Kegel's Exercise: Females
Definition[edit | edit source]
Kegel exercise is also known as pelvic-floor exercise . It involves frequently contracting and relaxing the muscles that form part of the pelvic floor.
The aim of these exercises is to strengthen the pelvic floor muscles which have many functions in our body.
The first published description of these exercises was made by American gynecologist Arnold Kegel in 1948. The perineometer ( the vaginal manometer) has been designed to record the contraction strength of pelvic floor muscles. It can be used to guide the participants to conduct the exercises correctly. Dr. Kegel’s study showed that the exercises could help in the prevention of:
- cystocele, rectocele, and urinary stress incontinence 
Function[edit | edit source]
In the female`s body, they are responsible for:
- holding up the bladder
- preventing urinary stress incontinence (especially after childbirth)
You can find more information about pelvic floor anatomy here.
Mechanism of Action[edit | edit source]
The main goal of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor.
The pelvic-floor exercises involve the entire levator ani, which contracts, and relax as one muscle.
The supportive systems composed by :
- the pelvic floor muscles ( levator ani, coccygeus muscles). The levator ani muscle has three portions: the puborectalis which forms a sling around anorectal junction, pubococcygeus, and iliococcygeus muscles. When contracting the puborectalis muscle, the urogenital hiatus closes during physical activities. The pubococcygeus muscle defines from the pubis to the coccyx. You can find the iliococcygeus muscle in the most lateral part of the levator ani muscle. Together, they form a flat plate called the levator plate. Their role is in helping stabilize the pelvic organ. Unfortunately, in some cases, the pelvic floor muscles may become weakened by aging, pregnancy, vaginal delivery, and surgery, and the patients will suffer from urinary incontinence and pelvic organ prolapses.
- the vaginal wall, the arcus tendinous fascia pelvis, and the endopelvic fascia.
- The pelvic floor muscles are crucial for supporting pelvic organs.  
You can find information regarding pelvic organ prolapse here.
Understand the importance of Kegel exercises[edit | edit source]
Many factors can lead to weak pelvic floor muscles: pregnancy, childbirth, surgery, aging, being overweight, excessive straining from constipation, or chronic coughing.
Kegel exercises may help you if you have problems like :
- Leak a few drops of urine while sneezing, laughing, or coughing (stress incontinence)
- Have a strong, sudden urge to urinate just before losing a large amount of urine (urinary urge incontinence)
- Leak stool (fecal incontinence)
These exercises can also be done during all periods of pregnancy or after childbirth.
Try to make these like a daily routine. You can expect results after a few weeks but it can also take a few months, depending from person to person.
Pelvic floor exercises strengthen the muscles around your bladder, bottom, and vagina or penis.
The importance of strengthening pelvic floor muscles is that it will help in conditions like urinary incontinence, and pelvic organ prolapse. It will make sex better too.
People should continue doing the exercises even when they start to notice results.
Some lifestyle changes may also help:
- Drink only when you feel thirsty. Do not exceed six to eight 8-ounce cups of fluid per day from all sources, including soup.
- Quitting smoking reduces coughing, which puts pressure on the bladder.
- Minimize bladder irritants : caffeine, alcohol, carbonated drinks, spicy foods, citrus flavouring.
- Losing weight through a healthy diet and exercise helps relieve urinary incontinence as extra weight puts extra pressure on the bladder and pelvic muscles. Studies have also shown that middle-aged women who are most physically active are least likely to develop incontinence.
- Urinating on a schedule helps to learn to gradually increase the amount of urine that can be comfortably held. It's most often recommended for women with an overactive bladder. "Many women do not know that they should be able to wait three to six hours between urinating. Bladder training retrains the way the brain and bladder interact to give the woman more bladder control," says Dr. Wakamatsu. 
Kegel`s during and after pregnancy[edit | edit source]
Pregnant women or the ones who are planning to get pregnant, should start doing pelvic floor exercises immediately as it will lower the chances of experiencing incontinence after having the baby. 
