A well-known gynecologist from the USA A. Kegel in the middle of the last century proposed a simulator for the effective restoration of the muscles of the perineum in women with postpartum urinary incontinence. He saw the cause of this disorder in a weakened urethro-vaginal sphincter. Exercises called Kegel exercises are widely distributed in information sources. Sometimes there may be doubts about their authenticity, since in a number of sources such an exercise as “straining” is recommended, which can hardly be recommended by a doctor to his patients who have suffered from a similar strain in childbirth.
The basic principles of gymnastics, declared by A. Kegel:
Regular independent work of the necessary muscles;
Use of elastic load;
Monitoring of the received results by means of periometer.
Kegel exercises and urination. There is a misconception that Kegel exercises are based on interruption of urination. This is not entirely true, because starting and stopping urine is one of the many ways to train the muscles of the perineum. Only the bulbospongius muscle is involved in this process, while the doctor strongly recommended developing all the muscles of the pelvic floor.
Abuse of such an exercise can lead, according to the inventor of the method, “to anxiety, stress and loss of control.” Many women perceive the interruption of urination exercise as a kind of test for the ability of muscles to recover after childbirth. If they cannot perform this exercise, then they agree to surgery. This practice gives surgeons the erroneous reason to believe that Kegel exercises are useless.
The doctor defined 3 important steps of his technique:
The first step is a manual examination. The patient during the external examination should lie on her back with her legs bent at the knees. The doctor examines her ability to tighten perineal tissue at will.
The second step is a vaginal examination. Its goals are to assess the development of the pubococcygeus muscle, as well as to assess the patient’s ability to find and correctly contract the desired muscles. The process alternately includes the muscles of the urethro-vaginal sphincter and the muscles of the anal region, the pelvic floor. You can not connect the muscles of the press, hips, diaphragms, which create intra-abdominal pressure.
The third step is the introduction of a Kegel simulator into the vagina to measure the strength of contractions of the muscles of the vaginal region. The introduction of the perimeter, invented by Kegel, is made after five to ten correctly performed contractions. This is the starting point of the third phase of the program.
Before the invention of the perimeter, there was no similar biofeedback tool in the world practice for assessing the strength of the perineal muscles. This device can be used both in medical practice and in its independent use by a woman at home.
Kegel exercises and feedback. Dr. Kegel was convinced of the need for biofeedback using a perimeter. He repeatedly mentioned this in his works. Kegel was convinced from his own experience that different women have different ability to contract the muscles of the vaginal muscles. At the beginning of gymnastics, many patients cannot create pressure of a few millimeters. After strengthening the muscles of the perineum, the compression of the perimeter reaches 60-80 mm Hg. Art. and even more than this value.
Kegel was convinced that episodic training resulted in minimal gains, while hard work would lead to complete success. In addition, visible changes, measured by the perimeter, encourage the woman to continue exercising.
Subjectivity of manual research. The data of manual measurement of the strength of contractions of the perineum at the present stage are considered approximate values with a gross error. There are more accurate devices for measuring the efforts of the pelvic floor muscles, such as, for example, the VAGITON laser simulator. But such simulators are deprived of the main advantage of the Kegel simulator – the ability to create a load with elasticity. The very resistance of this resistance effectively pumps up the muscles of the pelvic floor.
How much to do? On the recommendation of the doctor, it should be carried out with the perimeter placed in the vagina for at least 60 minutes a day. To be more precise, only 300 contractions, three sets of 20 minutes. If you divide the total number of seconds (3600) by the number of repetitions (300), the remainder is a cycle of 12 seconds. According to Kegel’s instructions, the cycle consists of 6 seconds of contraction and 6 seconds of rest between contractions.
Dr. Kegel argued that the patient receives a powerful motivation if she sees a daily increase in perimeter readings of several millimeters of mercury daily.
What is the efficiency? According to a study conducted by a doctor in 1950 in Los Angeles, out of 300 randomly selected patients, 93% of women completely got rid of pelvic floor muscle weakness and related problems using his exercises. For other doctors, this figure reached 91%. All of these women were spared the need to undergo surgery.
Despite the unimpressive results, the Kegel technique is still not fully used. The use of the simulator proposed by the doctor allows you to train the muscles of the perineum, tracking the effectiveness of training using the feedback method.
[Video] A gynecologist talks about kegel exercises, how to perform them correctly and what methods exist: