Pelvic floor exercise, also known as Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the “Kegel muscles”. The exercise needs to be performed multiple times each day, for several minutes at a time, for one to three months, to begin to have an effect.
Exercises are usually done to reduce urinary stress incontinence (especially after childbirth) and reduce premature ejaculatory occurrences in men, as well as to increase the size and intensity of erections.
Several tools exist to help with these exercises, although various studies debate the relative effectiveness of different tools versus traditional exercises.
They were first described in 1948 by Arnold Kegel.
Factors such as pregnancy, childbirth, aging, being overweight, and abdominal surgery such as cesarean section, often result in the weakening of the pelvic muscles. This can be assessed by either digital examination of vaginal pressure or using a Kegel perineometer. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases.
Pelvic floor exercise is the recommended first-line conservative treatment for women with urinary incontinence of the stress, urge, or mixed types. There is tentative evidence that biofeedback may give added benefit when used with pelvic floor muscle training.
The symptoms of prolapse and its severity can be decreased with pelvic floor exercises. Effectiveness can be improved with feedback on how to do the exercises.
In 1952, Dr. Kegel published a report in which he stated that the women doing this exercise were attaining orgasm more easily, more frequently and more intensely: “it has been found that dysfunction of the pubococcygeus exists in many women complaining of lack of vaginal feeling during coitus and that in these cases sexual appreciation can be increased by restoring function of the pubococcygeus”.
Health effects for men
Though most commonly used by women, men can also use Kegel exercises. Kegel exercises are employed to strengthen the pubococcygeal muscle and other muscles of the pelvic diaphragm. Kegels can help men achieve stronger erections, maintain healthy hips, and gain greater control over ejaculation. The objective of this may be similar to that of the exercise in women with weakened pelvic floor: to increase bladder and bowel control and sexual function.
After a prostatectomy there is no clear evidence that teaching pelvic floor exercises alters the risk of urinary incontinence (leakage of urine).
A paper found that pelvic floor exercises could help restore erectile function in men with erectile dysfunction. There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis.
Mechanism of action
The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and childbirth. Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women and for treating prostate pain and swelling resulting from benign prostatic hyperplasia (BPH) and prostatitis in men. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Kegel exercises may also increase sexual gratification, allowing women to complete pompoir and aid in reducing premature ejaculation in men. The many actions performed by Kegel muscles include holding in urine and avoiding defecation. Reproducing this type of muscle action can strengthen the Kegel muscles. The action of slowing or stopping the flow of urine may be used as a test of correct pelvic floor exercise technique.
It is now known that the components of levator ani (the pelvic diaphragm), namely pubococcygeus, puborectalis and ileococcygeus, contract and relax as one muscle. Hence, pelvic floor exercises involve the entire levator ani rather than pubococcygeus alone. Pelvic floor exercises may be of benefit in cases of fecal incontinence and pelvic organ prolapse conditions e.g. rectal prolapse.
- Bridgeman, Bruce; Roberts, Steven G. (2010-03-01). “The 4-3-2 method for Kegel exercises”. American Journal of Men’s Health. 4 (1): 75–76. doi:10.1177/1557988309331798. ISSN 1557-9891. PMID 19477754.
- “MedlinePlus Medical Encyclopedia: Kegel exercises”. Nlm.nih.gov. 2011-08-29. Retrieved 2011-09-02.
- Dumoulin C, Lemieux MC, Bourbonnais D et al 2004 Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstetrics and Gynaecology 104:504-510