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Pelvic floor exercises

From the Editors

Pelvic floor exercises involve squeezing and relaxing muscles in the pelvic and genital area. These exercises help maintain the strength, endurance and proper action of your pelvic floor muscles, which are important for bladder and bowel control. The exercises are also referred to as Kegel exercises, after Arnold Kegel, the doctor who first described them. When performed correctly, regular pelvic floor exercises can help improve or maintain bladder and bowel control.

How to do pelvic floor exercises
First locate your pelvic floor muscles. Imagine that you're trying to stop from passing gas. Squeeze and lift the rectal area and, if you're a woman, the vaginal area, without tightening your buttocks or belly. You should sense a pulling or closing feeling in your genital area when you squeeze. Men may feel their penis pull in slightly.

Here are three ways to practice pelvic floor exercises:

  • Holding — This exercise works the muscles' ability to hold. Slowly tighten, lift and draw in the pelvic floor muscles and hold them for a count of three. Relax, then repeat. At first you probably won't be able to tighten the muscles for very long. Start with holding for one to two seconds, and gradually increase over a period of several weeks to a goal of 10 seconds. If you feel the contraction letting go, just retighten the muscles. Rest for 10 seconds between each contraction. Over time your contractions should also become stronger.

  • Quick flicks — This exercise is a series of rapid contractions and releases. You quickly tighten the muscles, lift them up and let them go.

  • Urge control — This exercise can be done when you feel an urge to go to the bathroom. First, stop and stand very still. Sit down if you can. Relax. Take a deep breath, then let it out. Try to think of something other than going to the bathroom. Contract your pelvic muscles three to four times to keep from leaking. When you feel the urge lessen somewhat, walk normally to the bathroom. If the urge happens again on the way, stop and repeat the exercise.

You can do pelvic floor exercises almost anywhere — while you're driving, watching television, or sitting at your desk. Ask your doctor how many exercises to do each day. One simple starting program is todo 10 before getting out of bed in the morning, 10 after lunch, 10 in the evening while watching television, reading or doing the dishes, and another 10 before falling asleep.

After six to 12 weeks of doing pelvic floor exercises correctly, you should notice improvement in your bladder and bowel control. To further strengthen the urinary and pelvic floor muscles, women can use vaginal weights. These are tampon-shaped cones that you insert into your vagina and try to hold in place. You'll know you're doing the contraction incorrectly if the cone falls out. As your contraction technique improves and your muscles grow stronger, you increase the weight of the cone.

Things to remember
A few key things to remember when doing pelvic floor exercises:

  • Avoid doing them while urinating. This can cause difficulties in emptying your bladder.

  • Don't strain as you're doing these exercises. Your abdominal, buttock and thigh muscles shouldn't tighten. Put your hand on your belly. If your hands feel pressure, you're straining.

  • To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Another way to be sure you're doing the exercises correctly is a simple finger test. Place a clean finger in your anus or vagina (for women). This may be easier to do while you're in the shower or with the help of a rubber glove and a lubricant such as K-Y Jelly. Then squeeze around your finger. The muscles you contract are your pelvic floor muscles. If you're still not sure if you're using the right muscles, ask your doctor to refer you to a physical therapist for biofeedback techniques that will help you identify and contract the right muscles. Electrical stimulation is another alternative.

  • Although you may not be able to hold the contraction for more than a second at first, with regular practice you'll be able to hold your contractions longer.

  • Contract your pelvic floor muscles before an event that causes you to leak urine, such as nose blowing, sneezing or coughing. For example, as you feel the urge to cough, tighten your pelvic floor muscles before and during your cough.

  • After the first few days of doing the exercises, you may notice some soreness around your pelvic area. This is normal and will ease as your muscles become stronger. But don't overdo it. If the soreness becomes too uncomfortable, talk to your doctor.

Editor's note: This is an excerpt from the book "Mayo Clinic on Managing Incontinence."

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