Sunday, December 9, 2012

All about Kegels Exercises For Women - 5 parts blog

A kegel is the name of a pelvic floor exercise, named after Dr. Kegel who discovered the exercise. These muscles are attached to the pelvic bone and act like a hammock, holding in your pelvic organs. To isolate these muscles try stopping and starting the flow of urine. Involuntary leakage of urine (urinary incontinence) is the bane of many of us who've reached our 40's — and often affects younger women, too. Decreasing levels of estrogen can weaken the muscles that have control over the urethra (the tube carrying urine from the bladder to the outside of the body). Other factors, such as weight gain as we get older, can make incontinence worse.

What Are Kegels Exercises for Women?
Kegel, or pelvic floor muscle exercises are done to strengthen the muscles which support the urethra, bladder, uterus and rectum.

Why Do Kegel Exercises? 
Often the pelvic floor muscles are weak which contributes to problems with losing urine. Doing the exercises correctly and regularly with resistance can strengthen the muscles. Stronger muscles lead to little or no urine loss for many women.

How Do I Do Them?
Over one-third of women start out squeezing the wrong muscles. Therefore, it is helpful to work with a doctor or nurse who can teach you the correct technique. You can also check yourself by placing a finger in your vagina and squeezing around it. When you feel pressure around your finger, you are using the correct muscle. Try to keep everything relaxed except the muscles right around the vagina. At the same time, do not bear down or squeeze your thigh, back or abdominal muscles. Breathe slowly and deeply. At first you can do the exercises with your knees together (lying or sitting).

How Often Should I Do The Exercises?
Be sure you are doing them correctly before you start. We recommend doing the exercises for five minutes twice a day. You should squeeze the muscle for a count of four and relax for a count of four. At first, you may not be able to do the exercises for a whole five minutes or hold the squeeze for a count of four. With practice it will become easier as the muscles get stronger.

When Should I Expect Improvement In My Symptoms?
It takes from six to twelve weeks for most women to notice a change in urine loss. Remember, if you do the exercises with resistance regularly you could see results sooner and prevent stress incontinence.

How Should I Do The Exercises?
If you read that these exercises can be done anywhere, anytime - that is not necessarily true. We have studied different ways of doing the exercises to see what works best to decrease urine loss. What we found worked best was five minute sessions done twice a day. Many women report that five minutes before they get up in the morning and five minutes before they sleep is a helpful routine.

Is There Anything I Should Change Once The Exercises Become Easy?
Once the exercises become easy, you can further strengthen the muscles by squeezing to a count of eight and relaxing to a count of eight with our recommended resistance exerciser. Repeat this for five minutes two times a day. It will also work the muscle more to do the exercises with your knees apart.

How Long Do I Have To Do The Exercises?

Once you have attained your goal, you can do the exercises for five minutes three times a week. If you start having problems again with urine loss, you may need to go back to five minutes two times a day.

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Benefits of Kegel Exercises

Kegel exercises are exercises that strengthen the pelvic floor muscles (the muscles that support the urethra, bladder, uterus, and rectum). They are also called pelvic floor muscle exercises.

Kegel exercises are usually recommended for women with urinary or “stress” incontinence. Urinary incontinence often follows childbirth or menopause.

You may experience the following benefits if you do Kegel exercises on a regular basis:
  • Stronger pelvic muscles 
  • Reduced urinary incontinence and “leaking” of urine 
  • Increased pleasure with sexual activity

How to Do Kegel Exercises
Kegel exercises are very simple, risk-free, and painless. They involve squeezing the pelvic floor muscles. They can be done any time, anywhere.

Identifying the Correct Muscles
Some women initially have difficulty identifying the correct muscles. They contract their abdominal or thigh muscles instead of their pelvic floor muscles.

Tips on identifying the correct muscles:
Sit on the toilet and place one finger in your vagina. Squeeze your finger with your vaginal muscle. You should be able to feel the muscle tighten around your finger.

While urinating, stop the flow of urine midstream by contracting your pelvic floor muscles. Do not do this repeatedly.

Imagine that a tampon is going to fall out of your vagina. Tighten your pelvic muscles in order to hang onto it.

Imagine that you are trying hard not to urinate or pass gas. Squeeze those muscles.
The muscles you tighten are the muscles you should contract during Kegel exercises. If you continue to have problems identifying these muscles, talk to your doctor or nurse.

Doing the Exercises
Once you have identified your pelvic floor muscles, you are ready to begin doing Kegel exercises. You may experience very mild muscle soreness when you first begin doing these exercises. If you do too many exercises before you are ready, however, you might experience more pronounced muscle soreness and fatigue. Starting out at the maximum number of exercises is not recommended.

