KEGEL EXERCISES
Kegel exercises are designed to strengthen the pelvic floor muscles. These
muscles support the bladder and bowel openings in both men and women.
Strengthening the muscles of the pelvic floor can aid in preventing leakage of
urine or feces with coughing, sneezing, lifting, and other stressful movements.
Other benefits of kegels include enhanced sexual function, conditioned muscles
to make childbirth easier, decrease and/or prevent prolapse of pelvic organs,
and improve the ability to pass stool.

Who should do Kegel Exercises?
? Women and men with urinary and /or bowel incontinence
? Women and men who have demonstrated weakening of the pelvic floor
? Pregnant women or women who have previously had children
? Middle aged and older women
What you need to know about Kegel Exercises
The success of Kegel exercises depends on the use of proper technique as well
as compliance to a regular exercise program. When doing the exercises, it is
important to identify the correct muscles of the pelvic floor. At first, most
people contract the abdominal or thigh muscles while neglecting the pelvic
floor muscles. This may actually worsen pelvic floor tone and incontinence.
Kegels may be done as a part of biofeedback, when some patients require
assistance. Biofeedback consists of placing a sensor on the abdomen and
around the anal area, which measure the contraction of the pelvic floor
muscles. Occasionally, an electrode may be placed in the vagina in women, or
in the rectum in men.

Three Steps to an Effective Kegel
? Learn to tighten the muscles around the vaginal/anal area
? Contract the vaginal and rectal muscles. Note that when you perform
steps 1 and 2 correctly, you should also feel the muscles around the anus
tighten slightly. This is normal, but do not consciously try to tighten
those muscles.
? In a quiet, relaxed setting with no distractions, practice your Kegels and
determine how long you can hold your contraction and how many you
can do before becoming fatigued. Do not do more than 5-10 reps at time
with a 3-5 second hold.

Detailed Instructions on how to do Kegels:
Step #1: The urethra?The Functional Stop Test
After partially emptying your bladder, stop your urine flow in a slow controlled
manner, paying attention to how it feels.
Note: Stopping and starting the urine repeatedly as an exercise can be harmful
and should not be done. Holding your urine can contribute to bladder
infection, causing damage to normal urinary reflexes. The Functional Stop Test
is useful for assessing what it feels like to gradually stop urine flow, and should
not be done more than once per urination.
Step #2: The vagina and rectum as your window to the pelvic floor
For this step, you will internally assess the ability to squeeze and elevate the
muscles around the opening of the vagina or rectum, while lying on your back.
This is accomplished by inserting one finger into the vaginal or rectal opening
while you try to lift and squeeze with the muscles. Pay attention to how this feels.
Step #3: Putting it all together
Begin practicing while lying on your back with your knees bent, or lying back
with pillows under your head and shoulders. When your knees are bent you
should have pillows under them so that the muscles around the hips and
buttocks can relax. In this position, you can practice the actual Kegel, which
involves lifting and tightening the pelvic floor all at one time. This will be a
combination of what you felt when you gradually stopped urine flow, with the
feeling squeezing and elevating the muscles around the vaginal or rectal area.

How long and how many?
When you are first starting out, it is common to find that you can only hold a
Kegel for 3-6 seconds, and that performing 3-6 repetitions causes muscle
fatigue. When this happens, you are usually performing the exercise correctly.
If you find you can hold it for much longer right away, recheck your technique.
For patients with incontinence or pelvic floor weakness, it is important to
concentrate on correctly performing the technique and gradually improving the
muscle quality and tone, even though you may be weak first starting out.
Making Kegels a part of your life
After you have become experienced in performing these exercises, you will
want to do them as follows:
? A series of strong, steady squeezes for 8-10 seconds each ? Try to do 8-10 at a time
? For most people, 30 repetitions per day are adequate.
As they get easier, you will find you can do them while sitting or standing, for
example, you can do them while driving, working on the computer, or waiting in
long lines.
Please note that you may not see any noticeable change in bowel / bladder
control for a while. In some cases it may be many months.