Thursday, 18 October 2012

PELVIC FLOOR EXERCISE (PFE)




Kegel Exercise
First published in 1948 by Dr. Arnold Kegel, a pelvic floor exercise, more commonly called a Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". Dr. Kegel attempted to develop diverse exercise for the injured women’s pelvic muscle due to childbirth or natural urinary incontinence.

Introduction
The aim of Kegel exercises is to improve muscle toneby strengthening the pubococcygeus muscleof the pelvic floor. Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floorfor physiological stresses of the later stages of pragnancy and childbirth. Kegel exercises are said to be good for treating vaginal prolapse and preventing in women and for treating prostate pain and swelling resulting from benign prostatic hyperplasis (BPH) and prostitis in men. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Kegel exercises may also increase sexual gratification and aid in reducing prematue ejeculation. There are many actions performed by Kegel muscles include holding in urine and avoiding defecation. Reproducing this type of muscle action can strengthen the Kegel muscles. The action of slowing or stopping the flow of urine may be used as a test of correct pelvic floor exercise technique but should not be practiced as a regular exercise to avoid urinary retention

Indications:
1. 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. Meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "PFMT (Pelvic floor muscle training) should be the first-line conservative programs for women with stress, urge, or mixed, urinary incontinence.

2. Pelvic prolapse - The exercises are also often used to help prevent prolapse of pelvic organs. A meta-analysis of rabdomised controlled trials by the Cochrane Collaboration concluded that "(there is now some evidence available indicating a positive effect of PFMT for prolapse symptoms and severity.)''


Steps:
Here’s how to do your Kegels to strengthen your pelvic floor: Lie or sit down, whichever you prefer. You may use a pillow as a wedge under the small of your back if you like.
Find the muscle you identified earlier and clench it, then relax. Clench again, than relax. And so on. One clench-and-relax constitutes a repetition, and both sides of the repetition both the clenching and the unclenching are equally important.
You may find it difficult to do Kegels at first if your muscles are very weak. But each repetition really will increase the strength of the muscles, and in time, doing your Kegels will become easier guaranteed.
1.      Tighten the muscle and hold for 10 seconds, relax for 10 seconds. Do 10 repetitions to strengthen   your slow-twitch pelvic floor muscles.
2.       Tighten and hold for two seconds, relax for two seconds. Do 10 repetitions to strengthen the fast-twitch fiber muscles. The two different basic Kegel exercises differ only in timing, not in the process.

Effect of Kegel Exercise
1. At the last month of pregnancy, the fetus goes down and the head puts pressure upon of the perineal region, which causes a pain. Kegel Exercise helps to mitigate the pain by strengthening the perineal region.
2. In case of training the ability of moving the pelvic floor musclefreely though Kegel exercise during the period of pregnancy, it is possible to put pressure upon the exact region at the time of childbirth. This helps to shorten the childbirth time.
3. At the time of giving birth, it is possible to prevent the tear of perineal region by applying the power to the region slowly. If not Kegel exercise, sudden application of power to the region may cause the tear of weak perineal region.
4. After childbirth, urinary incontinence may be occurred due to the relaxation of muscle under the bladder or the rupture of the nerve cell or muscle. In ordinary time, cough, sneezing or laughing may cause incontinence. Kegel Exercise is useful to settle such problems economically.
5. In case of taking a long time in natural childbirth, the fecal incontinence may be occurred. Kegel Exercise helps to return such the anus muscle to the normal state.
6. With steady exercises, it is possible to strengthen the vaginal muscle and regenerate the injured cell due to childbirth by promoting blood circulation around the vagina.
7. This exercise helps to reduce the risk of hemorrhoids caused by constipation during the period of pregnancy or after childbirth.
8. By recovering the elastic force of the vaginal muscle, which is weakened after childbirth, it helps to increase sexual gratification and feel orgasm intensively.

A study by Cammu et al., comprising a 10-year follow-up of women after pelvic floor muscle exercise for stress incontinence, concluded that when pelvic floor muscle training is initially successful there is a 66% chance that the favorable results will persist for at least 10 years.
The trials suggest that the treatment effect (especially self reported cure/improvement) might be greater in women with stress urinary incontinence participating in a supervised PFMT programme for at least three months. It also seems that the effectiveness of PFMT does not decrease with age: in trials with stress urinary incontinent older women it appeared that results for both primary and secondary outcome.

Conclusion
There is evidence for the widespread recommendation that pelvic floor muscle exercise helps women with all types of urinary incontinence. However, the treatment is most beneficial in women with stress urinary incontinence alone,

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