Pelvic Muscle Exercise Kegel Exercises

In the late 1940s,Arnold Kegel developed a vaginal balloon perineometer to teach pelvic muscle exercises for poor tone and function of the genital muscles. He was instru mental in developing a standardized program for treating urinary stress incontinence and recommended structured home practice with the perineometer along with symptom diaries. His clinical use of these techniques showed that muscle reeducation and resistive exercises guided by sight sense is a simple and practical means of restoring tone and function of the pelvic musculature and improves urinary incontinence.

Unfortunately, clinicians taught Kegel exercises without the use of instrumentation. It has been shown that verbal or written instructions alone are often inadequate and that up to 50% of patients perform Kegel exercises incorrectly. There is a strong tendency to substitute abdominal and gluteal contractions for weak pelvic floor muscles (PFMs). For patients with fecal or urinary incontinence, abdominal contractions increase intraabdominal pressure, thus increasing the probability of an accident or even further worsening pelvic floor weakness. For patients to begin performing isolated pelvic muscle contractions, they are instructed to contract the PFMs without contracting abdominal, gluteal or leg muscles, and to hold this contraction to the best of their ability. The patient must tighten the pelvic diaphragm (levator ani) in a manner similar to stopping the passage of gas or to stop the flow of urine. Patients should be advised that the initial aim of treatment is not to produce a contraction of maximum amplitude, but to contract the PFM in isolation from other muscles without undue effort. To build muscle endurance, training proceeds with gradual increases in the duration of each contraction along with gradual increases in the number of repetitions. Rhythmic breathing patterns during contractions should also be encouraged.

Recommended home practice is tailored according to the patient's ability and the degree of muscle fatigue observed during the session. At each stage of treatment, patients are encouraged to practice these exercises daily without instrumentation feedback.

The goal of PFM retraining includes attaining normal resting tone, quick recruitment of the PFMs, sustained isolated pelvic muscle contraction, quick release to a normal ized resting tone, and appropriate relaxation during defecation or micturition.

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