolapse. [3] [4] In men, these muscles are responsible for urinary continence, fecal continence, and ejaculation. [5] [4] Several tools exist to help with these exercises, although various studies debate the relative effectiveness of different tools versus traditional exercises. [6]

The American gynecologist Arnold Kegel first published a description of such exercises in 1948.[ citation needed ]

Mechanism of action

Kegel exercises aim to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Kegel is a popular[ quantify ] prescribed exercise for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and childbirth. Various advisors recommend Kegel exercises for treating vaginal prolapse [7] and preventing uterine prolapse [8] in women and for treating prostate pain[ citation needed ] and swelling resulting from benign prostatic hyperplasia (BPH) and prostatitis in men. Kegel exercises may have benefits in treating urinary incontinence in both men and women. [9] Kegel exercises may also increase sexual gratification, allowing women to complete pompoir and aiding men in reducing premature ejaculation. [5] The many actions performed by Kegel muscles include holding in urine and avoiding defecation. Reproducing this type of muscle action can strengthen the Kegel muscles. The action of slowing or stopping the flow of urine may be used as a test of the correct pelvic-floor exercise technique. [10] [11]

The components of levator ani (the pelvic diaphragm), namely pubococcygeus, puborectalis and iliococcygeus, contract and relax as one muscle. [12] Hence pelvic-floor exercises involve the entire levator ani rather than pubococcygeus alone. Pelvic floor exercises may help in cases of fecal incontinence and in pelvic organ prolapse conditions e.g. rectal prolapse. [13]

Health effects

Women

Factors such as pregnancy, childbirth, aging, and being overweight often weaken the pelvic muscles. [14] This can be assessed by either digital examination of vaginal pressure or using a Kegel perineometer. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases. [15]

The symptoms of prolapse and its severity can be decreased with pelvic floor exercises. [16] [11] Effectiveness can be improved with feedback on how to do the exercises. [17]

Men

Kegel exercises can train the perineal muscles by increasing the oxygen supply and the strength of those muscles. [18] The names of the perineal muscles are: ischiocavernosus (erection), bulbocavernosus (ejaculation), external sphincter of the anus, striated urethral sphincter, transverse perineal, levator of the prostate, and puborectalis. [19]

Premature ejaculation is defined as when male ejaculation occurs after less than one minute of penetration. [20] The perineal muscles are involved in ejaculation when they are involuntarily contracted. [18] The ischiocavernosus muscle is responsible for male erection, and the bulbocavernosus muscle is responsible for ejaculation. By actively contracting the perineal muscles with Kegel exercises regularly, strength and control of these muscles increase, possibly aiding in the avoidance of premature ejaculation. [18] [21]

Urinary incontinence

Pelvic floor exercises (muscle training) can be included in conservative treatment approaches for women with urinary incontinence. [22] There is tentative evidence that biofeedback may give added benefit when used with pelvic floor muscle training (PFMT). [23] There is no clear evidence that teaching pelvic floor exercises alters the risk of stress urinary incontinence in men that develop this condition post prostatectomy. [24]

In pregnant women, antenatal PFMT probably helps prevent urinary continence during pregnancy and up to six months after giving birth but for pregnant women who already have incontinence, it is not clear if antenatal PFMT helps to reduce symptoms. [19]

Fecal incontinence

In pregnancy, it is not yet clear if antenatal PFMT helps to prevent or treat fecal incontinence. [19]

Pelvic toning devices

Some devices, marketed to women, are for exercising the pelvic floor muscles and to improve the muscle tone of the pubococcygeal or vaginal muscle.

As of 2013 there was no evidence that doing pelvic floor exercise with weights worked better than doing Kegel exercises without weights; there is greater risk with weights, because a foreign object is introduced into the vagina. [25] [6]

Marketing

During the latter part of the 20th century, a number of medical and pseudo-medical devices were marketed to consumers as improving sexual performance or orgasms, increasing "energy", "balancing hormones", and as having other health or lifestyle benefits. There is no evidence for any of these claims, and many of them are pseudoscience. [26] [27]

See also

Related Research Articles

<span class="mw-page-title-main">Urinary incontinence</span> Uncontrolled leakage of urine

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

<span class="mw-page-title-main">Fecal incontinence</span> Inability to refrain from defecation

Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery, altered bowel habits. An estimated 2.2% of community-dwelling adults are affected. However, reported prevalence figures vary. A prevalence of 8.39% among non-institutionalized U.S adults between 2005 and 2010 has been reported, and among institutionalized elders figures come close to 50%.