General Guidelines
  • Don’t do these exercises while urinating, stopping the flow of urine midstream. This could eventually lead to voiding difficulties. 
  • Empty your bladder before beginning the exercises. 
  • Keep your abdominal and thigh muscles relaxed. 
  • Draw the muscles up and in. Do not strain down with your abdomen. 
  • Breathe while holding the muscles contracted. 
  • Try to get the maximum tightening with each muscle contraction. 
  • Try contracting the muscles while you are in different positions. Try it while you’re standing, sitting, lying, and with your feet together and apart.

Week 1
  • Tighten your pelvic floor muscles for 6 seconds. Relax pelvic floor muscles for 6 seconds. 
  • Repeat 25 times. (This takes about 5 minutes.) 
  • Do this 3 times a day—a total of 75 contractions.

Week 2
  • Tighten your pelvic floor muscles for 6 seconds. Relax for 6 seconds. 
  • Repeat 50 times. (This takes about 10 minutes.) 
  • Do this 3 times a day—a total of 150 contractions.

Week 3
  • Tighten your pelvic floor muscles for 6 seconds. Relax for 6 seconds. 
  • Repeat 75 times. (This takes about 15 minutes) 
  • Do this 3 times a day—a total of 225 contractions.

Weeks 4-24
  • Tighten your pelvic floor muscles for 6 seconds. Relax for 6 seconds. 
  • Repeat 100 times. (This takes about 20 minutes.) 
  • Do this 3 times a day—a total of 300 contractions.

After 24 weeks
  • Tighten your pelvic floor muscles for 6 seconds. Relax for 6 seconds. 
  • Repeat 50 times. (This takes about 10 minutes.) 
  • Do this 3 times a day—a total of 150 contractions.

Or you can try this variation:
  • Tighten your pelvic floor muscles for 6 seconds. Relax for 6 seconds. 
  • Repeat 75 times. (This takes about 15 minutes.) 
  • Do this twice a day–a total of 150 contractions.

Making Kegel Exercises a Habit
The following tips may help you remember to do your Kegel exercises:
  • Try to schedule your Kegel exercises at the same time every day, such as during a regular TV show, while you do the dishes, or before you go to bed). 
  • Find a way to remind yourself to do your Kegel exercises. For example, you could put a note or sign on your mirror or refrigerator. 
  • Reward yourself for each day that you do your Kegel exercises. For example, you could put a gold star on your calendar. 
  • You may forget to do your exercises for a few days. It’s common to have a few slips when you’re trying to make any new change. Don’t get discouraged. Just get back to your exercise program.
  • Chart your progress on a daily or weekly basis. Eventually, you should begin to notice that you are “leaking” urine less frequently or in smaller amounts than before. It should also be easier for you to stop your urine midstream. (Note: You should not try this any more than once a week.)

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Performing Kegel exercises

Definition of Kegel exercises:
Kegel exercises are a series of pelvic muscle exercises designed to strengthen the muscles of the pelvic floor.

Dr. Arnold Kegel developed Kegel exercises in 1948 as a method of controlling incontinence in women after childbirth. These exercises are now recommended for:
  • Women with urinary stress incontinence
  • Some men who have urinary incontinence after prostate surgery
  • People who have fecal incontinence

Kegel exercises strengthen the muscles of the pelvic floor to improve urethral and rectal sphincter function. The success of Kegel exercises depends on proper technique and sticking to a regular exercise program.

Some people have trouble finding and isolating the muscles of the pelvic floor. It's important to learn how to tighten (contract) the correct muscles. Most people contract the abdominal or thigh muscles, and don't work the pelvic floor muscles. These incorrect contractions can worsen pelvic floor tone and incontinence.

Several techniques can help you find the right muscles. One approach is to sit on the toilet and start to urinate. Try to stop the flow of urine midstream by tightening your pelvic floor muscles. Repeat this action several times until you learn the feel of contracting the right group of muscles. Do not contract your abdominal, thigh, or buttocks muscles while doing the exercise.

Another approach to help you find the correct muscle group is to insert a finger into the vagina (in women), or rectum (in men). Try to tighten the muscles around your finger as if holding back urine. The abdominal and thigh muscles should stay relaxed.

A woman can also strengthen these muscles by using a vaginal cone, which is a weighted device that is inserted into the vagina. Then try to contract the pelvic floor muscles to hold the device in place.

If you are unsure whether you are doing the Kegel correctly, you can use biofeedback and electrical stimulation to help find the correct muscle group to work.

Biofeedback is a method of positive reinforcement. Electrodes are placed on the abdomen and along the anal area. Some therapists place a sensor in the vagina in women or anus in men, to monitor the contraction of pelvic floor muscles.

A monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help find the right muscles for performing Kegel exercises.

Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy can be done in the clinic or at home.

