Kegel exercises


The DEEP Pelvic floor muscles

(Keywords: Kegel exercises, chiropractic help, non bacterial prostatis, pubococcygeus muscle, deep pelvic muscles)

The Kegel exercises help maintain the health of the deep pelvic floor muscles, improving the stability of the pelvis as well as the organs therein. Good tone prevents incontinence, improves sexual performance. These exercises are a simple way of strengthening the vital pelvic floor muscles.

Normal posture of the pelvis is vital, not only for the spine, which has the sacrum has its foundation, but also for the support of the internal organs of the pelvis. The most important muscles of the pelvic "corset" are:

  1. The abdominal muscles
  2. The small lumbar extensor muscles, and
  3. The deep pelvic floor muscles.

Pubo-Coccygeus  (PC) muscle

There are nine different muscles belonging to the deep floor of the pelvis, most note-worthy of which is the Pubo-coccygeus (PC) muscle, which is slung like a hammock from the pubic bones in the front to the coccyx at the back. Notice that in the male the prostate rests on the PC, and the urethra must penetrate through a small hole in the PC muscle.



They stretch from the pubic bones in the front, sideways to the ilium and backwards to the sacrum and coccyx, hitching onto these bones.


Again, can you see the 'hammock' made up by nine muscles, primarily the PC which stretches from the pubic bones in the front to the coccyx posteriorally?


Aside: the coccyx is a vital little bone for the attachments of these muscles. NEVER have it surgically removed. It's quite exposed and prone to injury from direct trauma. This last month a lady with acute back and coccyx pain (and neck and rib pain) after a fall from a horse. Fraid I dislike horse riding, more dangerous that motor bikes and gliders!

Her coccyx is 50% better after external mobilisation of the coccyx, and a coccyx cushion that she made from these plans: Coccyx pillow ...

Neck, rib and back pain are almost over with chiropractic help, but that little coccyx is being stubborn. May still have to do an internal though neither of us relish it.

the pelvic 'corset' of course are vital for good spinal and organ health, but the third, the deep pelvic muscles are the most often neglected. To maintain good spinal posture and healthy internal organs, it is vital that these muscles have continuous, partial contraction (tonus), quite apart from any conscious control.

Note how the vagina and urethra pass through the PC muscle. A healthy PC promotes greater pleasure in coitus and prevents a leaking bladder during and after pregnancy, and in old age.

Reflexes

I’m sure you’re aware that when your chiropractor tests to see whether the nerve circuits in your leg are intact - by tapping on a tendon, for example just below the kneecap - that the Quadriceps muscle responds automatically, tightening in an unconscious manner, and making your foot shoot forward. It is very important that the body responds immediately in this way if any sudden demand is placed on a muscle.

A healthy PC muscle behaves similarly, able to contract spontaneously and clamp the urethra closed, preventing any leakage when a woman goes jogging for example. It acts in exactly the same way in the male, preventing premature ejaculation, and increasing his and his partner's pleasure. In women, if these muscles are weak then the bladder, uterus and even the bowels could drop down pressing onto the vagina and contributing to urinary incontinence, a horrid and embarrassing, and largely preventable, condition. Hence the need for the Kegel exercises.

Chronic Pelvic Pain Syndrome = Non-Bacterial Prostatitis

Numerous medical groups have suggested that this annoying and painful male condition, often thought to eminate from an infection of the prostate gland, but known not to respond to anti-biotics, is in fact an abnormal pelvic muscle spasm.

Trigger points in these muscles are a major cause of prostate pain in men. Whilst there is much relief to be had from intra-rectal cross-friction of the deep pelvic floor muscles and the prostate itself, it is obviously an awkward procedure, and the Kegel exercises are a better preliminary treatment.

The NIH did some very interesting research on a group of men whose doctors had typically attributed their pelvic pain to a prostatitis infection. By intrarectal examination they assessed the pain and tenderness in the deep pelvic muscles:

41% had pain in the prostate gland itself, but in 27% the pain was in the deep pelvic muscles.


Phytosterols

Fascinating and conclusive research now concludes that a group of substances in plants (sitosterol is the one mainly used) make a VITAL contribution to benign prostate conditions.

What are phytosterols ...?



Chiropractic Help Treatment

Every chiropractor, and medical doctor, is trained to examine the prostate muscle. There remains debate: is this a 'medical' condition? If the prostate is involved, then yes, probably. But if trigger points in the PC are the culprit (just the same, say as in a tennis elbow ) then your chiropractor is the expert who should be treating this condition.

In practice? Neither medical doctors, nor chiropractors frequently do the required simple, basic, relieving cross friction of the prostate and pelvic floor muscles. Medical doctors give anti-biotics that research proves don't help, and most men find it too awkward to mention to their chiropractor, or don't realise that chiropractic help is available.Frankly, I too don't do this procedure (it's simple, quick, largely painless, but unpleasant for doctor and patient) unless asked to by a patient. Not many ask perhaps, but there are a good many men out there suffering unnecessarily.