<span class="mw-page-title-main">Levator ani</span> Broad, thin muscle group, situated on either side of the pelvis

The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.

<span class="mw-page-title-main">Vaginismus</span> Involuntary muscle spasm that interferes with vaginal penetration

Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often it begins when vaginal intercourse is first attempted.

<span class="mw-page-title-main">Episiotomy</span> Surgical incision of the perineum and the posterior vaginal wall

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

Arnold Henry Kegel was an American gynecologist who invented the Kegel perineometer and Kegel exercises as non-surgical treatment of urinary incontinence from perineal muscle weakness and/or laxity. Today pelvic floor exercises are widely held as first-line treatment for urinary stress incontinence and any type of female incontinence and female genital prolapse, with evidence supporting its use from systematic reviews of randomized trials in the Cochrane Library amongst others. Kegel first published his ideas in 1948. He was Assistant Professor of Gynecology at the Keck School of Medicine of USC.

<span class="mw-page-title-main">Perineal massage</span> Massage of a pregnant womans perineum prior to childbirth

Antenatal perineal massage (APM) or Birth Canal Widening (BCW) is the / massage of a pregnant woman's perineum – the skin and deep tissues around the opening to the vagina or, performed in the 4 to 6 weeks before childbirth, i.e., 34 weeks or sooner and continued weekly until birth. The practice aims to gently mimic the 'massaging' action of a baby's head on the opening to the birth canal (vagina) prior to birth, so works with nature, to achieve the 10 cm diameter opening without using the back of baby's head, i.e., doing some of the hard work of labour (birth) before the start of labour, making birth less stressful on the baby and mother. The intention is also to attempt to: eliminate the need for an episiotomy during an instrument delivery; to prevent tearing of the perineum during birth and in this way avoid infection, helping to keep antibiotics working into the future. This technique uses Plastic Surgeons 'skin tissue expansion' principle, to aid a natural birth.

<span class="mw-page-title-main">Pelvic floor</span> Anatomical structure

The pelvic floor or pelvic diaphragm is an anatomical location in the human body, which has an important role in urinary and anal continence, sexual function and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and smooth, ligaments and fascia. and separates between the pelvic cavity from above, and the perineum from below. It is formed by the levator ani muscle and coccygeus muscle, and associated connective tissue.

<span class="mw-page-title-main">Rectocele</span> Bulging of the rectum into the vaginal wall

In gynecology, a rectocele or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele.

<span class="mw-page-title-main">Pelvic floor dysfunction</span> Medical condition

Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects women, up to 16 percent of men are affected as well. Symptoms can include pelvic pain, pressure, pain during sex, urinary incontinence (UI), overactive bladder, bowel incontinence, incomplete emptying of feces, constipation, myofascial pelvic pain and pelvic organ prolapse. When pelvic organ prolapse occurs, there may be visible organ protrusion or a lump felt in the vagina or anus. Research carried out in the UK has shown that symptoms can restrict everyday life for women. However, many people found it difficult to talk about it and to seek care, as they experienced embarrassment and stigma.

<span class="mw-page-title-main">Pelvic organ prolapse</span> Descent of the pelvic organs from their normal positions

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.

<span class="mw-page-title-main">Stress incontinence</span> Form of urinary incontinence from an inadequate closure of the bladder

Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

<span class="mw-page-title-main">Perineometer</span> Instrument for measuring the strength of voluntary contractions of pelvic floor muscles

A Kegel perineometer or vaginal manometer is an instrument for measuring the strength of voluntary contractions of the pelvic floor muscles. Arnold Kegel (1894–1972) was the gynecologist who invented the Kegel perineometer and Kegel exercises. This followed the observation that muscles of the pelvic floor inevitably weakened following the trauma of childbirth. Ascertaining the air pressure inside the vagina by insertion of a perineometer, while requesting the woman to squeeze as hard as possible, indicates whether or not she would benefit from strengthening the vaginal muscles using the Kegel exercises. More modern electromyograph (EMG) perineometers, which measure electrical activity in the pelvic floor muscles, may be more effective in this purpose. Assessment of pelvic floor strength during gynaecological examination may help to identify women with fascial defects of the pelvic floor, as well as those at risk of genital prolapse or urinary incontinence. Both the Kegel perineometer and a digital examination are effective and concordant in their results in this assessment.

