First, a little background: Kegels tone and strengthen the pubococcygeal (PC) muscles — three sets of muscles that run like a hammock from your back to your pubic bone, encircling the openings to the vagina and the rectum. “During orgasm, these muscles contract rhythmically. The stronger they are, the more intense the sensation,” says urogynecologist Hilary Cholhan, M.D., director of the Rochester Regional Continence Center in Rochester, NY. Another sex bonus: A woman with strong PCs can grasp her partner’s penis and heighten his sensations by contracting and releasing her muscles.

Locate the right muscles by stopping your urine stream the next time you’re in the bathroom. (Don’t routinely do Kegels while urinating or with a full bladder, though, because this can actually weaken the muscles.) You can also find your PC muscles by inserting a finger into your vagina and trying to squeeze your finger. Make sure you’re not tensing your thighs, buttocks, or anal muscles. Then try these exercises:

The basic Kegel: Slowly contract your muscles, drawing inward and upward. Hold for a count of three; then slowly relax for three seconds. Repeat as many times as you can, working up to 25 or 30 three-second squeezes.

Flutter Kegels: Squeeze and relax the PC muscle rapidly, in a pulsing motion. In the beginning aim for consistency of pulses, rather than speed; that will come with time and practice. Work up to 25 or 30 pulses.

The Kegel push-out: After releasing the contraction, gently push down and out with your PC muscles (no bearing down!). Create Kegel sequences that combine long and short repetitions with push-outs — for example, 10 short squeezes, 10 long squeezes, and five push-outs (any sequence will do).

Elevator Kegels: Picture your vagina as an elevator shaft, with the elevator car at the opening of your vagina. Slowly tighten your muscles as you imagine raising the elevator, pausing at the top, and then lowering it again. Repeat 10 times.

Finally, to really work the PC muscles, do Kegels in various positions — while sitting, standing, lying down, or kneeling — two or three times a day. If you do them regularly, you’ll feel the difference in eight to 12 weeks.

One brave woman opened up an asked this question in a women’s forum:

Let’s talk about kegels. Or rather, incontinence. I know, it’s a very delicate subject, and I have frequently been embarrassed, ashamed, etc. about this little problem. For one thing, I didn’t think I’d even face this until into my 80s or so. I’m too young to have to wear pads every day. I do kegels, when I think about it. I’m probably 10 pounds overweight, most of it in my belly and thighs. I don’t have health insurance, so getting that little ‘tie-up surgery’ is out. And besides, my little sister had that done and 6 years later, it’s no longer effective. Anyone else struggle with this?

So, let’s talk about urinary incontinence (UI) in women. To begin with, there are several types, but we’ll focus on the two main ones here.

Stress urinary incontinence (SUI) (that’s the kind that occurs when you sneeze, cough, lift something, etc) is the most common form, affecting about 50% of those who experience incontinence. It seems to be more common in younger women, though occurs in older women as well.

Urge urinary incontinence (UUI) is more common with advancing age (this is the kind that when you gotta go, you GOTTA go NOW!).
Many women will have a mixture of both.

There are various causes, but interestingly enough; studies have been inconsistent in identifying factors that regularly contribute to UI. Some contributing factors may include:

* childbirth – the more vaginal deliveries, the greater the overall risk

* current smoking status as been associated with UI (though the results are inconsistent in former smokers)

* obesity (it does improve with weight loss)

* constipation

* hysterectomy – Some studies show a 60% greater risk of UI following a hysterectomy.

* hormone therapy (A recent study showed that hormone therapy actually has been shown to increase the incidence of UI. JAMA. 2005;293:935-948.)

Kegels become and important part of treatment with SUI since frequently the pelvic floor muscles are weakened. Just like we need to do strength training for our overall health, we need to do pelvic muscle strength training to support our bodies.

When doing Kegels, it’s important to make sure you are doing them correctly. To identify the correct muscles, sit on the toilet and try and stop your urination. You may notice that your attempts at stopping urinary are ineffective…well those are the very muscles you need to work on. Use this as a bench mark for yourself and re-test yourself weekly.

Kegels must be done several times each day. Fortunately, they can be done anywhere and no one need know what you are doing. When they are done frequently enough, most women will be able to tell a difference. In addition to the contractions, try holding the muscle tight for a count of 8-10.

Other possible treatments include: behavioral modification therapy using biofeedback, physical therapy using weighted cones to help strengthen pelvic floor muscles, bladder training, acupuncture, medications and surgery.

Treatment often takes a multi-pronged approach beginning with an evaluation to discover the exact type of UI that is present (they have different treatment approaches). Often times, treatment will consists of a few different modalities.

For women who wish to try self treatment first, do consider doing kegels, and increase your fluid intake. While that sound counter-intuitive, concentrated urine, along with caffeine are actually bladder irritant and will make the problem worse. Keep a diary to assess how often this is a problem, what may be some contributing factors, and what you are doing to address the problem. When you do see your health care provider, take this diary with you.

If you are faced with this issue, please do see your health care provider for an exam. Left untreated, it generally does not get better on its own, but can improve with the proper treatment.

©2005, Barbara C. Phillips, Nurse Practitioner and founder of OlderWiserWomen™ inspires women to embrace the freedom, magic and wisdom of Successful Aging. Visit http://www.OlderWiserWomen.com for your copy of “Celebrating You: 50 Tips for Vibrant Living”.

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