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.