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Stephan L. Werner, M.D., F.A.C.S. Kegel Exercises are commonly used pelvic exercises to strengthen the voluntary muscles controlling urination and my be very successful in controlling mild stress incontinence, or improving control in urgency incontinence or mixed incontinence. The muscles used are the muscles of the pelvic floor, the same muscles you use to might use to hold back an urge to void, or to prevent passing gas at an inappropriate moment. These muscles should be tightened without tightening the abdominal muscles at the same time. If you are not sure which muscles to tighten, the next time you urinate, try stopping the steam. These are the same muscles. At the same time you are tightening the muscles, place a hand on your abdomen. If you feel the abdominal muscles tighten as well you must learn not to do so. It may take a little practice, like rubbing your belly and patting your head at the same time, but it can be done. To do the exercise, tighten the pelvic floor for a slow count to 10 and then let go for a slow count to 10 then repeat in sets of 15-20 reps. Just like working out at the gym, you must increase the tightness and the number of reps over time. Start with 2 or three sessions of 15-20 reps twice or three times a day. You can do it while you do other things such as reading or driving or watching TV. As you increase the number of reps a day you should begin to see some improvement in your incontinence. The second step is to consciously contract these muscles when you are about to sneeze, or cough, or stand up, or whatever causes your stress incontinence. As these actions become reflex over several months you should see improvement in your symptoms. Kegel exercises will not control moderate or severe stress incontinence, but they are useful for many patients. A side benefit to strengthening the pelvic floor is the use of these same muscles during sex to improve your performance.
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