<span class="mw-page-title-main">Perineal tear</span> Medical condition

A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury. Tears vary widely in severity. The majority are superficial and may require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction. A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery. Episiotomy, a very rapid birth, or large fetal size can lead to more severe tears which may require surgical intervention.

Descending perineum syndrome refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. The syndrome was first described in 1966 by Parks et al.

<span class="mw-page-title-main">Vaginal support structures</span> Structures that maintain the position of the vagina within the pelvic cavity

The vaginal support structures are those muscles, bones, ligaments, tendons, membranes and fascia, of the pelvic floor that maintain the position of the vagina within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to pelvic organ prolapse. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and urinary retention.

Pelvic floor physical therapy (PFPT) is a specialty area within physical therapy focusing on the rehabilitation of muscles in the pelvic floor after injury or dysfunction. It can be used to address issues such as muscle weakness or tightness post childbirth, dyspareunia, vaginismus, vulvodynia, constipation, fecal or urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Licensed physical therapists with specialized pelvic floor physical therapy training address dysfunction in individuals across the gender and sex spectra, though PFPT is often associated with women's health for its heavy focus on addressing issues of pelvic trauma after childbirth.

References

  1. ↑ "Pelvic floor muscle training exercises". MedlinePlus. 10 October 2018. Archived from the original on 28 July 2016. Retrieved 14 May 2020.
  2. ↑ "Pelvic floor muscle training exercises: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 2016-07-28. Retrieved 2019-02-26. Pelvic floor muscle training exercises are a series of exercises designed to strengthen the muscles of the pelvic floor.
  3. ↑ "Kegel Exercises | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 2018-04-22. Retrieved 2017-12-02.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  4. 1 2 "Pelvic floor muscle training exercises: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 2016-07-28. Retrieved 2017-12-02.
  5. 1 2 La Pera, G; Nicastro, A (1996). "A new treatment for premature ejaculation: the rehabilitation of the pelvic floor". Journal of Sex & Marital Therapy. 22 (1): 22–6. doi:10.1080/00926239608405302. PMID   8699493.
  6. 1 2 "A randomised controlled trial of the PelvicToner Device in female stress urinary incontinence". BJUI.org. Archived from the original on 2011-09-27. Retrieved 2011-09-02.
  7. ↑ September 2, 2011 (2011-02-09). "Vaginal Prolapse". eMedicineHealth. Archived from the original on 2006-07-21. Retrieved 2011-09-02.{{cite web}}: CS1 maint: numeric names: authors list (link)
  8. ↑ "MedlinePlus Medical Encyclopedia: Uterine prolapse". Nlm.nih.gov. 2011-08-29. Archived from the original on 2001-08-20. Retrieved 2011-09-02.
  9. ↑ "MedlinePlus Medical Encyclopedia: Kegel exercises". Nlm.nih.gov. 2011-08-29. Archived from the original on 2001-06-17. Retrieved 2011-09-02.
  10. ↑ Kenway, M., and Goh, J. (2009). Inside Out: The Essential Women's Guide to Pelvic Support.
  11. 1 2 "Cystocele (Prolapsed Bladder) | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 2017-10-04. Retrieved 2017-12-02.
  12. ↑ Gowda, Supreeth N.; Bordoni, Bruno (2022). "Anatomy, Abdomen and Pelvis, Levator Ani Muscle". StatPearls. StatPearls Publishing. PMID   32310538. Archived from the original on 9 November 2022. Retrieved 11 May 2022.