Treatment sessions usually last 20 minutes and may be done every 1 - 4 days. Some studies have shown that electrical stimulation might help in treating stress and urge incontinence.

1. Begin by emptying your bladder.
2. Tighten the pelvic floor muscles and hold for a count of 10.
3. Relax the muscle completely for a count of 10.
4. Do 10 exercises, 3 times a day (morning, afternoon, and night).

You can do these exercises at any time and any place. Most people prefer to do the exercises while lying down or sitting in a chair. After 4 - 6 weeks, most people notice some improvement. It may take as long as 3 months to see a major change.

A word of caution: Some people feel that they can speed up the progress by increasing the number of repetitions and the frequency of exercises. However, overexercising can instead cause muscle fatigue and increase urine leakage.

If you feel any discomfort in your abdomen or back while doing these exercises, you are probably doing them wrong. Some people hold their breath or tighten their chest while trying to contract the pelvic floor muscles. Relax and concentrate on contracting just the pelvic floor muscles.

When done the right way, Kegel exercises have been shown very effective for improving urinary continence.

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Exercises for Pregnant Women

These exercises are highly recommended and should take only ten minutes per day.
Check with a qualified prenatal exercise instructor if you are not sure that you are doing the exercises correctly.

Arm/upper back stretch
(Flying arm exercise) - repeat 5 times

  • Raise your arms over your head. 
  • Keep your elbows straight and the palms of your hands facing one another. Hold for at least 20 seconds.
  • Lower your arms out to your side. Keep your upper back straight.
  • Bring the backs of your hands together as far as possible behind your back and stretch.

Abdominal muscles
Before beginning the pelvic tilt and sit-ups exercises, review the following information on separation of the abdominal muscles.

During pregnancy, it is important to check for advanced separation of the abdominal muscles in order to avoid any further separation.

The abdominal muscle (from the navel to the top of the pubic bone), is divided by a seam running up and down, so the muscle is really two halves.

The hormones present during pregnancy cause this seam to soften and stretch as the abdominal muscles accommodate the growing baby. If the seam stretches enough, a separation of the abdominal muscle may occur.

A separation can happen gradually or as a result of sudden exertion if the abdominal area is weak. You may be unaware of the separation as it causes no direct pain. However, you might have increased backache, as the abdominal muscles are needed to control a pelvic tilt and maintain proper posture.

Pelvic tilts
This exercise is very important because it is the building block of good posture. It also strengthens your abdominal and back muscles, decreasing back strain and fatigue. Practice it often.
  • Lie on your back with your knees bent.
  • Inhale through your nose and tighten your stomach and buttock muscles.
  • Flatten the small of your back against the floor and allow your pelvis to tilt upward.
  • Hold for a count of five as you exhale slowly.
  • Relax, repeat.
  • You can also perform the pelvic tilt on your hands and knees or standing up.

CAUTION: DO NOT arch your back, bulge your abdomen or push with your feet to obtain this motion!

Sit-ups There are two variations of sit-ups:

Forward Sit-up
  • Lie on your back with your knees bent. Slowly breathe in through your nose.
  • Breathe out through partially pursed lips as you raise your head, hands pointing to your knees or placed behind your head.
  • Tuck your chin toward your chest and lift your shoulders off the floor (not more than 45 degrees).

Diagonal Sit-up
  • Lie on your back with your knees bent. Slowly breathe in through your nose.
  • Point your right hand toward your left knee while raising your head and right shoulder. Breathe out slowly through your mouth. Keep your left knee bent slightly and your heel on the floor.

Kegel exercises tone the pubococcygeal (PC) muscle. This is the muscle you use to stop and start the flow of urine. Exercising this muscle helps prevent hemorrhoids, supports your growing baby, assists during and after labor, keeps the muscles of the vagina toned, and may increase sexual pleasure for you and your partner.

Learn to isolate this PC muscle by stopping the flow of urine a few times. Use this technique only to locate the muscle. Do not exercise the muscle this way as it may lead to a urinary tract infection. Another way to locate the muscle is to put your clean finger in the opening of your vagina and tighten. By feeling the muscle tighten around your finger you will know you are doing the exercises correctly.

Squeeze the PC muscle for five seconds; relax for five seconds, then squeeze again. At first do 10, five-second squeezes, three times a day.

Flutter exercises: Squeeze and release, then squeeze and release as quickly as you can.
Work up to doing 100 Kegels each day.

  • Move to the squatting position, knees over your toes.
  • Keep your heels on the floor; feel the stretch in the back of your thighs.
  • Hold for 20 to 30 seconds. Gradually increase the time to 60 to 90 seconds.
  • Relax your head and arms throughout this exercise.
  • This is a good exercise to prepare for squatting during the pushing stage of labor.

