Pelvic Floor Strengthening Exercises

Introduction:

• It is also referred to as Kegel exercises.

• It was 1st described by Arnold Kegel for pelvic floor muscle strengthening.

Anatomy & physiology of pelvic floor:

• In 1555, Andreas Vesalius composed a record of the pelvic floor muscles, which he named "Musculus sedem attollens".

• This was subsequently supplanted by the more conclusive name of "levator ani" by Von-Behr. 

• The pelvic stomach, first so named by Meyer (1861) included crude flexors and abductors of the caudal piece of the vertebral section. 

• These muscles included coccygeus (likewise alluded to as ischiococcygeus), ileococcygeus and pubococcygeus and these three muscles were felt to comprise the levator ani muscle. 

• They start from the pectinate line of the pubic bone and the belt of the obturator internus muscle and are embedded into the coccyx. 

• Holl (1897), a German anatomist depicted that a portion of the pubococcygeus muscle strands, rather than embedding into the coccyx, circled around the rectum and to these filaments he allocated the name "puborectalis" or "sphincter recti".

• Apparently the puborectalis muscle starts from the center of mediocre pubic rami rather than from the pubic symphysis. 

• The puborectalis muscle is presently remembered for the levator ani muscle bunch and the expression "Levator ani" is utilized equivalently with pelvic stomach muscles.

Who should do Kegel Exercises?

• Kegel exercises are a great tool for many people, whether you’re wanting to reduce symptoms of urinary incontinence or you’re just looking to keep your pelvic floor healthy. 

• Increasing the strength and tone of the pelvic floor can help relieve many symptoms, such as a bladder prolapse, bladder leakage, and urinary urgency.

•  Kegels are often recommended for women or men whose pelvic floor requires better support. 

• Kegel workouts, like any other strength training program, can help to tighten up the muscles and restore their natural role in pelvic organ support and pelvic stability.

• However, it’s important to note that kegel exercises are not for everyone. 

• In fact, some people may even do more harm than good by doing too many Kegels.

• Some pelvic floor disorders are a result of the pelvic floor being too active or tense. 

• When this happens, it makes it hard for the pelvic floor to relax and rest completely. 

• This may lead to the pelvic floor being in a continuous overactive state.

Why is it bad for your pelvic floor to be so active or tense all the time?

• When your pelvic floor is continuously operating in an overactive state, it makes it harder for it to respond when you actually need it to contract, not only because the muscle is already fatigued, but because there is little range for it to contract further. 

• The muscle is already in a shortened state. 

• Therefore, clenching when you sneeze or trying to keep from having an accident when you really have to go may result in leakage because the muscles are less effective in their reaction to the situation.

• In these cases, doing Kegels for strengthening or improving tone is NOT recommended. 

• It’s hard to know if you have a weak pelvic floor, or an overactive pelvic floor without consulting a pelvic floor therapist, which is why it’s always recommended to see one prior to beginning any kegel exercise routine.

Early assessment: 

• It is common to forget about your pelvic floor. 

• Like any injury or illness, the early treatment is best. 

•  There are some signs that your pelvic floor may need to be assessed:

• Leaking urine during laughing, coughing, sneezing or exercising.

• Having the urge to go to the toilet but not making it in time.

• Difficulty emptying your bladder.

• The feeling of ‘heaviness’ or pain in the pelvic floor area.

• Your pelvic floor muscles may be stretched and weakened or too tight. 

• Many things including pregnancy, a long history of back pain, being overweight, heavy lifting, chronic cough or sneeze, prostate surgery and general aging cause pelvic floor problems. 

• If you are experiencing any symptoms or have concerns about your pelvic floor health then getting an assessment is the first thing you should do.

Procedure: 

• Contracting Your Pelvic Floor Muscles

• Focusing on the pelvic floor with more precision

• Relax the muscles of your thighs, buttocks and stomach and keep them relaxed. 

• Squeeze in the muscles around the urethra or front passage as if trying to stop the flow of urine. 

• (For women, also squeeze in the muscles around the vagina and pull them upwards inside the pelvis).

• Squeeze in the muscles around the anus as if trying to stop passing wind.

• Do not clench the buttocks, thighs or stomach.

• The muscles around the urethra and anus should squeeze up and inside the pelvis.

• Identify the muscles that contract when you do all these things together.

• Then relax and loosen them. 

Importance: 

• If you have a weakened or stretched pelvic floor then you need to strengthen it.

• Exercising your pelvic floor muscles is important for both men and women.

• Strengthening the muscles provides support for your bladder and bowel so that you have better control. 

• It can also improve sexual function.  

• Just like any other muscle the pelvic floor needs regular exercise to stay strong.

• The first step to exercising your pelvic floor is making sure you know where it is and how to activate it.

• An assessment is the best way to do this. 

• There are also a few simple things you can check at home. 

• The easiest way to identify your muscles is to stop the flow of urination mid stream while on the toilet. 

• This is not an exercise and should not be used regularly. 

• It is a simple quick test to see if you can activate your pelvic floor muscles.

• Another simple way to identify the pelvic floor is to sit upright with thigh and bottom muscles relaxed. 

• Now try to tighten the muscle around the back passage then release.  

• Complete this a few times to make sure you have the right muscles. 

• If you can’t feel a distinct lift of your pelvic floor or you can’t stop the flow of urination then you need an assessment with a physiotherapist. 

• An assessment will help you to identify the pelvic floor muscles.

• Once you know how to use your pelvic floor muscles then getting an idea of your current strength is the next step. 

• The best way to measure this is counting how long you can hold your pelvic floor activation. 

• This time will be different for everyone. Make sure your pelvic floor activation is strong and tight regardless of the number a seconds you can hold. 

• A good goal is to aim for 8-10 seconds with every pelvic floor activation. 

• Always relax for an equal amount of time before activating the pelvic floor again.

Signs of Pelvic Floor Strength Improvement:

Don’t be discouraged if you are not able to control your bladder as soon as you would like, but rather look for these signs as proof that your pelvic floor muscle exercises are working and that you are on your way to better bladder health:

• Longer time between bathroom visits
• Fewer “accidents”
• Ability to hold the contractions longer, or to do more repetitions
• Drier underwear, without the feeling of always being wet
• Sleeping through the night

• Women and men who have difficulty performing kegel exercises on their own may find biofeedback therapy helpful. 

• With professional instruction from a nurse specialist or pelvic floor therapist, many people experience significant improvement in pelvic floor muscle strength, tone, and function with a good regime.

• It's crucial to remember that incontinence and pelvic floor symptoms almost always have solutions and shouldn’t be shrugged off as normal. 

• You can try these exercises regardless of how long you have had your symptoms.

• Even if you have been experiencing leakage for as short as 1 month or as long as 10 years, it is never too late to try Kegels.

• Find time each day to “squeeze” it into your routine. Most of the time kegels will result in improvement of your symptoms. If you are not experiencing the desired effect, you may benefit from a consultation with a specialist.