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kegel exercises strengthening the pelvic floor may allow some men to achieve a form of orgasm without allowing ejaculation, and thereby perhaps reach multiple ‘climaxes’ during sexual activity

Can Kegel Exercises Help Men with ED?

In 1948, gynecologist Dr. Arnold Kegel developed a series of exercises involving what is now commonly referred to as the “pelvic floor” to help women develop physical control over the incontinence that is often associated with childbirth.

Physicians generalized the prescription of these “Kegel exercises” to help overcome urinary incontinence from any cause, and eventually urologists began to prescribe these exercises for men who experienced incontinence after a prostatectomy.

A number of studies reported in the international literature in recent years have suggested that pelvic floor exercises are useful in the treatment of a different problem: erectile dysfunction in men. In some instances, Kegel exercises were found to offer relief from ED equivalent to that of Viagra and similar drugs.

Ralph and Barbara Alterowitz report in their book, “Intimacy with Impotence” that a 2003 British study found rates of improvement similar to those “seen in a large trial of men taking Viagra.” Dr. Frank Somer, in a 2001 study published in the International Journal of Impotence Research, observed that pelvic floor exercises had an even higher rate of success than a PDE5 inhibitor (the class of drugs that includes Viagra and Cialis).

Given that Kegel exercises are easy to do, don’t cost anything, have no side effects, and have been shown effective in several studies, it seems to me that they might be worth a try. There’s nothing to lose by trying, and they just might work.

Here are the four steps of a set of Kegel exercises:

1. Tighten your urinary flow muscles as if you wanted to stop urination.
2. Hold those muscles tight as you count to 10.
3. Hold this position while also tightening your anal muscles to another count of 10.
4. Do a set of ten repetitions three times a day.

Effective Kegel Exercises

Kegel exercises (Kegels) are exercises designed to strengthen the muscles of the lower pelvic girdle, or pelvic floor—the pubococcygeal (PC) muscles. The PC muscles support the bladder, urethra, and urethral sphincter—the muscle group at the neck of the bladder that acts as a spigot for controlling urine flow into the urethra—and the vagina, uterus, and rectum. Anything that puts pressure on the abdomen can weaken or damage these pelvic muscles. Such conditions include pregnancy, childbirth, excess weight, hormonal changes, and aging. Kegel exercises enable the PC muscles to better withstand increases in intra-abdominal pressure (pressure inside the abdomen). They make the bladder, urethra, and vagina more resilient, and improve bladder control and sexual relations.

Thirteen to 20 million American women suffer from urinary incontinence, primarily stress urinary incontinence (SUI)—urine leakage while laughing, coughing, sneezing, standing up suddenly, or exercising. SUI occurs when intra-abdominal pressure increases and the urethral sphincter opens inappropriately. During pregnancy, the fetus puts pressure on the bladder and the sphincter may relax and leak.

Postpartum incontinence may result from muscle and nerve damage during childbirth due to delivery of a large baby, prolonged labor, excessive pushing, a forceps delivery, or an episiotomy (an incision made during delivery to prevent tearing of maternal tissue). About 40% of American women suffer from incontinence after childbirth, and the incidence increases by about 12% following each birth. Childbirth also increases the risk for incontinence later in life. During menopause, as a result of lower levels of estrogen, women with SUI may have thinning of the lining of the outer urethra, a sensation of having to urinate often, and recurrent urinary tract infections (UTIs). Beginning Kegels in midlife can help prevent urinary incontinence later.

Origins

In the 1930s, Dr. Joshua W. Davies hypothesized that strengthening the PC muscles could improve bladder control by assisting the closure of the urethral sphincter. By 1948, Dr. Arnold M. Kegel, a Los Angeles-area obstetrician and gynecologist, was having his patients practice vaginal contractions in preparation for childbirth. That same year he invented the Kegel perineometer, or pelvic-muscle sensor, to help prevent urinary incontinence (leakage) following childbirth.

