Kegel exercise
Encyclopedia
A pelvic floor exercise, more commonly called a Kegel exercise (named after Dr. Arnold Kegel
), consists of contracting and relaxing the muscles that form part of the pelvic floor
, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective. Exercises are usually done to reduce urinary incontinence
and aid with childbirth in women, and reduce premature ejaculatory
occurrences in men, as well as increase the size and intensity of erections.
by strengthening the pubococcygeus muscle
s 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 vaginal 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 and aid in reducing premature ejaculation
. Many actions that are controlled by Kegel muscles include "holding in" urine or avoiding defecation. Reproducing these types of muscle actions can yield stronger Kegel muscles.
The original pelvic toning device was the perineometer invented by Arnold Kegel to facilitate the measurement of the strength of the pubococcygeus muscle
when it was resting and being actively squeezed - sometimes referred to as the Kegel tone.
Unfortunately his device was a combination of rubber balloons and tubes that measured pressure using a column of water. It was neither easy to use nor portable.
During the latter part of the 20th century a number of medical and pseudo-medical devices were developed and launched onto the market. Some of these are used in a clinical setting, but most are designed for women to use in the privacy of their own home.
Pelvic toning devices fall into a number of different types:
Unfortunately there are a number of products on the market that have no impact at all on the pubococcygeus muscle
. If the PC muscle is not engaged then it is impossible to improve the muscle tone or strengthen the muscle. Devices that are used externally, for example between the thighs, may exercise the adductor muscle but do nothing for the pelvic floor.
Clinical research published in the British Medical Journal compared pelvic floor exercises, vaginal weights and electro-stimulation in a randomised trial. The research recommended that pelvic floor exercise should be the first choice of treatment for genuine stress incontinence because simple exercises proved to be far more effective than electro-stimulation or vaginal cones.
This situation was confirmed in a comprehensive review of the treatment of stress incontinence published in the British Journal of Urology International in 2010. The report author noted that electrical stimulation devices and weighted vaginal cones are not recommended by the UK National Institute for Clinical Excellence (NICE) and "are not universally advocated by clinicians as they have yet to produce sufficient evidence of efficacy".
Clinical trials of a progressive resistance vaginal exerciser concluded that the device was as effective as supervised pelvic floor muscle training, the gold standard treatment of the UK NHS where patients are referred to a specialist continence advisor for one on one training over a three month period. The report also noted that the device can help overcome the fundamental weaknesses associated with pelvic floor muscle exercises (PFME), i.e. poor training, lack of patient confidence and poor compliance with the exercise recommendations.
Key points noted by the research are that:
A progressive resistance vaginal exerciser is the only form of pelvic toning device available on prescription in the UK to women presenting with symptoms of urinary stress incontinence or pelvic floor weakness.
, 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.
of randomized controlled trials by the Cochrane Collaboration
concluded that "PFMT [Pelvic floor muscle training] be included in first-line conservative management programs for women with stress, urge, or mixed, urinary incontinence...The treatment effect might be greater in middle aged women (in their 40s and 50s) with stress urinary incontinence alone...".
of pelvic organs. A meta-analysis
of randomized controlled trials by the Cochrane Collaboration
concluded that "there is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse".
and other muscles of the pelvic diaphragm. Kegels can help men achieve stronger erections 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.
of randomized controlled trials by the Cochrane Collaboration
found "conflicting information about the benefit of
pelvic floor muscle training for either prevention or treatment of urine leakage".
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. It is also possible that strengthening the pelvic floor may allow some men to achieve a form of orgasm
without allowing ejaculation
, and thereby perhaps reach more than one "climax" during sexual activity. In men, this exercise lifts up the testicles, also strengthening the cremaster muscle
, as well as the anal sphincter muscles
, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus and runs up to the urinary sphincter.
Arnold Kegel
Arnold H. Kegel M.D., F.A.C.S. was a gynecologist who invented the Kegel Perineometer and Kegel exercises as non-surgical treatment of genital relaxation...
), consists of contracting and relaxing the muscles that form part of the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective. Exercises are usually done to reduce urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
and aid with childbirth in women, and reduce premature ejaculatory
Premature ejaculation
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....
occurrences in men, as well as increase the size and intensity of erections.
