The Kegel (pronounced KEE gull) exercises are named after Dr. Arnold Kegel, the doctor who developed them. They are designed to restore or improve pelvic floor muscle tone and to increase control over those muscles. Figure 4.1 shows the results of a well-toned pelvic floor, while Figure 4.2 shows the consequences of a poorly toned pelvic floor.
The muscles of the pelvic floor can be pictured as hammock that is attached to the pubic bone in the front and to the coccyx in the back (See Figure 4.1). This muscle group is also called the pubococcygeus, named for its position. Part of this group—the sphincters—forms a figure 8 around the urethra and vagina in the front and the anus in the back (See Figure 4.3).
With exercise you can achieve voluntary control of the pelvic floor, which will enable you to release the area consciously during birth. Relaxation of the pelvic floor will allow your baby an easier passage during expulsion and perhaps reduce the need for an episiotomy. During birth, the pelvic floor muscles are stretched, and Kegel exercises can help eliminate the problems that often result from this stretching—prolapsed (sagging) uterus, prolapsed bladder, and urinary stress incontinence (uncontrolled leaking of urine caused by sudden movements such as coughing or sneezing). If done shortly after birth, contracting the muscles of the pelvic floor shortens the muscle fibers that were stretched during birth and thus aids their restoration. After an episiotomy, doing this exercise increases the blood flow to the area, reducing swelling and aiding healing.
An added bonus of Kegels is increased sensitivity in the vagina during sexual intercourse. Improving the pelvic floor muscle tone causes the vagina to become more snug, and the response from the nerve endings beneath the vaginal walls is improved. Your husband, too, will appreciate this extra snugness! The benefits of the Kegels therefore are not limited to the period of birth, but extend into the immediate postpartum period and can continue throughout life.
To exercise the pelvic floor muscles, your first step should be to locate the muscles. Do this by contracting the muscles around the urethra as if you were trying to hold back urine. Next, try urinating at a time when your bladder is not full, stopping and starting the flow of urine several times. Stopping the flow tightens the pelvic floor, while releasing the flow relaxes it.
Another way to check for pelvic floor tension and relaxation is to tighten your vaginal muscles around your partner’s penis during sexual intercourse. Your partner can give you feedback on the effectiveness of this exercise.
Once you recognize your pelvic floor muscles, you should discontinue practicing the exercise during urination. Instead, practice after urinating, contracting the pelvic floor by lifting and tightening the muscles and holding for a count of 20 seconds. Try to maintain the contraction. If you feel the muscles relaxing, tighten them again. Do 1 rep of this exercise ten times a day. This particular Kegel exercise has been labeled the super Kegel by Penny Simkin, a well-known childbirth educator and author. It increases the awareness of and the strength of the pelvic floor muscles.
Hint: Do a super Kegel while washing your hands after urinating, since it is best to perform this exercise with an empty bladder. Pr, use everyday activities such as washing the dishes and stopping at red lights as reminders to do a super Kegel. After the baby comes, doing a super Kegel with every diaper change will ensure plenty of practice.
- Compliment your mate on her good posture.
- Do not let your mate lift heavy items.
- Exercise with your mate.
- Remind your mate to do her Kegels.
- Take walks with your mate.
- Discourage your mate from becoming overheated in hot tubs, saunas, and steam rooms.
- Discourage your mate from performing strenuous exercise on hot, humid days.
- Start performing perineal massage on your mate at 34 weeks.
- Offer to give your mate a massage.
Another Kegel exercise that will help prepare you for birth is the elevator exercise. This exercise is done by imagining the pelvic floor to be an elevator. Contract the muscles upward, from the first floor to the fifth floor, stopping at each floor and getting tighter as you go higher. Then, relax downward, releasing tension at each floor, from the fifth to the first. Continue to release the muscles completely, to a basement level, by giving them a slight push. This is the degree of relaxation you will need to achieve while pushing the baby down the birth canal. Always return to the second level to maintain a constant degree of tension in the pelvic floor. Imagine a hammock returning to its normal, higher position when you get up.
With continued practice, you should develop enough control to lift the elevator ten floors. Make sure that you do not hold your breath. This Kegel exercise helps you to achieve deeper muscle control in preparation for pushing. Practice this exercise, with your bladder empty, at least twice a day.
You should practice super Kegels for the rest of your life, not just while you are pregnant. Super Kegels will help you maintain optimum muscular condition of the pelvic floor. According to Penny Simkim, this is the most important exercise a woman of any age can do.