  13. ↑ Bø, K (2006). "Can pelvic floor muscle training prevent and treat pelvic organ prolapse?". Acta Obstet Gynecol Scand. 85 (3): 263–8. doi: 10.1080/00016340500486800 . PMID   16553172. S2CID   221452341.
  14. ↑ Services, Department of Health & Human. "Pelvic floor". Archived from the original on 2018-02-22. Retrieved 2018-02-21.
  15. ↑ Mentor, Physio (2022-10-15). "Kegel Exercises – Pelvic Floor Muscles Strengthening". Physiomentor. Archived from the original on 2022-10-15. Retrieved 2022-10-16.
  16. ↑ Hagen S, Stark D (2011). "Conservative prevention and management of pelvic organ prolapse in women". Cochrane Database Syst Rev. 12 (12): CD003882. doi:10.1002/14651858.CD003882.pub4. PMID   22161382.
  17. ↑ Herderschee, R; Hay-Smith, EJ; Herbison, GP; Roovers, JP; Heineman, MJ (6 July 2011). "Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women". The Cochrane Database of Systematic Reviews (7): CD009252. doi:10.1002/14651858.CD009252. PMID   21735442.
  18. 1 2 3 Puppo, Vincenzo; Puppo, Giulia (January 2016). "Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease: Anatomy and Physiology of Ejaculation". Clinical Anatomy. 29 (1): 111–119. doi:10.1002/ca.22655. PMID   26457680. S2CID   9213013.
  19. 1 2 3 Woodley, SJ; Lawrenson, P; Boyle, R; Cody, JD; Mørkved, S; Kernohan, A; Hay-Smith, EJC (6 May 2020). "Pelvic floor muscle training for preventing and treating urinary and fecal incontinence in antenatal and postnatal women". The Cochrane Database of Systematic Reviews. 5 (3): CD007471. doi:10.1002/14651858.CD007471.pub4. PMC   7203602 . PMID   32378735.
  20. ↑ Goldstein, Sam; Naglieri, Jack A., eds. (2011). Encyclopedia of child behavior and development. [New York]: Springer. ISBN   9780387790619. OCLC   704395400.
  21. ↑ Puppo, V.; Abdulcadir, J.; Mannucci, A.; Catania, L.; Abdulcadir, D. (April 2008). "T09-P-13 The importance of the Kegel exercises for the erection of the male and female erectile organs (male and female penis)". Sexologies. 17: S136. doi:10.1016/s1158-1360(08)72894-9. ISSN   1158-1360.
  22. ↑ Dumoulin, Chantale; Cacciari, Licia P.; Hay-Smith, E. Jean C. (2018-10-04). "Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women". The Cochrane Database of Systematic Reviews. 2018 (10): CD005654. doi:10.1002/14651858.CD005654.pub4. ISSN   1469-493X. PMC   6516955 . PMID   30288727.
  23. ↑ Herderschee R, Hay-Smith EJ, Herbison GP, Roovers JP, Heineman MJ (6 July 2011). "Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women". The Cochrane Database of Systematic Reviews (7): CD009252. doi:10.1002/14651858.CD009252. PMID   21735442.
  24. ↑ Anderson, Coral A.; Omar, Muhammad Imran; Campbell, Susan E.; Hunter, Kathleen F.; Cody, June D.; Glazener, Cathryn M. A. (2015-01-20). "Conservative management for postprostatectomy urinary incontinence". The Cochrane Database of Systematic Reviews. 1 (1): CD001843. doi:10.1002/14651858.CD001843.pub5. hdl:2164/6141. ISSN   1469-493X. PMC   7025637 . PMID   25602133.
  25. ↑ Herbison, GP; Dean, N (8 July 2013). "Weighted vaginal cones for urinary incontinence". The Cochrane Database of Systematic Reviews. 2013 (7): CD002114. doi:10.1002/14651858.CD002114.pub2. PMC   7086390 . PMID   23836411.
  26. ↑ Tuteur, Amy (18 December 2008). "Vaginal weight lifting". The Skeptical OB. Archived from the original on 8 November 2022. Retrieved 1 June 2018.
  27. ↑ "No, Gwyneth Paltrow, women should not put jade eggs in their vaginas, gynecologist says". Washington Post. Archived from the original on 12 February 2021. Retrieved 6 February 2017.
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