Stress incontinence and pelvic relaxation are common problems. They are usually a result of over stretching or injury to the floor and roof of the vagina during childbirth. It can be worsened with each subsequent birth. These conditions can also occur unrelated to childbirth. Most commonly they first become a problem by the late 40's however they may not become a problem until after menopause when estrogen levels are low and the lining and muscles of the vagina and bladder become atrophied.
Often stress incontinence is associated with some vaginal or uterine prolapse (falling vagina or uterus). When extreme they are generally treated as a surgical problem however, for many women surgery can be avoided by using a series of exercises to strengthen the muscles of the vagina and the floor of the bladder and roof of the rectum. These exercises are commonly referred to as the Kegel Exercises. Developed by the late Dr. Arnold Kegel, a Los Angeles Obstetrician and Gynecologist, these exercises were originally designed for women who were poor surgical risks. Dr. Kegel realized that for many women surgery would be an extreme hazard. He investigated the anatomy and physiology of the vagina and bladder and soon found that by strengthening the vaginal muscles most women could reduce their symptoms to a sufficient degree where surgery was no longer necessary.
Applying these exact same exercises to normal women, we see that many of these women also obtain excellent result and often no longer require surgery. While the Kegel exercises are relatively easy to do, persistent application and diligence are essential for good results.
What Dr. Kegel found was that the Pubococcygeus (pew-bo-kok-cye-gee-us) or PC muscles which makes up the major muscular support of the floor and roof of the vagina were in excessively relaxed or overstretched in women with stress incontinence. The PC muscle groups start on the back of the pubic bone in the front and passes toward the back to insert posteriorly at the edge of the spinal bones on both sides of the body. In doing so it creates a kind of sling which holds and supports the vagina. Joining with it are two other sets of muscles which encircle the vagina and make up the floor of the bladder and roof of the rectum. When these muscles are relaxed both the bladder and the vagina can pouch down, the uterus and vagina can also fall or prolapse down under the pull of gravity toward and even through the vaginal opening.
The Kegel Exercises Are Used for the Following Reasons
Stop Urinary Incontinence
Reduce prolapse of the uterus or vagina
Prevent surgery
They increase the circulation to the vaginal and bladder
Restore vaginal and bladder muscles and function after childbirth
Make childbirth easier, when performed during pregnancy in preparation for labor.
Increase awareness in the genital area.
Increase sexual arousal and sexual awareness during intercourse.
What Do I Need To Know To Help Myself?
The Kegel exercises are simple and easy to do. They can be done in the privacy of your own home. Learning to do them takes only seconds. You need little or know medical help or follow-up. You will know whether they work by the results you get.
The first thing you must do to learn them is to identify your own PC muscles. This can be done on your own, or if you wish, your doctor can easily help you to find them and teach you exactly how they work.
To find them on your own, it is best to look for them the next time you urinate. While sitting on the toilet spread your legs comfortably apart. See if you can stop and then restart your urine flow without moving your legs. The muscles you use to stop the flow of your urine are the PC muscles. If you are able to stop the flow of urine with little effort then you have strong PC muscles.
If you are not able to stop your flow of urine, then your PC muscles are too relaxed or too stretched out. If you are not able to recognize what muscles are contracting or you cannot stop your urine flow, don't be upset. Once you learn to use the Kegel exercises this will all resolve itself.
The Kegel Exercises
The Kegel exercises do not require you to be urinating nor even that you be undressed. You can do them while sitting, standing, lying down or walking, while watching television, doing the dishes, working at your desk, in school or even while on the phone or driving. Basically you can do them anytime you want to use them.
1. The Slow Kegel's:
Tighten your PC muscles just as you did when you tried to stop your flow of urine. Contract the PC muscles and then hold them for a slow count of three, 1 - - - 2 - - - 3 - - -. Then relax.
2. Quick Kegel's:
Tighten and relax your PC muscles as rapidly as you can until you become tired or for 2 to 3 minutes whichever come first. This should be somewhere around 100 to 150 times.
3. Pull In -- Push Out:
Tighten your PC muscle as before, hold for a count of three, then pull upward, as if you had a string on the top of your bladder. Pull it upward toward your chin. In doing this, you will actually pull up on the pelvic floor. Pretend that you have tied a string on the top of the vagina attached it to your belly button and you are pulling on the string with your diaphragm muscles, pull the top of the vagina up toward your chin. While you are actually not doing this, this is the sensation you want to produce to accomplish this specific exercise. Once you have pulled up, hold for a count of three and then relax. This exercise uses several sets of pelvic and abdominal muscles strengthening them.
Do each of these three exercises as often as you can remember to do them. At least three to five times a day. You may need to do them as much as 1000 to 2000 (individual contractions) each day for several months to obtain optimum results. To do this do 100 or more times, ten to twenty times a day. Most women tell me that it is really much easier than it sounds.
The idea is to do them so regularly that you can do them without anyone knowing that you are doing them. When you first start doing these exercises, they will seem awkward and uncomfortable. You may feel self-conscious, but like most women you will soon find that you can do them in public without anyone even suspecting that you are doing them.
Initially, when you do the Slow Kegel's, you might notice that your PC muscles may not want to stay contracted. You may also experience that you cannot do the Fast Kegel's very rapidly or for any prolonged length of time. If you stay with this program, in a short while these exercises will begin to feel almost effortless.
A good way to check your progress is to insert one or two lubricated fingers into the vagina and feel the contraction and how it is changing. You will soon see changes in stress incontinence and decrease in your uterine prolapse. As a side benefit you may experience an increase sensation during sex. These are all good indicators of progress.
It is important to remember to breathe naturally and evenly while you are doing your Kegel's exercises.
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