Another Life-Time Skill

***Warning!***
If you’re offended by intimate female information, read no further. What follows is medical information that may benefit you or someone near and dear to you.

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I’ve mentioned before that some of the skills one learns in Prepared Childbirth classes will serve in unexpected ways. One of the most useful instructions is how to do the Kegel (pronounced kay-gill) Exercise.

Named after a Los Angeles Obstetrician/Gynecologist, Arnold Kegel, who practiced in the 1950’s and who was in the vanguard of the U.S. adaptation of Lamaze Childbirth techniques, the Kegel Exercise is a life-time skill. Don’t worry—I’m not going to wade into explicit details of how to do them—but it’s a way of understanding how to control the Pubococcygeal muscles, which are the base of support for the pelvic floor.

The medical folks refer to the Pubococcygeals as the P-C muscles, which gives a whole new slant on the term PC. Both sexes are usually capable of developing good P-C control, with the most gratifying use being the tetanic-like contractions that one experiences with orgasm. The challenge for many women, though, is that often they have no idea as to how to do the Kegel Exercise in a productive manner. I sometimes examine a woman who thinks that she has good P-C control, but in reality, all she’s doing is some weird abdominal maneuver.

The reason that the Kegel Exercise is taught in childbirth classes is that good P-C control allows one to release the pelvic floor muscles, hopefully so fully that the baby’s head will rotate down on to the perineum. If the woman is fortunate enough to have a patient birth attendant, as the baby is pushing through the complex pelvic floor, the muscles will release enough to not tear or require the attendant to cut them, allowing the baby’s passage. That cutting procedure has various medical codes to describe how deeply the cut had to be made and is called an episiotomy.

A second reason for doing Kegels is improved toleration of every woman’s least favorite activity: the yearly pelvic exam. When I was in Grad School, I developed a handy little “How to Do Kegel Exercises” handout, replete with a simplified illustration of the intricate pelvic floor muscles. We still use it in our department and refer to it as the “Pink Kegel Sheet;” it’s helpful for someone who has trouble tolerating pelvic exams, because tight P-C muscles make for a very uncomfortable pelvic exam. The good examiner will usually be able to help a fearful patient release her P-C muscles, enabling her to work with the examiner rather than against him/her.

It’s the third and most useful reason for doing Kegel Exercises that I believe has potential to be the best reason for good pelvic muscle control. We’ve all seen the TV ads for Poise pads or some other “feminine protection” product that tries to present urinary incontinence as an expected consequence of aging. I’ve found that if a woman has good P-C control, she typically will not have difficulty with leaking when she coughs, sneezes or laughs. It’s not unusual for me to encounter a woman whose youngest child is 20+ years and who has been putting up with constant leaking since that child’s birth. The P-C muscles, not surprisingly, can be damaged during birth either by being stretched or torn. An associated cause for poor P-C control after birth can sometimes be traced to damaged nerves caused by a traumatic delivery. And, of course when a woman is post-menopausal, the decreased estrogen level can cause drooping pelvic muscle support.

Poor P-C control is an equal opportunity medical problem. Men can develop leaking when the muscle control is damaged during pelvic surgery, such as prostate removal. Certain medical conditions can cause incontinence for both sexes: Diabetes, Multiple Sclerosis, to name a few.

If you or your loved one isn’t sure that they’re doing the Kegel Exercise adequately, I highly recommend a health care provider’s assessment. If he/she doesn’t seem to know how to help you, move on to someone else. Sometimes there is an underlying medical problem that interferes with one’s ability to control the muscles, and a good examiner will refer patients to a specialist when needed.

But if it seems that the problem is simply related to inability to recognize the right muscles to tighten, one can have great fun getting them toned up. For women, the British call Kegels “The Internal Kiss,” and I tell my patients to enlist their partners’ assistance in their practice sessions.

As I say, Kegels are a great life-time skill.