Calf stretch
  • Lean against a wall or firm surface.
  • Reach one leg out behind you, keeping your heel on the floor.
  • Lean into the wall to increase the stretch of your calf.
  • Hold for 20 to 30 seconds.
  • Repeat with each leg.
  • This is a good exercise to do before going to bed if you are bothered by leg cramps at night.

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Ease Labor with Pelvic Exercises

No one — not your doctor, midwife, or even your mother — can reliably predict how your labor will progress. Fortunately, there are a few exercises you can do now to help prepare your body for what's to come.

Kegels: Kegel exercises are small internal contractions of the pelvic floor muscles that support your urethra, bladder, uterus, and rectum. Strengthening your pelvic floor muscles improves circulation to your rectal and vaginal area, helping to keep hemorrhoids at bay and speeding healing after an episiotomy or tear, if you have one during childbirth. There's even some evidence suggesting that strong pelvic floor muscles may shorten the pushing stage of labor.

You can do Kegels anywhere — sitting at your computer, watching TV, even standing in line at the supermarket.

Here's how:
• Tighten the muscles around your vagina as if trying to interrupt the flow of urine when going to the bathroom.
• Hold for a count of four, then release. Repeat ten times. Try to work up to three or four sets about three times a day.

Pelvic tilt :
This variation of the pelvic tilt, done on all fours, strengthens the abdominal muscles and eases back pain during pregnancy and labor.
• Get down on your hands and knees, arms shoulder-width apart and knees hip-width apart, keeping your arms straight but not locking the elbows.
• As you breathe in, tighten your abdominal muscles and tuck your buttocks under and round your back.
• Relax your back into a neutral position as you breathe out.
• Repeat at your own pace, following the rhythm of your breath.

It may not be the most elegant position, but squatting is a time-honored way of preparing for and giving birth. This exercise strengthens your thighs and helps open your pelvis.
• Stand facing the back of a chair with your feet slightly more than hip-width apart, toes pointed outward. Hold the back of the chair for support.
• Contract your abdominal muscles, lift your chest, and relax your shoulders. Then lower your tailbone toward the floor as though you were sitting down on a chair. Find your balance — most of your weight should be toward your heels.
• Take a deep breath in and then exhale, pushing into your legs to rise to a standing position.

Tailor or Cobbler Pose
This position can help open your pelvis and loosen your hip joints in preparation for birth. It can also improve your posture and ease tension in your lower back.
• Sit up straight against a wall with the soles of your feet touching each other (sit on a folded towel if that's more comfortable for you).
• Gently press your knees down and away from each other, but don't force them.
• Stay in this position for as long as you're comfortable.

Remember to start slowly and work at your own level for each exercise.
In addition to the well-known benefit of relieving urinary incontinence in pregnant women, regular pelvic exercises (also known as Kegel exercises) make them less likely to have a prolonged second stage of labor (pushing stage), according to a study in the British Medical Journal (2004;329:378–80). Pelvic exercises consist of alternately squeezing and relaxing the muscles of the pelvic floor, as when stopping and starting the flow of urine.

Following the first stage of labor, characterized by contractions that lead to increasing dilation of the cervix (the opening of the uterus), the second, or active, pushing stage, ends with the birth of the baby. (The placenta is delivered in the third stage and the fourth stage is the recovery phase during which the mother’s condition stabilizes.)

Women who have a prolonged second stage of labor are more likely to damage the tissues around the birth canal and to need an episiotomy (a surgical cut into the vagina and surrounding tissues to facilitate delivery). 

They are also more likely to bleed excessively after the birth and to need a Cesarean section to deliver the baby.

The goal of the new study was to determine the effect of pelvic-floor-strengthening exercises on labor in 301 pregnant women. The women were assigned to either a pelvic-exercise-training group or a control group.

The women in the exercise group trained with an exercise therapist for 60 minutes one time per week for 12 weeks between the twentieth and thirty-sixth weeks of pregnancy.

The women were also encouraged to perform 8 to 12 intensive pelvic muscle contractions two times per day at home during this period. The control group was not given pelvic exercise instruction, but was not discouraged from doing the exercises.

The duration of the second stage of labor and the number of prolonged second stage labors were recorded. Women in the pelvic-exercise-training group were far less likely to have a prolonged second stage of labor (lasting more than 60 minutes) than women in the control group.

The new study provides more evidence of the benefit of pelvic-exercise training in pregnant women. Pelvic-floor exercises also increase circulation to the area, and may help speed healing time and decrease pain after delivery.

Previous studies have shown that these exercises also improve urinary incontinence, which occurs when the muscles in the pelvic area become stretched during pregnancy, losing much of their strength and elasticity, and providing less support for the uterus and bladder.