Kegel’s perineometer was the first biofeedback machine designed for clinical use. Employing a vaginal sensor, an air-pressure balloon, and a tire gauge, it enabled patients to verify that they were performing Kegel’s correctly and to monitor their progress. The patients continued their practice at home. Kegel published numerous papers on his work and claimed to have cured incontinence in 93% of 3,000 patients. He produced a documentary movie to teach the procedure to other physicians. However, his perineometer was never marketed effectively and there was a widespread misconception that Kegels could not be performed without it. In the 1970s, more sensitive electromyography (EMG) perineometers became available for those with severely debilitated pelvic muscles.

Benefits

Kegel exercises strengthen the PC muscles and increase blood flow and nerve supply to the pelvic region, promoting or resulting in:

* increased pelvic support
* restoration of vaginal muscle tone and improved vaginal health
* protection from the physical stresses of childbirth
* restoration of sexual function and improved sexual response and pleasure
* increased vaginal-wall thickness and lubrication after menopause (cessation of menstruation)
* prevention or reversal of urinary leakage and rectal incontinence
* relief from pelvic pain or pain of vulvar vestibulitis (inflammation of the vaginal opening)

Description

Locating the Pc Muscles

The PC muscles can be felt by:

* stopping and starting urine flow to identify the forward PCs
* squeezing the vagina to identify the back of the PCs
* squeezing around two fingers placed in the vagina
* imagining sucking a marble up the vagina
* preventing a bowel movement or the passing of gas by tightening the muscles around the anus

There is a pulling sensation when the correct muscles are contracted. Weaker and stronger contractions are practiced until the PC muscles can be squeezed at will.

Practicing Kegels

There are numerous suggestions for practicing Kegels, which include:

** Contracting the PC muscles for three to 10 seconds and relaxing them three to 10 seconds for five to 15 repetitions, three to 12 times per day.
** Contracting the PC muscles strongly for one second, then releasing for one second, 20 times, three times per day, speeding up the contractions until there is a fluttery sensation.
** While emptying the bladder, stopping the urine flow at least three seconds, 10 times during each urination, which provides 60–80 contractions per day.

The complete exercise requires muscle contraction from back to front. It may take three to eight weeks for noticeable improvement. Once good muscle tone is achieved, Kegels may be performed just once a day.

The PC muscles can be exercised at almost any time—while lying down, sitting (in the car at a stop light, at work, etc.), squatting, standing, or walking—and varying the exercise position is said to be most effective. Sitting or standing adds weight to the exercise. It may be helpful to perform a Kegel squeeze before coughing, standing up, or lifting a heavy object. It may also be helpful to incorporate Kegels into a daily routine and keep a log. It is recommended that pregnant women practice Kegels regularly before, as well as after, childbirth.

Squeezing with two fingers in the vagina will confirm that only the vaginal muscles are contracting. Placing a hand on the lower abdomen is a reminder to keep the belly soft and relaxed, to refrain from tightening other muscles such as the stomach, buttocks, or leg muscles, or to hold the breath, all of which increase intra-abdominal pressure, working against the Kegels.

Vaginal Cones

Kegels can be performed by the ancient Chinese technique of placing a weighted cone in the vagina and holding it in place up to 15 minutes twice a day. The practice is initiated using the heaviest cone that can be held easily for one minute. The cones weigh from 15–100 gm (0.04–0.3 lb). Brands include FemTone Weights, Kegel Weights, Kegel Kones, and Perineal Exerciser. Sequentially heavier cones are used until a maintenance program is established. This method automatically uses the correct muscles. Some of these products require a doctor’s prescription.

Biofeedback Devices and Electrical Stimulation

Nerve damage may prevent some people from performing Kegels properly. Vaginal or anal sensors and EMG perineometers with computerized visual or auditory feedback displays can measure the PC contraction. A handheld over-the-counter product (called the Myself pelvic muscle trainer) costs about $90. Another device can send mild electrical impulses to help locate the PC muscles.

With a vaginal sensor and biofeedback monitor, two 20-minute sessions per day for seven to nine months—with a specific goal such as holding 45-microvolts for 60 seconds—can relieve vulvar vestibular pain in the majority of women.

