AUTHOR: DELENA CAAGBAY, BOUNCEREHAB WOMEN’S HEALTH PHYSIOTHERAPIST & MATTHEW CRAIG PRINCIPAL PHYSIOTHERAPIST AT BOUNCEREHAB
Most women who have had a baby have heard about Kegel’s or pelvic floor muscle (PFM) exercises. Arnold Kegel first described ‘Kegel’ exercises in 1948 as a way of restoring function to the pelvic floor muscles after child birth (Kegel, 1948). While we may have heard of these elusive exercises it is difficult to know if you’re doing them the right way.
A recent study found that 1 out of 6 women incorrectly performed a PFM contraction with verbal instruction (Henderson et al., 2013).
Don’t feel bad if you’re having a hard time getting it right because performing PFM exercises correctly is actually quite tricky. Not only is it important to accurately contract the PFMs but to also know how to fully relax them is problematic in many cases.
WHAT ARE THE PELVIC FLOOR MUSCLES?
The PFMs sit in the base of the pelvis like a hammock. The muscles go from the pubic bone to the tailbone (front and back) and from both ‘sit-bones’ (side-to-side) (Bo et al., 2015). They are a group of muscles and soft tissue that work together to support the pelvic organs. These muscles give us voluntary control over the bladder and bowel so that we can decide when to empty them. When these muscles are weak, the closing pressure around the urethra and anus decreases leading to accidental flatulence and urinary/faecal incontinence.
Above: Side view of the pelvic floor (red hammock of muscle) containing the bladder, vagina, uterus and rectum. “The Boat Theory” gives an analogy of the pelvic floor muscles acting as a suspensory ‘elevating’ system.
If you’re an anatomy nerd, watch this:
WHO SHOULD DO REGULAR PFM EXERCISES?
• Pregnant women • Women who have had a baby • Women during menopause • Women who have a pelvic organ prolapse • High level athletes • Men and women over 60 years old • Men and women with urinary or faecal incontinence • Men with prostate issues • Men with erectile dysfunction
HOW TO START A PFME PROGRAM?
One of the hardest things about a PFM exercise program is remembering to actually do it! It is recommended that the exercises are performed three times a day. One way to remember to do them is to pick three things you do every day and pair them up. For example, brushing your teeth, putting the kettle on, watching the news or driving to work. Another way is to use a memory jogger; this could be a small circle sticker that is placed in a spot that you see every day. You could have a sticker on the fridge, bathroom mirror or bedside table to remind you about doing your exercises. In today’s modern age, setting an alert on your phone is a very easy option also.
There are three common descriptions that are used to visualise how to contract the pelvic floor muscles.
They are: 1. “Imagine trying to slow the flow of urine”, and/or 2. “Imagine trying to stop passing gas”, or 3. “Squeeze and lift your muscles inside your pelvis”.
When you squeeze your PFMs, the muscles are inside your pelvis and no one should be able to tell you are doing your exercises.
HERE’S A GREAT EXPLANATION OF HOW TO DO YOUR PFM EXERCISES:
COMMON MISTAKES DURING A PFME PROGRAM
Some common mistakes people make when doing their PFMEs: • Hold their breath • Tighten their stomach muscles • Squeeze their buttocks and thighs • Bear down or push down through the muscles • Don’t fully relax the muscles between contractions