Effective Pelvic Floor Exercises

[Robyn]

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

[thomas bibu]

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