Insurance may not pay for EMG biofeedback therapy; however, Medicare will reimburse the patient if conventional Kegel exercises have failed.

Preparations

Training may be provided before initiating a Kegels routine.

Precautions

A temporary loss of muscle and nerve function following childbirth may make Kegels more difficult.

Kegel exercises do not work if abdominal, thigh, or buttock muscles are contracted. Furthermore, such contractions can increase pressure on the bladder, aggravating incontinence. Vaginal cones are not recommended in the presence of infection, neurological damage, diuretic medicines, or caffeine.

Side Effects

There are no side effects to Kegel exercises.

Research & General Acceptance

When performed properly and consistently, Kegels are usually helpful. The United States Agency for Health Care Policy and Research recommends that behavioral methods, including Kegels and biofeedback, be utilized to treat urinary incontinence before initiating drugs or surgery. Randomized controlled studies have shown that as many as 50–90% of women can reduce or overcome SUI with Kegels alone. However, reports of effectiveness vary since many people do not receive proper Kegel instruction. Consistent use of vaginal cones can improve or cure incontinence within four to six weeks in 70% of women.

The use of Kegels to improve urinary incontinence in men has not been extensively studied, although many clinicians report improvement. One study found that after the removal of a cancerous prostate, men who performed Kegels twice a day regained bladder control faster than those who did not do the exercises.

Training & Certification

Patient training in Kegel exercises can be given by a knowledgeable healthcare provider.

Kegel exercise

A Kegel exercise, named after Dr. Arnold Kegel, is an exercise designed to strengthen the pubococcygeus muscles. The exercises consist of the regular clenching and unclenching of the muscles which form part of the pelvic floor (sometimes called the “Kegel muscles”).

Explanation

The aim of Kegel exercises is to restore muscle tone and strength to the pubococcygeus muscles in order to prevent or reduce pelvic floor problems and to increase sexual gratification. Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Kegel exercises are also known as pelvic floor exercises, or simply Kegels.

Although Dr. Kegel contemporized and popularized this practice, it is by no means new. The Taoists of ancient China developed a number of different sexual practices to strengthen and tone these same muscles for health, longevity, sexual gratification, and spiritual development.[citation needed] Directly akin to the Kegel exercise is the Taoist practice of the Deer Exercise. The Yogis of India also had a similar practice in Hatha Yoga known as Aswini Mudra (the horse gesture) which is taught and practised to this day.

Benefits for women

Factors such as pregnancy, childbirth and being overweight often result in the weakening of the pelvic muscles. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases. Regular Kegel exercise can also increase sexual pleasure for woman and their partners. After childbirth, practicing pelvic floor contractions during vaginal sex will allow the woman immediate feedback from her partner, who can tell her whether they can feel her muscles tightening. In this manner, a newly postpartum woman can retrain her pelvic floor muscles to their pre-pregnancy strength and tone.

Benefits for men

Though most commonly used by women, men can also use Kegel exercises. They are used to strengthen the pubococcygeal muscle, which may allow them to achieve orgasm without ejaculation and perhaps reach multiple climaxes during sexual activity. In men this exercise lifts up the testicles, also strengthening the cremaster muscle as well as the anal sphincter, as the anus is the area contracted when a Kegel is done. In fact, men should solely contract their anal sphincter to perform a kegel, and not the urinary sphincter. This is because the pubococcygeus muscle begins around the anus and runs till the urinary sphincter.

Men should be patient when they begin kegel exercises as it may take 4 to 6 weeks to see a substantial difference. Women are able to add resistance to the exercise through isometrically gripping a hard object (such as a Kegel exerciser), or by compressing an object such as foam, but there are no known techniques that would add resistance to male Kegel exercises.

