Who should do the Kegel exercises ?
Kegels exercises are the most common exercises that are very often suggested to do when presenting with symptoms of urinary leakage . When done properly these exercises are a very effective tool to minimize and eliminate bladder leakage and to strengthen the pelvic floor muscles .
People who have complaints of urinary urgency , make statements similar to “ As soon as I feel the urge to urinate I have to run to the bathroom or else I may have an accident . I just don’t seem to be able to hold it . ” This is generally indicative of a weak pelvic floor and there could be other factors but I will talk about in my future blog posts , for simplicity sake let’s just consider plain pelvic floor muscle weakness. These exercises are effective when the muscles have a moderate weakness .When a person has very weak pelvic floor muscles and unable to elicit a minimal pelvic floor contraction upon attempting to do kegel exercises such people will require supervision of a pelvic therapist who could use different methods to help improve the muscle strength during a PT session .
How should the Kegels be done ?
- First ,try practising these exercises while lying down on your back , with knees bent.
- Squeeze the muscles of the gential area as if you are trying to stop the flow of urine or trying to stop from stopping passing gas .Be careful to not squeeze the muscles of your belly , and inner thighs.
- Contract for 3 seconds and relax for 3 seconds .Do 3 sets of 5 .
- As the pelvic floor gets stronger one can progress to doing this in sitting or standing , and these can be done anywhere , sitting at the desk , doing dishes etc.
- Caution : If you feel pain in the abdomen ,back or any pain after you do kegels ,it’s a sign that Kegels are not being done correctly .Stop and seek medical advice.
- To check to see if you are doing the exercise correctly ,place one hand on the lower abdomen and one hand on the inner thigh to feel if the muscles are contracting when you are contracting pelvic floor muscles to do Kegels.Avoid contraction if you feel the abdominal and inner thigh muscles contract .
How long before one can expect to see results ?
As with any exercise regime , results need consistent practice , it may vary person to person because many factors can influence the outcome, on an average approximately 2 to 3 weeks , better bladder control should be start to become evident .If Kegels seem ineffective after that time period , you may need further assistance to assess technique or if having difficulty with isolating the pelvic floor muscle contraction.
So now you know what Kegels exercises and how to assess if you are doing them correctly and the role in improving incontinence . I would love to hear of your experience at with Kegels .Please leave your comments below .
Physiology of Painful sex or Dyspareunia
When intercourse is painful (dyspareunia) our muscles naturally contract to protect from the pain. and in anticipation of pain. This anticipation of pain can lead your nervous system to react with a cascade of events leading to even tighter muscles, vaginal dryness and loss of lubrication. When this happens, intercourse becomes even less comfortable, resulting in more pain. Hence this becomes a viscous cycle that need to be broken and can be done with Pelvic Physical therapy.
Types of painful sex or dyspareunia ( in women)
1.Superficial Dyspareunia
2.Deep Dyspareunia
1. Superficial Dyspareunia :
Pain at the entrance of vagina during attempted penetration is superficial dyspareunia.
Causes of Dyspareunia
This type of dyspareunia can occur due to any of the following
Dryness of the vagina due to
Inadequate foreplay
Hormonal imbalance as in perimenopausal women and in women who are breastfeeding.
UTI
Injuries to the Genital area
Vaginismus
Vulvodynia – involuntary contraction of the vaginal muscles
Surgery: anything that narrows the vaginal opening such as episiotomy and it’s repair post child birth.
Congenital tight hymen
2.Deep Dyspareunia
Pain post penetration during the thrusting movement is Deep Dyspareunia
Causes:
Retroverted Uterus : Normally the uterus is tilted forward on the bladder, but it can be tilted back in retroverted uterus and this can cause dyspareunia.This can be surgically corrected if severe.
Vaginismus
P.I.D. ( Pelvic Inflammatory diseases) infection of cervix , uterus or vagina .
Endometriosis
Gynecological cancers: Ovarian, Uterine cancers and Fallopian tubes.
Scarring from radiation and Chemotherapy or surgical scars.
Diagnosis for painful sex or dyspareunia
Subjective History:The diagnosis depends on the symptoms the patient reports such as when does the pain occur and where is the pain.For ex.
1.When do you have pain during intercourse ? Is it at the entrance of the vaginal opening or during thrusting?.
2. How long does the pain last ?
3.Was there ever a time when intercourse was not painful?
4. Any history of sexual abuse or genital trauma?
5.Any History of sexually transmitted diseases?
Pelvic Exam: This may be followed by a gentle but through pelvic exam to assess hypersensitivity to touch and any increased inflammation.The pelvic area may be touched by a cotton swab to assess the area of pain and sensitivity externally.The pelvic muscles may be assessed internally by gently inserting a gloved and lubricated finger through the vagina.
Pelvic Physical Therapy for painful sex or dyspareunia:
Physical Therapy: Intervention will include
Massage techniques/ Myofascial release.
Relaxation training , with Diaphragmatic breathing and Reverse Kegels.
Stretching.
Strengthening of weak muscles.
Postural training and coordination of the muscles that support your core.
I evaluate the back, hips and possibly the rib cage region to see if there are any imbalances in those regions contributing to your pain. I also be teach self-care techniques for you to utilize at home and possibly with your partner. PT is a process with which one has to have patience if you wonder about the duration of PT before you see results check this article I wrote on that subject matter.
Painful sex or Dyspareunia in Men
Painful sex or dyspareunia defined by ICS: It is Penile discomfort occurring during intercourse , may be caused by penile diseases ,altered vaginal anatomy( vaginal tightening and scarring) or various positions during intercourse, that causes impingement of the uterine cervix.
Chronic Dyspareunia: is recurrent or continuous pain that occurs in the pelvic and genital area that occurs during and after sexual intercourse, for 3 months or more pain may in the penis may be accompanied by a burning sensation.
Causes:
Psychological Causes:
Sexual Abuse
Anxiety
Stress
Fear
Medical Causes:
Phimosis: Tight foreskin
STD
Testicular Cancer
It can also be due to tears in the foreskin or Peyronie’s diseases.
Infections of bladder, UTI can cause painful ejaculation.
Conclusion
Painful sex is a common occurrence but not normal
This is treatable and there is a solution to the problem.
Pelvic Physical Therapy can effectively treat this condition in most cases with success.
Please leave your questions and comments below .
