Pelvic floor muscles, just like those in the rest of your body, need a workout too! During the aging process, the pelvic floor muscles weaken and need exercise to keep in optimal shape. Strong muscles mean fewer of those annoying bladder leaks, fewer chances of developing a pelvic organ prolapse, and for some women, more enjoyable intercourse.

This last in a series of articles looks at how just two simple and discreet exercises, Kegels and ‘the Knack,’ mean better pelvic health during and beyond menopause.

Kegel exercises
Developed and named after Dr. Arnold Kegel, these exercises help women regain the strength in their pelvic region, particulary in the genital/vulvar areas. Enter Kegel exercises on Google and the options are endless but generally, the regimen is similar. These instructions are adapted from the Mayo Clinic Web site.

*Locate the proper muscles – squeeze the muscles you would use to stop the flow of urine and you can either try this while urinating or just concentrate on the act. Note that the Mayo Clinic cautions that once you have figured out the correct muscles, do not try to stop your urine flow itself as this can cause additional health concerns.

*The technique – with an empty bladder, squeeze the muscles as if you were trying to stop urinating. At first, you may prefer to sit or lie down but later you can do these exercises anywhere. Squeeze the muscles and hold for a few seconds; some sources say for three seconds, while the Mayo Clinic recommends five and then working up to 10 seconds. Allow for the same amount of time between squeezing; if you squeeze for 5 seconds, rest for 5 seconds and so on.

*Focus and breathe – concentrate on the urinary flow muscles alone and try not to contract any other abdominal muscles. Breathe in and out slowly with each contraction.

Work out anytime, anywhere – once you master the technique, work up to at least three sets of around 10 to 15 squeezes. You can do these discreet exercises just about anywhere and anytime including driving, watching television or waiting in line.

The Knack
The Knack is a technique similar to the Kegel exercises. The Knack involves contracting the pelvic floor muscles before and during events that place additional pressure on the abdomen and cause bladder leakage, such as coughing or sneezing.

Outlined in a paper based on a study conducted at the University of Michigan at Ann Arbor, Michigan, the Knack requires patients to squeeze their pelvic floor muscles just before an act that would normally cause bladder leaks. Two groups of women, pregnant and non-pregnant, were instructed to produce a sharp cough and to squeeze the pelvic floor muscles at the same time. Results showed that the amount of urine lost using the Knack technique measured less than without the Knack.

To replicate this, imagine you are about to feel the force of a cough or a sneeze and you squeeze your pelvic floor muscles at the same time. While a little more difficult to master, doing three sets of 10 to 15 Knack acts will further strengthen the pelvic muscles and help prevent bladder leaks and organ prolapses.

Mastering Kegel exercises and ‘the Knack’ will take some time and patience but just a few minutes a day can go a long way to an improved quality of life.

Sources:
Pelvic floor muscle training for organ prolapse: Braekken IH, Majiida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvis organic prolapsed and reduced prolapsed symptoms? Am J Obstet Gyenecol 2010;203:170.el-7 as provided in the October 26, 2010 First to Know release from NAMS.

Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence.
Miller JM, Sampselle C, Ashton-Miller J, Hong GR, DeLancey JO.
School of Nursing, University of Michigan, Ann Arbor, MI, USA. janismm@umich.edu https://www.ncbi.nlm.nih.gov/pubmed/18204797

https://www.mayoclinic.com/health/kegel-exercises

Menopause, Your Doctor, and You