Some believe[attribution needed] draping a towel over the shaft and lifting it does this, but any force possibly applied to the muscle in this way would be limited to the biological heritability of the penis’ shaft to stay erect and resist bending, in a combination of blood flow (‘hardness’), genetic construction, and tissue integrity. No serious scientific studies have been done into the ‘bodybuilding’ and strength-building of the member through this method, although a niche market definitely exists in the realm of penis enlargement, and various urban legends abound for (with groups dedicated to the propagation of) methods of strengthening and enlarging the penis through various methods of exercise and resistance.

Potential concerns

The pubococcygeal muscles are those used to stop the flow of urine during urination, and they may be easily identified in this way. However, after the muscle has been identified, practicing Kegel exercises during urination is not recommended, as this could lead to a urinary tract infection.

Postpartum Health

After nine months of carrying around that extra weight, you’re probably ready to think about your own fitness, including how to shed those last few pounds that didn’t disappear when your baby was born. On average, women gain about 30 pounds during pregnancy, 18 to 20 of which are usually lost within about a month of having the baby. That’s when it gets tough. Those last 5 to 10 pounds can be hard to get rid of, but consistent, safe exercise can help you do just that and maintain your well-being, too.

BACK IN THE SWING

Getting back to exercise after the birth of your baby should be a gradual process. Your doctor may start you out with simple exercises for the first week or two, such as Kegel exercises and short, slow walks.

Kegel exercises, small contractions of the muscles at the vaginal wall and opening, should be a priority. They will help to repair and strengthen the pelvic floor. Slow walks during this initial period will not only help you to feel you’re getting back into a fitness routine, but help you relieve tension and get some fresh air. Don’t push yourself — work to establish a regular walking time and keep a steady pace. A full-fledged return to the aerobic activities you participated in pre-pregnan-cy usually comes around the time of your postpartum doctor’s visit, or after about six weeks.

Back pain and posture concerns are still present in the postpartum period. The abdominal wall is loose now that the uterus is no longer pressing against it, and it can’t adequately support the lower back. Try to incorporate low-back exercis-es and range-of-motion movements to ease the strain and strengthen the lower back. You may also experience upper-back strain caused by fatigue and breast weight if you are lactating. Shrugging the shoulders and performing flexibility exer-cises for the chest and back should pro-vide relief.

TONING YOUR MIDDLE

You may be anxious to begin abdominal exercises, but do only what you’re capable of. Pelvic tilts and abdominal compression exercises are a good place to start. Remember to tighten the pelvic floor when performing these since they may place pressure on it and stretch it further. As your pelvic floor gradually becomes stronger, other curl-up exercis-es may be added.

EATING RIGHT

Your first instinct may be to start eating less to expedite weight loss, but since breast-feeding and increased physical activity require more energy during the postpartum period, it isn’t recommended. New mothers who breast-feed their babies shouldn’t cut their calorie intake. In fact, they should increase it. Breast-feeding mothers need to take in an addi-tional 500 calories per day to provide their babies with the proper nutrients. If you skimp on calories, you’re less likely to get the nutrients both you and your baby need.

CAESAREAN CARE

If you have had your baby by Caesarean section, your body will need more time to heal and regain strength, and chances are you will feel less like plunging into an exercise routine. Start slow and use caution when exercising, especially with your abdominal muscles. It is important to consult with your doctor to develop a safe exercise program.

THAT BOTTOM LINE

Talk with your doctor before and after delivery to determine the best plan for you to follow once your baby is born, and don’t hesitate to consult with them at any time if you have questions. Go slowly with exercise to build a safe foundation for taking care of you and your newborn, and you’ll both be on the pathway to good health and well-being.

Urinary Incontinence In Men

While bladder control problems occur twice as often in women, men too experience involuntary loss of urine, particularly after prostate surgery.

But most men will seek medical treatment much sooner than will women. Why? Perhaps because women are used to “bodily fluid loss” as a normal part of life, such as during menstruation and childbirth. Wearing pads and changing clothes because of an “accident” are outside a man’s realm of experience.

Whatever the reason, men who learn to correctly exercise their pelvic floor muscles are not as likely to experience incontinence in their later years. Physical therapists can help men as well as women with a program of exercises to improve bladder control.

