Kegel Pelvic Floor Strengthening Program What are Kegel Contractions? Kegel pelvic floor muscle exercises help women improve stress incontinence or the involuntary loss of urine with sudden increases in their abdominal pressure (i.e. sneezing, coughing, running, or exercising). The Kegel exercise is an isometric program designed to strengthen the internal pelvic muscle called the pubococcygeus muscle (the "P.C." muscle). This muscle forms the floor of the pelvis and surrounds the urethra, vagina, and anus, thereby, providing support for all the pelvic organs. It is the muscle used to stop urination, to prevent a bowel movement, or to tighten the vagina during intercourse.   The P.C. muscle contains two types of muscle fibers called "slow-twitch" muscle fibers (70%) and "fast-twitch" muscle fibers (30%). Both muscle fiber types should be exercised so as to improve the muscle's resting tone (slow-twitch) and its rapid reflex contraction (fast-twitch) during episodes of sudden increases in intra-abdominal pressure (i.e., a cough or sneeze). The muscle can be felt by placing your fingers one to two inches inside your vagina, tightening your PC muscle, and feeling the squeeze.   Incorporate the one minute series of contractions (described on the opposite side) as a regular part of your normal voiding routine for the rest of your life. You will significantly improve the strength of your pelvic floor muscles and improve your bladder control and vaginal tightness. During a sudden cough or sneeze, the pelvic floor muscles will contract reflexly, thereby stabilizing the position of the bladder neck and decreasing the accidental loss of urine. Additionally, when you feel an urge to urinate and you contract your PC muscle, there is an immediate reflex stimulation sent to the bladder to relax and thereby suppress the inconvenient sense of urinary urgency. The stronger your PC muscle, the greater the stimulation for relief of the urge sensation.   How Do You Identify the P.C. Muscle? Sit on the toilet and begin urinating. When your bladder is nearly empty, attempt to stop the flow of urine WITHOUT contracting your abdominal, buttocks, or inner thigh muscles. This will help you identify the correct muscle. (Contraction of the P.C. muscle is performed by "drawing in" the vaginal muscles and tightening the bladder and anal sphincters as if to stop urination or defecation.) When you can successfully start and stop urinating or feel the vaginal muscle contract, you are using your P.C. muscle. If you do not succeed initially, keep trying until you have identified the correct muscle, and then do the following exercises as described below.  Performing Kegel exercises: Every time you go to the bathroom (after you finish urinating, but before you stand up) remain sitting on the toilet for one minute and perform either of the following muscle exercises (perform on alternating days):   Slow-Twitch Exercise (perform on odd numbered days): Squeeze your P.C. muscle. Hold the muscle tight for a slow count of three to ten seconds, relax, and repeat again for a total of five to ten contractions. (Remember, do not tighten your thigh, abdominal, or buttocks muscles; tighten only your P.C. muscle).   Fast-Twitch Exercise (perform on even numbered days): Quickly contract and relax your P.C. muscle ("quick flicks") 20 to 50 times, relax for five seconds, and repeat again for a total of two to four sets. You may only be able to start out with a total of 40 "quick flicks"; however, over a period of a few weeks you will be able to increase the number up to a total of 200.   After 6 - 8 weeks you will begin to notice a definite improvement. Don't quit. Remember, this is part of your voiding routine.   This should now be a regular every time you go to the bathroom, forever. It is like any isometric exercise. If you don't exercise this muscle regularly, it will become weak again and your symptoms will return. Many patients with urinary stress incontinence have cured their symptoms completely with these exercises.