Pelvic floor

First published in 1948 by gynecologist Dr. Arnold Kegel, a pelvic floor exercise, more commonly called a Kegel [key-guhl] 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.’

Exercises are usually done to reduce urinary incontinence after childbirth, and reduce premature ejaculatory occurrences in men, as well as to increase the size and intensity of erections. The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus (PC muscle) of the pelvic floor.

Kegels are recommended for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and childbirth. 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 but should not be practiced as a regular exercise to avoid urinary retention (failure to urinate).

It is now shown 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. In men, Kegels 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 PC muscle begins around the anus and runs up to the urinary sphincter.

The original pelvic toning device was the perineometer, invented by Arnold Kegel to facilitate the measurement of the strength of the PC muscle when it was resting and being actively squeezed – sometimes referred to as the Kegel tone. 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.

Since then, a number of medical and pseudo-medical devices have been designed for women to use in the privacy of their own home. Barbells, vaginal weights or cones are designed to be held in the vagina, passively or actively retaining the device internally. Barbells are made of smooth, polished solid stainless steel, cylindrical in shape, with a rounded bulge at each end. They typically weigh one pound. Electro-stimulation or TENS devices administer an electrical current through an internal probe which stimulates the adjacent muscles to twitch.

Rubber resistance balls and indicators 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. However, 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 fundamentals of an exercise regimen by applying a variable and increasing resistive force to maximize the exercise effort. Devices that are used externally, for example between the thighs, may exercise the adductor muscle but do nothing for the pelvic floor.

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