Treatments for urinary incontinence can include:

• Education about the bladder, pelvic floor muscles, and normal emptying techniques

• Bladder retraining and timed schedules for urinating

• Exercises to strengthen the pelvic floor muscles

• Vaginal weights to strengthen the pelvic floor muscles

• Medication to treat infection, replace hormones, stop abnormal bladder muscle contractions, or tighten sphincter muscles

• Dietary modifications

• Surgery to correct the bladder position

If muscles are very weak, your physical therapist may also use:

1. EMG/biofeedback: The therapist places an electrode over the pelvic floor muscle and this “reads” the activity in your muscle. A wire connects the electrode to a TV monitor and you may watch yourself contracting the muscles (see Kegel exercises, page 10) on the screen. You learn how much to squeeze, when to let go, and how many exercises to do, and you can see yourself improve in a few weeks.

2. Electrical stimulation of the pelvic floor muscles: Gentle electrical stimulation over the pelvic floor muscles helps the muscles to contract and may also help the bladder to be less irritable. Most types of bladder control problems benefit from a customized intervention program that emphasizes strengthening the pelvic floor muscles. This is another area in which your physical therapist can help.

How Physical Therapists Help

Many physical therapists concentrate their practice in women’s health, and incontinence is one of the most common problems they treat. Physical therapists use a variety of methods to help their clients correct pelvic floor weakness. Your physical therapist will teach you how to strengthen your pelvic floor muscles, which may prevent the onset of incontinence or help to reverse the process. He or she will evaluate the extent of your incontinence, identify treatment goals, and make sure you understand how your treatment works—now and in the future. Physical therapists may also offer some tips on lifestyle changes that will help the bladder be less irritable. These suggestions include:

• Lifting and moving correctly

• Bracing the pelvic floor muscles when you cough, laugh, or sneeze

• Avoiding common bladder irritants

• Keeping a bladder diary to promote normal urinating habits

• Exercising correctly and avoiding improper sit-up techniques

How to Strengthen Pelvic Floor Muscles

Exercises to strengthen your pelvic floor muscles can help improve your bladder control. But these exercises are not easy to do correctly, unless you follow your physical therapist’s instructions.

First, identify your pelvic floor muscles by trying the following: Partially empty your bladder, then try stopping or slowing down the flow of urine. If you can stop or slow the flow, then you’re contracting (tightening) the right muscles? Use this technique about once a month, only to identify the right muscles and to see if you are improving.

Once you have learned how to contract the pelvic floor muscles, try doing these contractions, called Kegel exercises, throughout the day. Do them with daily activities, such as sitting in a meeting, while stopped in your car at a traffic light, or when talking on the phone. Hold the muscles contracted for about three seconds, 12 to 15 times in a row, making sure to rest for a few seconds between each exercise set. Do this at least three to six times a day.

If your pelvic floor muscles are weak, you may need to lie down while you exercise. As you feel stronger, you can go to a sitting position, and then do these exercises while standing. Your physical therapist will help guide you.

You should also vary these exercises: Contract your pelvic floor muscles and hold for 5 to 10 seconds. Or contract and release quickly. Or clear your throat or cough while holding the muscles contracted. You should do these exercises several times throughout the day. Remember that Kegel exercises are discreet. Nobody will notice that you are doing them.

Kegel Exercises:

Contract your pelvic floor muscles for three seconds, then relax the muscles for three seconds. Do this 10 to 15 times several times a day. Although shown here while lying down, these exercises can be done during a variety of daily activities, such as sitting in a meeting, while stopped in your car at a traffic light, or when talking on the phone.

How Early in Life Should You Begin Kegel Exercises?

Many women learn about their pelvic floor muscles and Kegel exercises during childbirth classes, but what about individuals who don’t have children or athletes who experience incontinence while exercising?

Perhaps the best time for a young woman to learn about the function of her pelvic floor muscles is when she is an adolescent or when she has begun menstruating. At this age, she will be old enough to understand where the pelvic muscles are, and she will be developing health habits for a lifetime that should include Kegel exercises as part of her regular exercise program for health and fitness.