PELVIC FLOOR (KEGEL) EXERCISE OVERVIEW: EXERCISES FOR PREGNANCY, POSTPARTUM AND THROUGHOUT LIFE New York physiotherapist Amy Stein suggests identifying the muscle group in question by stopping the flow of urination only briefly and temporarily. She suggests that doing it frequently while urinating may cause more dysfunction from mixed messaging to the brain: empty bladder, then stop! Instead, she suggests a clench/relax cycle three times a day that follows these steps: 1. Tighten the muscle, hold for 10 seconds, and then relax for 10 seconds. Do 10 repetitions. 2. Tighten and hold for 2 seconds, and then relax for 2 seconds. Do 10 repetitions. These two different basic Kegel exercises differ in timing, but not the process. The longer lasting, first set of exercises addresses the slow-twitch fibers that make up 70% of these muscles. These are the muscle fibers that provide support and resist fatigue. The quicker second set of Kegels strengthens those fast contraction fibers that help open and close the bladder and bowel and that are so essential in sexual activity. By doing both types, the expectant woman can strengthen both her marathon endurance muscles and the sprinter muscles that provide a quick jolt of power when needed. 1 In The Birth Partner, noted childbirth educator and physical therapist Penny Simkin advocates conditioning of the pelvic floor muscles as a woman approaches labor with another activity, known as bulging. The ability to let go of these muscles, while pushing to help the baby through them, is important in labor. Simkin suggests that pregnant women rehearse for crowning by consciously bulging out the pelvic floor at the end of a Kegel. To do this, the woman holds her breath and gently strains as though she were having a bowel movement. Alternately, as she contracts her pelvic floor, she may imagine that it is like an ascending elevator. As she next releases the contraction, the “elevator” descends gradually. She bulges the pelvic floor by imagining the elevator reaching basement level. In completion, she brings the elevator back to the first floor so that it is engaged in supporting the uterus. Simkin recommends that, in the last 6 weeks of the pregnancy, she should increase her emphasis on the bulging phase of Kegels.2 Elizabeth Noble suggests another alternative training method involving holding a smooth object inside the vagina while standing. The pelvic floor muscles must contract to retain either homemade devices or a vaginal cone,3 a weighted aid used by physical therapists in treating urinary incontinence. This type of pelvic floor strengthening may help women to more precisely target pelvic floor muscle contractions. The very discernable sensation of the vaginal cone slipping out of the vagina provides valuable feedback in contracting the pelvic floor.4 1. 2. 3. 4. Stein A. Heal Pelvic Pain. NY: McGraw Hill, 2009. Simkin P. The Birth Partner.Third Edition. Boston: Harvard Common Press, 2008. http://www.stepfreevaginalweights.com/ Accessed January 10, 2011. Noble E. Essential Exercises for the Childbearing Year. Harwich, 1995.