Kegel Exercises Female Pdf

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Thereare lots of treatments to manage the pelvic floor weakness, including medication and surgeries. Kegel exercises are among the most popular therapies because people can implement them as a daily routine. Kegel exercises are usually custom-made. The number of contractions, duration of holding time, and sets vary across different participants. Currently, there is no fixed protocol for Kegel exercises, but the fundamental rules include: (1) to identify the appropriate muscles which stop or slow the urination, (2) to contract the muscles as mentioned earlier in a correct manner and (3) to repeat the cycle for several times. Many people may contract their hip adductor, abdomen, and gluteal muscles, instead of the pelvic floor muscles during the exercises. Furthermore, alternating fast and slow contractions serve as the key elements of the exercises (Figure 1).

During the fast contractions, the patients tighten and relax the pelvic muscles quickly. During the slow contractions, the patients hold the contracted muscles for a longer period and then relax. The fast contractions train the pelvic floor muscles to adapt to the increased intra-abdominal pressure during coughing and laughing. The slow contractions help with muscle strengthening. Kegel exercises can be used in combination with biofeedback and electrotherapy to improve the treatment effect. Specific devices such as perineometer, Kegelmaster, and vaginal cones are an option in conjunction with Kegel exercises for resistance training.

Several studies compared the effectiveness of supervised Kegel exercises with the unsupervised group. The group undergoing supervised Kegel exercises showed better outcomes of pelvic floor function, including improvement of quality of life, decreasing urine leakage, and higher satisfaction rate.[3][5] Moreover, some studies indicated that brief verbal instruction might not be adequate for beginners who were not familiar with Kegel exercises.[6] Performing Kegel exercises with adequate intensity and frequency is also an important factor for better outcomes. A study in 2006 showed that the treatment might be effective if the training programs last for more than three months.[7] Cavkaytar et al. recommended eight weeks as the minimum period to strengthen the pelvic muscles.[8]

When the pelvic supportive systems become weak or loose, the pelvic organs tend to descent to an abnormal position through the vaginal canal, which called the pelvic organ prolapse (POP). The supportive system comprises a combined action of pelvic floor muscles and connective tissues. POP affects more than half of the women aged over 50 years, and the study based on western Australian females showed that the lifetime risk of POP needing surgery was 19%.[12] However, about 30% of patients still suffered from recurrence after the surgery. The Americans spent more than one billion dollars on treating POP annually.[13] These highlight the importance of prevention, detection, and intervention of POP. The pelvic floor muscles play significant roles in supporting pelvic organs, and the belief is that the POP may experience relief through adequate pelvic muscle training. Kegel et al. first described the effect of Kegel exercise in preventing cystocele and rectocele.[1] Many physical therapists treat POP with pelvic floor muscle training, despite a lack of sufficient evidence and standardized protocols. According to the study of Brkken et al., the pelvic floor muscle training (PFMT) not only improved the stage of POP but also reduced the frequency of symptoms from the disease. The elevation of the bladder and rectum due to improved strength and endurance of the pelvic muscle also occurred in the trained group.[14] Currently, the short- term effects of PFMT has been approved, which is the grade A recommendation from the International Consultation on Incontinence. However, the long-term effects of PFMT remain unclear.[15]

Urinary incontinence and pelvic organ prolapse are common bothersome among women. There are lots of treatments to manage these diseases, including medication and surgeries. Clinicians consider Kegel exercises, designed for pelvic floor muscle strengthening, as the first-line therapy for patients as there are few reported few side effects. Currently, there is no fixed protocol for Kegel exercises, but the critical point is that the patients should contract the pelvic floor muscle rather than abdominal, buttock, or inner thigh muscles.

It is always important to consult with an interprofessional team of specialists that include a general practitioner, obstetrician, gynecologist, urologist, and a physiatrist. The physiotherapists also play crucial roles in the interprofessional group. They should teach the patients the proper way to perform Kegel exercises and how to contract the pelvic floor muscles correctly. The nurses are also vital members of the healthcare team since they will assist with the education of the patient and family.

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Urinary incontinence is the loss of bladder control. The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence, also called overactive bladder. Incontinence affects twice as many women as men. This may be because pregnancy, childbirth, and menopause may make urinary incontinence more likely. Urinary incontinence is not a normal part of aging, and it can be treated.

Urine is made by the kidneys and stored in the bladder. The bladder has muscles that tighten when you need to urinate. When the bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body.

Incontinence can happen when the bladder muscles suddenly tighten and the sphincter muscles are not strong enough to pinch the urethra shut. This causes a sudden, strong urge to urinate that you may not be able to control. Pressure caused by laughing, sneezing, or exercising can cause you to leak urine. Urinary incontinence may also happen if there is a problem with the nerves that control the bladder muscles and urethra. Urinary incontinence can mean you leak a small amount of urine or release a lot of urine all at once.

Urinary incontinence affects twice as many women as men. This is because reproductive health events unique to women, like pregnancy, childbirth, and menopause, affect the bladder, urethra, and other muscles that support these organs.

Urinary incontinence can happen to women at any age, but it is more common in older women. This is probably because of hormonal changes during menopause. More than 4 in 10 women 65 and older have urinary incontinence.1

Women have unique health events, such as pregnancy, childbirth, and menopause, that may affect the urinary tract and the surrounding muscles. The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker or damaged. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate. This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.

Also, the female urethra is shorter than the male urethra. Any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in until you are ready to urinate.

Urinary incontinence is not a disease by itself. Urinary incontinence is a symptom of another health problem, usually weak pelvic floor muscles. In addition to urinary incontinence, some women have other urinary symptoms:4

Urinary incontinence is usually caused by problems with the muscles and nerves that help the bladder hold or pass urine. Certain health events unique to women, such as pregnancy, childbirth, and menopause, can cause problems with these muscles and nerves.

As many as 4 in 10 women get urinary incontinence during pregnancy.7 During pregnancy, as your unborn baby grows, he or she pushes down on your bladder, urethra, and pelvic floor muscles. Over time, this pressure may weaken the pelvic floor muscles and lead to leaks or problems passing urine.

Some women have bladder control problems after they stop having periods. Researchers think having low levels of the hormone estrogen after menopause may weaken the urethra.8 The urethra helps keep urine in the bladder until you are ready to urinate.

If you have urinary incontinence, you can make an appointment with your primary care provider, your OB/GYN, or a nurse practitioner. Your doctor or nurse will work with you to treat your urinary incontinence or refer you to a specialist if you need different treatment.

The specialist may be a urologist, who treats urinary problems in both men and women, or a urogynecologist, who has special training in the female urinary system. You might also need to see a pelvic floor specialist, a type of physical therapist, who will work with you to strengthen your pelvic floor muscles that support the urinary tract.

Your doctor or nurse may ask you to keep a diary for 2 to 3 days to track when you empty your bladder or leak urine. The diary may help your doctor or nurse see patterns in the incontinence that give clues about the possible cause and treatments that might work for you.

You and your doctor or nurse will work together to create a treatment plan. You may start with steps you can take at home. If these steps do not improve your symptoms, your doctor or nurse may recommend other treatments depending on whether you have stress incontinence or urge incontinence or both.

Your doctor or nurse may suggest some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:

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