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Exercise To Reduce or Eliminate Overactive Bladder and Stress Incontinence

No doubt, every woman has heard of Kegel exercises. A recent Google search listed approximately 63,700,000 "hits" regarding the subject. There is good reason for the interest in these exercises: Properly performed, Kegel exercises can be 60-80 percent successful in reducing or even eliminating the symptoms of overactive bladder and stress urinary incontinence. Unfortunately, for large numbers of women attempting Kegel exercises, the results are quite unsatisfactory for two main reasons. In most situations, these women have never been taught exactly how to perform the exercises that target the muscles in the pelvic region and, in some cases, the muscles are already too weak to produce a successful outcome. Let's see how these problems can be overcome.

To perform these exercises properly, women must have at least some knowledge of female pelvic anatomy and what the exercises are expected to accomplish.

If one were to examine a Halloween skeleton, one would discover that the ring of bones forming the pelvis is "open" at the top and the cavity that they form is continuous with the abdominal cavity. Further inspection would reveal that these bones are also "open" at the bottom (the pelvic outlet). Therefore, if there were not some type of support for the organs within the female pelvis (the uterus, vagina, bladder, urethra, and rectum), when a woman stood up, these organs would simply "fall out of her body through the pelvic outlet and onto the floor."

Obviously, such a situation would not be acceptable. Nature has provided for this support in the form of the "pelvic floor muscles" that span the pelvic outlet and thus, support the pelvic organs. These muscles at various times have been called a sling or a hammock. Another way to picture these muscles is to imagine the "good hands" from the Allstate Insurance commercials, supporting and holding the pelvic organs in place. There are actually a number of pelvic floor muscles and their exact relationship to each other and to the pelvic organs that they support is complicated and still being discovered. However, collectively these muscles are called the levator ani muscles of which one of the primary supporting muscles is the pubococcygeus muscle; as proper strength and function of this muscle is critical for the control of urination, it is also this specific muscle that must be exercised for Kegels to work to reduce the symptoms of incontinence. The problem arises when women attempt to "identify or locate" this muscle so that they can subsequently exercise it.

If a woman were asked to bend her arm at the elbow, she would immediately and almost instinctively know to identify and contract her biceps muscle. This is muscle behavior that she has been familiar with all of her life; to bend her arm, she hardly has to think about which muscle is needed. The situation with the pelvic floor muscles is quite different. First, unlike the biceps muscle, for instance, the pelvic floor muscles can, and do contract "on their own" as part of a reflex maneuver. Therefore, a woman doesn't even need to be aware of these muscles for her body to function properly. Second, the muscles, being located deep in the pelvic cavity, essentially prevent someone (i.e. a healthcare worker) from pointing at the muscle or touching it and saying "now contract this muscle." Third, with pregnancy, delivery, aging, pelvic surgery, etc. these muscles can become weak to the point that even if a women can identify them, she is not able to notice any contraction.

There are two common methods used to help a women identify these muscles. The first is through instruction. The pelvic floor muscles are the muscles that one contracts to avoid passing stool or gas, or to interrupt the urinary stream. Therefore, if a woman contracts her muscles as though she were performing one of these maneuvers, then, by definition, she would be properly performing a Kegel exercise. Unfortunately, many women with weakened pelvic floor muscles are unable to target the correct muscles, and instead incorrectly contract their abdominal, hip, thigh, or buttocks muscles. -Working these muscles will not lessen incontinence. A second method is for a healthcare worker (physician, nurse, etc.) to place his/her finger in the patient's vagina and ask the patient to "squeeze" her muscles around the finger. Once again, doing so requires contraction of the pelvic floor muscles, resulting in a properly performed Kegel. Many times both of these methods require considerable trial and error and patience. However, when the correct muscles are finally located, there is a "gotcha" moment as a "light bulb" turns on and the patient finally understands. From that point on, she can be comfortable knowing that her exercise program will be maximally suited to help with her incontinence.

Once the appropriate muscles have been identified, the next step is determining how they should be exercised. There are a great many "recipes" that seek to answer this question and, while each may contain some of the correct ingredients, most are much too complicated for everyday use. It should be noted that the goal of Kegel exercises is three-fold: First, the strength of the muscle contraction, or how forcefully the muscle can be contracted, needs to be increased. Second, the endurance of the contraction, or the length of time the contraction can be held must increased. Third, the actual contraction process needs to become ingrained in the patient's mind, becoming second nature so that it can be instantaneously relied upon when a woman senses impending incontinence.

To accomplish these goals, the woman should begin with a series of contractions where the muscles are squeezed as tightly as possible for three seconds, then relaxed for three seconds, then squeezed for three seconds, etc., for a total of ten squeeze/relax repetitions. Ultimately, with time, practice, and perseverance, a woman should aim to maximally squeeze/relax for ten seconds each and repeat these maneuvers a total of ten times; this would constitute one complete set of Kegel exercises. Initially, of course, many women may not be able to squeeze very tightly, or hold the contraction for three seconds, or repeat the process ten times. They should definitely not despair. Remember, in most cases, the pelvic muscles have been neglected for years and it will take time to rehabilitate them properly. A committed patient should perform the exercises twice a day, and furthermore, at each session, she should perform one set of Kegels in a standing position, one set in a sitting position, and one set in a lying position. This plan may sound like it requires too much time. However, if a woman "does the math" - ten seconds to squeeze, ten seconds to relax, times ten repetitions, times three positions, the required time is only ten minutes twice a day.

There is increasing and convincing evidence that a great many female pelvic problems such as urinary incontinence, pelvic organ prolapse, chronic pelvic pain, etc. are simply the result of weakened pelvic floor muscles. Simple, entirely non-invasive Kegel exercises can be very helpful in reducing or eliminating these debilitating problems.