December 15, 2015

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continence ›   Kegels ›   pelvic floor ›  


Kegels: R U Doing Them Right?

Our friends at The National Association for Continence recently reported that fully 40 percent of women are doing Kegel exercises incorrectly.

Oh dear.

We want to do our part to correct that, because for one thing, it’s not really that hard to do them right. But most especially because, you really can’t do a single solitary thing to help you maintain pelvic health throughout your life that is more beneficial than Kegels. To avoid incontinence, pelvic organ prolapse, uncomfortable sex, urinary tract infections, a host of difficulties as we age.

Not. One. Thing.

And that goes for your mom. And your daughter.

And guess what? For any man in your life, too.

Yeah! Everybody!

Everybody! Do the Kegels!

But, well, we have a focus here at MiddlesexMD, so our links and discussion might be a bit more female-anatomy-ish. But here’s a very specific link for the men, just so you know I’m quite bullish about Kegels for men, too.

Okay. Let’s get our Kegels on. 

First, if you need a refresher, on your the pelvic floor muscles, I wrote all about that here. I encourage you to review that post so you can envision the lovely figure-eight sling of muscles that hold all of your important organs in their proper places, happily chugging along as you move through your busy day. 

Once you have a clear sense of that pelvic sling of yours, find a place to sit quietly, feet on the floor, straight out from your hips, hands just folded quietly in your lap, eyes closed, breathing softly, with the space and time to give this practice a little focus. 

Are you there? Good. Now, as if you were stopping the flow of urine mid-stream, tighten the muscles around your vagina. That’s all, just as if you were stopping the flow. 

And there they are! Those are the primary muscles we will be working!  Well done, you!

Let’s take it another step. Working just a little harder, imagine that you are sucking a heavy, marble ball into your vagina. But, let’s make it a warm one, and well lubricated! 

As you develop your sense of your inner landscape, try tightening your inner pelvic muscles to draw your pubic bones and tailbone together or imagine trying to draw your “sit bones” toward one another.

But! And here is where things can go wrong, and where people tend to run off the tracks. When you are doing your Kegels, you should not be tightening your buttocks. Let those stay relaxed. Don’t tighten your inner thigh muscles, either. Let those stay soft.

Definitely don’t hold your breath. Breathe softly. Do not suck in your gut. All is soft except that sling under your organs. Focus. And breathe. This thing that takes some concentration at first will become so natural with practice you will be able to do it while waiting in line at the grocery store. 

Here are further ways you can help yourself really refine your practice, and I love these recommendations, and very much encourage you to actually do them!

First, get up close and personal. Use a hand mirror and a good light to watch what happens when you contract these muscles. That’s right—look in the mirror at your pelvic floor in action. It’s pretty cool to see what you can do when you are working those muscles!

Second. Remember they are muscles, and like all muscles, they have a full range of motion that should be worked. Most of us do our Kegels just contracting them. But it’s good practice also to stretch, or elongate them. And one of the best ways to think about that is the Elevator visualization. It goes like this:

Think of your relaxed pelvic muscles as the first floor. Contracting your Kegels as we did for the urine-stop visualization is like taking them to the second or third floor. The marble sucking exercise is maybe the fourth floor. And if you use actual Kegel weights or barbells you can go to the higher floors still. But elongating, or stretching the muscles, is taking your pelvic floor to the basement. Something that’s very good for them. Elongation tends to happen naturally when you yawn. But it’s a nice thing to do for them at the beginning and end of your Kegel sessions. Stretching is a kind of pushing action, a little bit of a bearing down, to stretch the connecting ligaments a little bit, get the blood flowing. 

So, I hope that clears thing up. Don’t be among the 40 percent. And don’t let anyone you love be, either. Good pelvic health is everyone’s right. We ought to be the generation that ensures this for everyone.

The Things Up With Which We Put

We have recently learned that women will live with incontinence 7 (seven) times longer than men will before seeking help for it. 

Wow.

I am the help, so I had to put this to my friends to help me understand why this would happen, because, well, frankly, I try so hard to be easy to talk with, and so do my colleagues, especially my colleagues and all their care teams in urogenital care.

So why, oh why would it take so long for anyone to come to us with such a difficult problem? No news could be more worrying.

As it turns out, it’s one of those problems many of us imagine is untreatable, undiscussable, more embarrassing because we imagine a leaking bladder makes us somehow… less. I just read the word on an incontinence forum: Unwantable. It broke my heart.

Then it sort of made me mad. Because nothing could be further from the truth! If a leaky bladder made us unwantable, most of us would be unwanted! Because here’s the truth! Humans Leak! I’m a doctor! I know this for a fact. We leak all over, all the time! 

But particularly menopausal women leak. I hardly need to mention that, do I? Sneeze, leak. Laugh, leak. Giggle fit, leak. Dream about peeing, major leak.  

Fully a third of us will experience some form of incontinence in our lifetimes. That’s way too many unwanted people, isn't it? So of course that's not right. Incontinence is just human. And it's got lots of causes. And it's treatable. 

Today’s truth is, there are so many varied and layered causes, treatments and options for managing incontinence that we understand now so much better than before, it's as if we have dozens of baseball bats we can grab hold of to smash that tired old stigma to bits.

But we have to do this out loud, and together, and among all of our friends and acquaintances. Let no one you know not help with the stigma smashing! It especially makes sense for us to pay attention to continence issues, and the great people who are helping us understand it and learn to manage it before it manages us. We look forward to sharing more on this and related topics from our friends at the Below Your Belt, where resources are available for women of every age on all aspects of pelvic health.

Too, this month the National Association for Continence (NAFC) is gearing up with free classes all over the United States, and then continuing all year long with Twitter chats on bladder health to help you learn what you need to know to Stay Strong.

Their message: Kegels are important, yes. But we must learn to do them correctly. And they are not the only way to strengthen your pelvic basket. These coaches will teach us to get to know our whole anatomy and strengthen our entire pelvic arena by teaming up with physical therapists and pelvic floor experts across the country to help all of us learn and gain control that we may have lost or may have never had to begin with.

Knowledge is power. Partnering with a provider you trust can get you that knowledge quickly. Check out Below Your Belt and the NAFC website, where you can find classes, coaches, products, a forum to speak openly and honestly with other people who are experiencing exactly what you are, descriptions of different kinds of incontinence and lots of treatment options. It’s a whole new world for us. We don’t have to just live with any of it any more.