Preparing for a Natural Childbirth Experience
by Laurie Binder, LCCE, RNCNP, MS, LAc, Doctor of Acupuncture
Q: After my baby is born, how long should I wait to start Kegel exercises?
A: You can start with simple exercises to increase strength in the abdominal and perineal muscles, which have been stressed and stretched during pregnancy and delivery. Stomach tightening, gentle abdominal curls, and Kegel exercises are helpful. (Women who've delivered by Cesarean section should not attempt any abdominal exercises for six weeks.)
If you've had a baby, you've no doubt been told to do Kegel exercises, which strengthen the pubococcygeus (PC) muscles that form the pelvic floor between the legs. Toning these muscles, which contract during orgasm, helps many women climax more easily; yet many of us skip this exercise or do it wrong.
Multiple studies have been done with Kegel exercises showing success for urinary incontinence. A study in the Journal of Gerontology (J Gerontol 1993 Jul;48(4):M167-74) by Burns PA, et al showed that "biofeedback and pelvic muscle exercises are efficacious for sphincteric incompetence in older women. Benefits are maintained and improvement continues for at least 6 months post-intervention. These therapies may be useful before considering invasive treatment." A recent study by Cammu H, et al in the British Journal of Urology (BJU Int 2000 Apr;85(6):655-8) showed that pelvic floor exercises for urine incontinence, when successfully performed, had a 66% chance of favorable results for at least 10 years.
Unfortunately, women are poorly informed about the benefits from these exercises. The proper technique can often by initiated with proper teaching and continued on a daily basis. For optimal benefit, they need to be performed daily. The best part of these exercises is that they are free, painless, and can be done at any time of the day.
The proper technique relies upon finding the proper muscle group. Ask your physician about identifying this muscle group during your next gynecologic exam. Alternatively, this muscle (the levator group of muscles) is found by inserting your finger into the vagina and squeezing around it. If you feel pressure around your finger, you have found the correct muscle. This is also the muscle used to voluntarily stop your stream of urine. Try to isolate this muscle, while relaxing your legs, back, and abdominal muscles. Practice will make perfect. Initially, do these exercises while lying down or sitting comfortably. When comfortable with the technique, you can do these while driving, watching television, during meals, etc. To avoid confusing the bladder muscle, do not perform repetitively while urinating.
The correct number of exercises per day is variable. Evidence suggests that at least 50 repetitions are helpful. A repetition consists of squeezing the levator muscle for 5 seconds and relaxing for 5 seconds. Performing 10 repetitions five times a day will achieve the minimum 50 repetitions. You should be able to build up to holding the levator muscle for 10 seconds with practice. Do not expect miracles over night. Most women find improvement in urine incontinence and sexual relations after 4-6 weeks of therapy.
One of the most important aspects of these exercises (like any form of exercise) is persistence and a daily routine. Try to pick activities during the day to remind you of the exercises. Upon awakening, with morning tea, driving to work, at lunch, driving home from work, watching television, and before bed are common times for women to perform these exercises. Keep a calendar and monitor your improvement.
With a little persistence and patience, these exercises can be very effective. Please give them a try.