Kegel exercise

Overview
A Kegel exercise, named after Dr. Arnold Kegel, is an exercise designed to strengthen the pubococcygeus muscles. The exercises consist of the regular clenching and unclenching of the sex muscles which form part of the pelvic floor (sometimes called the "Kegel muscles").

Explanation
The aim of Kegel exercises is to restore muscle tone and strength to the pubococcygeus muscles in order to prevent or reduce pelvic floor problems and to increase sexual gratification. Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women; and for treating prostate pain and swelling resulting from Benign Prostatic Hyperplasia (BPH) and Prostatitis in men. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Kegel exercises are also known as pelvic floor exercises, or simply Kegels.

Although Dr. Kegel contemporized and popularized this practice, it is by no means new. The Taoists of ancient China developed a number of different sexual practices to strengthen and tone these same muscles for health, longevity, sexual gratification, and spiritual development. Directly akin to the Kegel exercise is the Taoist practice of the Deer Exercise. The Yogis of India also had a similar practice in Hatha Yoga known as Aswini Mudra (the horse gesture) which is taught and practiced to this day.

Benefits for Women
Factors such as pregnancy, childbirth, aging and being overweight often result in the weakening of the pelvic muscles. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases.

Urinary incontinence
The consequences of weakened pelvic floor muscles may include urinary or bowel incontinence, which may be helped by therapeutic strengthening of these muscles. A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "PFMT [Pelvic floor muscle training] be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence...The treatment effect might be greater in younger women (in their 40's and 50's) with stress urinary incontinence alone...".

Pelvic prolapse
The exercises are also often used to help prevent prolapse of pelvic organs. A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "there is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse".

Sexual function
Regular Kegel exercise can also increase sexual pleasure for women and their partners. After childbirth, practicing pelvic floor contractions during vaginal sex will allow the woman immediate feedback from her partner, who can tell her whether they can feel her muscles tightening. A newly postpartum woman - who has yet to return to sexual intercourse - can retrain her pelvic floor muscles to their pre-pregnancy strength and tone by inserting two or three fingers into her vagina and squeezing them with pelvic floor contractions.

Benefits for Men
Though most commonly used by women, men can also use Kegel exercises. They are used to strengthen the pubococcygeal muscle and other muscles of the pelvic diaphragm. The object of this may be similar to that of the exercise in women with weakened pelvic floor, i.e. to increase bladder and bowel control and sexual function.

Incontinence
Regarding postprostatectomy urinary incontinence, a meta-analysis of randomized controlled trials by the Cochrane Collaboration found that "there may be some benefit of offering pelvic floor muscle training with biofeedback early in the postoperative period immediately following removal of the catheter as it may promote an earlier return to continence".

Sexual function
There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis. It is also possible that strengthening the pelvic floor may allow some men to achieve a form of orgasm without allowing ejaculation, and thereby perhaps reach multiple 'climaxes' during sexual activity.

In men this exercise lifts up the testicles, also strengthening the cremaster muscle as well as the anal sphincter, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus and runs up to the urinary sphincter. Men should be patient when they begin kegel exercises as it may take 4 to 6 weeks to see a substantial difference. Women are able to add resistance to the exercise through isometrically gripping a hard object (such as a Kegel exerciser), or by compressing an object such as foam, but there are no known techniques that would add resistance to male Kegel exercises.

Potential concerns
The pubococcygeal muscles are those used to stop the flow of urine during urination, and they may be easily identified in this way. However, after the muscle has been identified, practicing Kegel exercises during urination is not recommended, as this could lead to a urinary tract infection.