Explanation
The aim of Kegel exercises is to improve muscle toneMuscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...
by strengthening the pubococcygeus muscle
Pubococcygeus muscle
The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles.-Function:The Pubococcygeus muscle controls...
s of the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
. Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
for physiological stresses of the later stages of pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
and vaginal childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. Kegel exercises are said to be good for treating vaginal prolapse
Vaginal prolapse
Female genital prolapse is characterized by a portion of the vaginal canal protruding from the opening of the vagina...
and preventing uterine prolapse
Uterine prolapse
Uterine prolapse is a form of female genital prolapse Uterine prolapse is a form of female genital prolapse Uterine prolapse is a form of female genital prolapse (also called pelvic organ prolapse or prolapse of the uterus (womb).Treatment is surgical, and the options include hysterectomy or a...
in women and for treating prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
pain and swelling resulting from benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH) and prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
in men. Kegel exercises may be beneficial in treating urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
in both men and women. Kegel exercises may also increase sexual gratification and aid in reducing premature ejaculation
Premature ejaculation
Premature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....
. Many actions that are controlled by Kegel muscles include "holding in" urine or avoiding defecation. Reproducing these types of muscle actions can yield stronger Kegel muscles.
Pelvic toning devices
A pelvic toning device (generically referred to as a Kegel exerciser, pelvic floor toner, pelvic floor muscle toner or pelvic toner) is a medical or pseudo-medical device designed to help women exercise their pelvic floor muscle and improve the muscle tone of the pubococcygeal or vaginal muscle.The original pelvic toning device was the perineometer invented by Arnold Kegel to facilitate the measurement of the strength of the pubococcygeus muscle
Pubococcygeus muscle
The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles.-Function:The Pubococcygeus muscle controls...
when it was resting and being actively squeezed - sometimes referred to as the Kegel tone.
Unfortunately his device was a combination of rubber balloons and tubes that measured pressure using a column of water. It was neither easy to use nor portable.
During the latter part of the 20th century a number of medical and pseudo-medical devices were developed and launched onto the market. Some of these are used in a clinical setting, but most are designed for women to use in the privacy of their own home.
Pelvic toning devices fall into a number of different types:
- barbells, vaginal weights or cones designed to be held in the vagina. The action of passively/actively retaining the device internally is supposed to improve muscle tone. Barbells are made of smooth, polished solid stainless steelStainless steelIn metallurgy, stainless steel, also known as inox steel or inox from French "inoxydable", is defined as a steel alloy with a minimum of 10.5 or 11% chromium content by mass....
, cylindrical in shape, with a rounded bulge at each end. They typically weigh one pound (454 g) and measure approximately 6¾ inches (17.1 cm) in length with a diameter of one inch (2.5 cm) at the widest part. Being made of stainless steel, vaginal barbells are nonporous and can be wiped clean with a cloth moistened with mild soap and water. - electro-stimulation or TENSTranscutaneous electrical nerve stimulationTranscutaneous electrical nerve stimulation is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes...
devices that administer an electrical current through an internal probe. The current stimulates the adjacent muscles to twitch. - rubber resistance balls and indicators. These devices provide a nominal resistance to squeeze against. An advantage of rubber bulb devices is that they provide visual feedback (via a gauge) of how much pressure is being applied.
- progressive resistance vaginal exercisers with springs are the only devices that meet all of Kegel's criteria. They provide a biofeedback that the correct muscles are being engaged and are capable of fulfilling the basic fundamentals of an exercise regime by applying a variable and increasing resistive force to maximise the exercise effort.
Unfortunately there are a number of products on the market that have no impact at all on the pubococcygeus muscle
Pubococcygeus muscle
The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles.-Function:The Pubococcygeus muscle controls...
. If the PC muscle is not engaged then it is impossible to improve the muscle tone or strengthen the muscle. Devices that are used externally, for example between the thighs, may exercise the adductor muscle but do nothing for the pelvic floor.
Clinical research published in the British Medical Journal compared pelvic floor exercises, vaginal weights and electro-stimulation in a randomised trial. The research recommended that pelvic floor exercise should be the first choice of treatment for genuine stress incontinence because simple exercises proved to be far more effective than electro-stimulation or vaginal cones.
This situation was confirmed in a comprehensive review of the treatment of stress incontinence published in the British Journal of Urology International in 2010. The report author noted that electrical stimulation devices and weighted vaginal cones are not recommended by the UK National Institute for Clinical Excellence (NICE) and "are not universally advocated by clinicians as they have yet to produce sufficient evidence of efficacy".
