Effective Pelvic Floor Exercises

Hi
Does anyone know if there is an evidence based protocol, or guidelines regarding pelvic floor exercises... ie. reps and how frequent, to be effective for stress incontinence or prevention of...for postpartum?
Thanx
Robbie

dear robbie,

well, dr. arnold kegel, an obstetrician/ gynecologist in california (1940), outlined a comprehensive program of progressive contractions of the pelvic floor muscles (PFMs), specifically the levator ani muscle, which is under voluntary control for treating young women with stress incontinence.

later on these exercises were named "kegel exercises" and were taught mostly to pregnant women during childbirth classes. it was in 1990s, following positive cohort studies dr.kegel's program was accepted as an effective treatment option for stress urinary incontinence.

the study emphasized that these exercises increase support to the urethral sphincter and detrusor (bladder) muscle, thereby preventing stress, urge and mixed UI, and are most appropriate in persons who have no cognitive impairments, motivated to comply with the exercise regimen and in those whose pelvic floor is neurologically intact.

well, if your treatment option is kegels, then the patient should be instructed to perform PFM exercises three times daily and, optimally to perform the exercises in 3 positions namely lying, sitting and standing. a minimum of 50-60 PMEs per day is recommended. a gradual increase in number of contractions over a period of PME practice has been shown to increase muscle strength significantly and decrease urine loss.

once the patient is able to identify the muscle, he or she is instructed to perform a series of "quick flicks" or 2-second contractions followed by sustained (endurance contractions) contractions of 5 seconds and longer as part of a daily exercise regimen. at least 10 seconds of relaxation is recommended between contractions.

the goal standard: the patient should aim for a high level of concentrated effort with each pelvic muscle contraction, as good contraction intensity is associated with improvement in pelvic muscle strength. (Bo et al, 1990; Dougherty et al, 1993).

emphasis on contractions before sneezing, coughing, lifting, standing can prevent stress UI from occurring. the muscle also can be contracted when he or she feels a strong urge to void. results may not occur until after 6-8 weeks of exercise, and optimal results usually take longer.

I think I have written a lot on it, anyway if you have any queries feel free to reply.

cheers,

thomas

There is a very good cochrane library systematic review on the various modalities and exercises and their effectiveness in pelvic floor exercises. its really good. If I find it again on internet I would forward u the link.

You would need to register, but Thera-band Academy (Thera-bandacademy.com) has information to supplement Kegels under both "Exercises" & "Research" topics on their website.

exactly correct sir...............thanks for the detailed explainations.

Thomas has given a thoughtful review of basic Kegel philosophy and exercise programming, so I won't try to repeat that. I would say, however, that sometimes the Pelvic Floor gets treated unlike any other musculoskeltal condition. It should not.
For instance, before a physical therapist would apply a good quads strengthening program, they would palpate and assess the Quads! Naturally.
So I would add, the exercise program of Kegel strengthening is only as good as the practioner that gives it. Each woman's injury from a Vaginal birth is different and worth assessing first. If that is how it is done everywhere, great! But I fear it is not always. Sometimes people want a cookie cutter answer to this complex problem. If such answers existed, Physical Therapist's wouldn't exist, would we!
- Crystal (Pelvic Physical Therapists of Alberta member)