A Korean study from 2013 indicated that Kegel exercise significantly reduced the development of urinary and fecal incontinence from pregnancy to postpartum. 
Dr Juraj Letko (urogynecologist) with advanced training in female and reconstructive surgery and co-director of the Center for Pelvic Health affirms: " Kegels improve blood circulation to the pelvic floor and vagina, and this may be helpful for arousal and lubrication. A lot of women, after childbirth, feel like their vagina is not as tight as it was before and they want to have surgery for that. But strengthening the pelvic floor muscles with kegel exercises can make it a little bit more taut. It might be tighter because women are better able to contract their muscles, and that might improve sensation. Even if it’s psychological, it can help women feel better about their pelvic floor, so there’s a positive benefit." 
How to do Kegel exercises[edit | edit source]
Step 1- Try to identify Kegel muscles-pelvic floor muscles. You can feel your pelvic floor muscles when are n the toilet and you try to stop the flow of urine.
It's not recommended to regularly stop the flow of urine midstream. This can be harmful to the bladder.
Step 2- You can do it in any position that works for you even when staying at your desk but most people prefer to do it lying down. Work on your technique every day. Try to imagine that you are sitting on a marble. Try tightening your pelvic muscles as if lifting the marble and holding it for three seconds. After that start relaxing for another three.
Step 3- Make sure you always maintain your focus when tightening your pelvic floor muscles. Do not flex the muscles in your abdomen, thighs, or buttocks and please do not forget to breathe freely during the exercises.
Step 4- Do at least three sets of 10 to 15 repetitions a day.
Step 5 - Try to include these exercises in your daily routine. 
Reverse Kegel[edit | edit source]
Fatigued pelvic floor muscles and/ or imbalanced intra-abdominal pressures can produce hypertonic pelvic floor muscles. The Reverse Kegel is a technique that helps to relax pelvic floor muscles. The mental attention of the patient is focused on the pelvic floor muscles . After that, he voluntarily tries to relax them.
You can find more about it here.
Devices used to increase tone in pelvic muscles[edit | edit source]
- A Kegel exerciser
- Jade eggs- used in vaginal weightlifting
- Ben Wa balls
It seems that no evidence doing pelvic floor exercises with weights worked better than doing Kegel exercises without weights. Using these devices comes with greater risk because a foreign object is introduced into the vagina: the risk of infection can lead to vaginosis or toxic shock syndrome. 
References[edit | edit source]
- Huang YC, Chang KV. Kegel Exercises. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32310358.
- Kegel Ah. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948 Aug;56(2):238-48. doi: 10.1016/0002-9378(48)90266-x. PMID: 18877152.
- Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007 Apr;1101:266-96. doi: 10.1196/annals.1389.034. Epub 2007 Apr 7. PMID: 17416924.
- Zanetti Mr, Castro Rde A, Rotta Al, Santos Pd, Sartori M, Girão Mj. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007 Sep 6;125(5):265-9. doi: 10.1590/s1516-31802007000500003. PMID: 18094892.
- Harvard Health Publishing- Harvard Medical School- New guidelines recommend Kegels, other lifestyle treatments for urinary incontinence in women , Written on September 17, 2014 , accessed on May 6 2023
- National Health Service - What are pelvic floor exercises? last reviewed 14 April 2020, accessed on 04.2023
- 6. Park SH, Kang CB, Jang SY, Kim BY. [Effect of Kegel exercise to prevent urinary and fecal incontinence in antenatal and postnatal women: systematic review]. J Korean Acad Nurs. 2013 Jun;43(3):420-30. Korean. doi: 10.4040/jkan.2013.43.3.420. PMID: 23893232.
- Dr Juraj Letko - Kegels: The 30-second exercise that can improve incontinence and sex - UChicago Medicine-article written on October 28 2019 , accessed on 04.2023
- Chief medical editor : Sandhya Pruthi, M.D.- Healthy Lifestyle- Women`s Health - Kegel exercises: A how-to guide for women - Mayo Clinic Staff , accessed on April 2023