Are KEGEL EXERCISES as effective as people say?

MEET Jody. She is a 29-year-old gym instructor. Jody had a relatively uneventful pregnancy two years ago, delivering a 6.5 lb baby at term. She came to see me six months after delivery, complaining of leaking urine whilst she trained her clients at the gym. It was embarrassing. She had to wear two pads, and always wore dark tights so that urine would not show. She had visited two OBGYNS prior, and was diagnosed with stress urinary incontinence. Both said the same thing: Do your Kegels, you will be fine.

“I’m all ‘Kegeled’ out, Dr Daley, what else is there to do ?”

The pelvic floor is a group of muscles that work together to keep the pelvic organs in place (uterus, bladder, rectum, and vagina). It is also responsible for providing tone to the vagina, that directly relates to sexual gratification. In some women, with increasing age, predisposing genetics, and childbearing, these muscles can become weakened causing myriad problems, among them genital prolapse, stress incontinence, and loss of sexual gratification.

Normally, the tube that connects the bladder to the genitals (urethra) is in place and controlled with coordination between the brain and the pelvic floor muscles. In stress urinary incontinence, the urethra is freely mobile (loss of tone of the pelvic floor muscles), resulting in the leakage of urine when external pressure in the abdomen is placed on the bladder — straining, exercising, jumping, etc. This affects up to 35 per cent of women worldwide at varying degrees and can be quite distressing.

Arnold Kegel was a brilliant American gynaecologist who developed a group of pelvic floor exercises called Kegel exercises, which has revolutionised female health care (and sexuality), making it a common therapy for stress urinary incontinence.

Dr Kegel discovered that women who had stress urinary incontinence and performed his exercises admitted to an improvement in symptoms and also sexual gratification.

So what exactly is a Kegel? In layman Jamaican terms, a Kegel is a “quint”. Dancehall artiste Busy Signal describes the process of “quinting” perfectly in his song

Pon Di Edge for those who need a refresher.

However, a Kegel exercise involves the squeezing of pelvic floor muscles repeatedly — I best describe it to patients as when you want to pass urine and you hold it; those are the muscles you are focusing on. It is recommended that a woman does this at least 180 times per day for maximum effect. It’s a very simple and effective exercise which can be done any time — driving, relaxing, working, at the hairdresser, or even during sexual intercourse.

So, do the Kegels really work? Yes and no. Kegels are excellent for women who suffer from mild stress urinary incontinence and, definitely, Kegels can heighten sexual pleasure. However, the group of exercises can be quite dubious and ineffective in some women. For women who have extreme symptoms of stress incontinence (such as Jody, above), prolapse, or loss of sexual gratification, Kegels provide minimal improvement.

At times, the exercises can be combined with controlled pelvic floor therapy and vaginal weights to improve the symptoms, but in some women this may not be enough.

Next week we will discuss how I treated Jody who, to this day, is doing well.

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician at Gynae Associates, 23 Tangerine Place, Kingston 10, and shops 46-50, Portmore Town Centre. He can be reached at 929-5038/9, 939-2859, 799-0588 or drdaryldaley@gmail.com.