Clinical trials of a progressive resistance vaginal exerciser concluded that the device was as effective as supervised pelvic floor muscle training, the gold standard treatment of the UK NHS where patients are referred to a specialist continence advisor for one on one training over a three month period. The report also noted that the device can help overcome the fundamental weaknesses associated with pelvic floor muscle exercises (PFME), i.e. poor training, lack of patient confidence and poor compliance with the exercise recommendations.
Key points noted by the research are that:
- the device gives “confidence to women that they were correctly contracting their pelvic floor, and this may be helpful encouragement when a woman is starting out on a regime of PFME”.
- the biofeedback given by the device “may be particularly helpful to demonstrate to the woman that she is carrying out the PFME appropriately”.
- the device is particularly relevant to those women “who do not consult their physician and wish to maintain confidentiality regarding their SUI symptom”.
A progressive resistance vaginal exerciser is the only form of pelvic toning device available on prescription in the UK to women presenting with symptoms of urinary stress incontinence or pelvic floor weakness.
Benefits for women
Factors such as pregnancyPregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
, aging, being overweight
Overweight
Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary...
, 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
Perineometer
A perineometer or Kegel perineometer is an instrument for measuring the strength of voluntary contractions of the pelvic floor muscles. Arnold Kegel was the gynecologist who invented the Kegel Perineometer and Kegel exercises...
. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases.
Urinary incontinence
The consequences of weakened pelvic floor muscles may include urinary or bowel incontinence, which may be helped by therapeutic strengthening of these muscles. A meta-analysisMeta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
of randomized controlled trials by the Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
concluded that "PFMT [Pelvic floor muscle training] be included in first-line conservative management programs for women with stress, urge, or mixed, urinary incontinence...The treatment effect might be greater in middle aged women (in their 40s and 50s) with stress urinary incontinence alone...".
Pelvic prolapse
The exercises are also often used to help prevent prolapseProlapse
Prolapse literally means "to fall out of place", from the Latin prolabi meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the...
of pelvic organs. A meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
of randomized controlled trials by the Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
concluded that "there is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse".
Benefits for men
Though most commonly used by women, men can also use Kegel exercises. Kegel exercises are employed to strengthen the pubococcygeal musclePubococcygeus muscle
The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles.-Function:The Pubococcygeus muscle controls...
and other muscles of the pelvic diaphragm. Kegels can help men achieve stronger erections 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.
Incontinence
Regarding postprostatectomy urinary incontinence, a meta-analysisMeta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
of randomized controlled trials by the Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
found "conflicting information about the benefit of
pelvic floor muscle training for either prevention or treatment of urine leakage".
Sexual function
Kegel workouts can provide men with stronger erections. Research published in 2005 issue of BJU International, have shown that pelvic floor exercises could help restore erectileErection
Penile erection is a physiological phenomenon where the penis becomes enlarged and firm. Penile erection is the result of a complex interaction of psychological, neural, vascular and endocrine factors, and is usually, though not exclusively, associated with sexual arousal...
function in men with erectile dysfunction
Erectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
. There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis. It is also possible that strengthening the pelvic floor may allow some men to achieve a form of orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
without allowing ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
, and thereby perhaps reach more than one "climax" during sexual activity. In men, this exercise lifts up the testicles, also strengthening the cremaster muscle
Cremaster muscle
-Contraction:Its function is to raise and lower the testes in order to regulate the temperature of the testes and promote spermatogenesis. Contraction may also occur during arousal which can prevent injury to the testicles during sex....
, as well as the anal sphincter muscles
Anal sphincter muscles
Anal sphincter muscles can refer to:* Sphincter ani externus muscle* Sphincter ani internus muscle...
, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus and runs up to the urinary sphincter.
External links
- Judith Florendo, PT. Kegels De-Mystified for Women. A Healthy Balance (National Association for Continence) Fall 2008 Vol 26 No 3
- MayoClinic.com. Kegel exercises: how to strengthen pelvic floor muscles
- Video on Kegel exercises for men to prevent erectile dysfunctionErectile dysfunctionErectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
from Channel 4Channel 4Channel 4 is a British public-service television broadcaster which began working on 2 November 1982. Although largely commercially self-funded, it is ultimately publicly owned; originally a subsidiary of the Independent Broadcasting Authority , the station is now owned and operated by the Channel...
's The Sex Education Show