So the Kegel exercises are perhaps a better option. If they don't work, then talk to your chiropractor if you have 'prostate' pain that is not responding to your doctor's treatment.



Intercourse

The Kegel exercises are beneficial to both sexes increasing the pleasure of sexual intercourse, by helping men not ejaculate too soon, and women to tighten the vagina, enabling them both to reach a more fulfilling and better timed climax.


Pregnancy

See where the 'sling' would run from the pubic bones to the coccyx?

There is special benefit from the Kegel exercises during pregnancy which places great strain on the pelvis in general, causing pain in the

and of course urine leakage. They are simple and quite safe. Aside: Did you know that taking post menopausal hormone treatment increases the risks of incontinence? And of course cancer, early dementia and a host of other diseases. Rather walk regularly and take vitamin D rich food and supplements like fatty fish.


Uterine and/or Bladder Prolapse

If you don't exercise the deep pelvic muscles the chances of the bladder or uterus dropping into a lower position is much greater. There will be pressure against the vaginal wall making sex painful, together with lower back and sometimes groin pain, and a discomfort bloated feeling in the lower abdoman. Like all things, start your Kegel exercises BEFORE you have a problem... prevention is better than a cure.


How the Kegel exercises are done

The Kegel exercises should not be done when you have a full bladder. But the best way to isolate these muscles is to IMAGINE you are urinating, and are going to stop the stream.

So, lying flat on your back, imagine you are having a sweet pee and you want to stop the flow. Squeeze those deep muscles, and relax them again. That's the Kegel Exercises.

You don’t actually stop the urine flow obviously. (Don't do them on the loo, literally stopping the flow. That's bad.)

You should feel the pelvic floor rising and falling as you contract the deep pelvic muscles, hold for several seconds, and then allow the floor to fall again. Repeat several times.

It’s usually recommended that you do the Kegel exercises lying down, but for my money you can do them just as effectively standing and sitting. Standing in a queue whilst waiting for the bus, when you switch the computer on and are waiting for Windows to wake up, or every time you have a cup of tea.

Do them slowly and rhythmically first, feeling the contraction grow, and reaching a climax, relax. You might then want to repeat the Kegel exercises by doing them really quickly, contracting and releasing in rapid succession.

Best of all, do them first thing in the morning, by lying on your bed and combining the Kegel exercises with a pelvic tilt. The Maignes Syndrome exercises ... In this beautiful exercise you combine all three muscle groups that constitute the pelvic corset. First thing in the morning, on your bed, and then at night again. Good for the back, great for the sagging abs, stop the dripping bladder, wonderful sex, what more can one ask for?! I do them EVERY morning. I mean it! Dinkum.

Unsure that you are contracting the correct muscles? Two things you can do:

  1. Place your hands lightly across the abdoman. During the Kegel exercises you should feel no contraction of the Abs. Now place you hands just above the pubes: contract - you should feel the deep muscles contracting.
  2. An alternative way for women to be quite sure is to insert a finger into the vagina (wash carefully first!), and then feel if the the deep vaginal muscles are contraction.



Pelvic tilt exercise incorporating the Kegel exercises

There are three groups of muscles incorporating the "pelvic corset" muscles:

  1. Oblique abdominal muscles
  2. Multifidi muscles - small muscles in the back
  3. Deep pelvic muscles

It's particularly useful to incorporate the Kegel exercises into the Pelvic tilt exercise to build strong "core muscles" - good for the low back, good for the bladder, better sex... See here how the Pelvic tilt can be done incorporating the Kegels...


Anecdotes, true and false

Health is full of anecdotes, some of great value, and others are pure hogwash. Slowly the scientists are separating the grain from the chaff:

One last thought whilst we are discussing the deep pelvic muscles...

Some women get a very deep pain that lies embarrassingly somewhere between the ischium bone, that bone you sit on, and the anus. That pain may well be the female equivalent of the non-bacterial prostatis in men: trigger points deep in the pelvic muscles.

One of those muscles, the Ilio-coccygeus muscle, arises from the ischium and is attached to the coccyx. When all else fails, talk to your chiropractor. Take hubby along if you agree on a course of treatment... that protects both you and your chiropractor. Or ask your gynae if he would examine the area, only he may not understand too much about treating trigger points in a muscle.


My Pilates Exercises - Pelvic floor technique 

If you want more exercises for the deep core muscles then this pelvic floor technique expert will give you some great ideas: Pelvic floor technique ...


Hip exercises

These hip exercises combine strengthening the deep pelvic muscles like the pubococcygeus along with the core muscles in and around the pelvic. It's difficult, so it comes in three parts...especially beneficial in this leg pain during pregnancy casefile ...



Important considerations


Have A Question about your lower back?

I receive many questions about Chiropractic. It might be help with a spinal condition, but it might also be from a person who can't walk after a hip operation, or some such thing.

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Do understand that lower back pain is extremely complex, so I can only give general guidelines. There's no substitute for a careful thorough chiropractic examination.

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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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