Frederick R. Jelovsek MD, MS
"Are the Kegel exercise devices found in many "home health" catalogs of any help in doing the exercises? "
"I am 72 years old, normal menstrual history, epilepsy under control, B.P. under control, a stroke 13 years ago, almost full recovery, swim 2x a week, year-round. " Evelyn
Kegel exercises were developed by Arnold Kegel MD, a surgeon, in the 1940's as treatment for stress urinary incontinence. He even developed a device called a perineometer to assist women in a biofeedback training program to strengthen pelvic muscles. By 1950. Kegel was reporting a 93% success rate in incontinence treatment.
He and his wife actually manufactured the perineometer which was comprised of a small rubber cone that was inserted into the vagina, a length of rubber tubing, and a 2-inch diameter manometer (air pressure gauge like on a blood pressure cuff) calibrated in millimeters of Mercury (HG). Women would start out squeezing the rubber cone generating pressures of 5-6 mm HG and by several months, they could generate pressures of 50-60 mm HG.
Can Kegel exercises be done without any vaginal devices?
Yes. In fact the most common way that instruction in Kegel exercises is carried out today is as an isometric contraction in which the bulbocavernosus muscle is contracted and held contracted for about 6 seconds. Then it is relaxed and another contraction begun. Five contractions a minute. See our pelvic floor exercise instructions.
The isometric pelvic floor contractions were popularized because of the expense and hassle of using any intravaginal device. The main problem has been that in order to effective, the right muscle has to be contracted and about 50% of women cannot identify and isolate the correct muscle with just verbal instructions. This can be improved if the doctor gives instruction by testing with a finger in the vagina to make sure the correct muscle is being contracted. The main problem in doing the exercises is the tendency to increase intraabdominal pressure (Valsalva) and/or to contract abdominal, buttock or thigh muscles instead of just the bulbocavernosus muscle.
This experience and the difficulty in carrying out the exercises from just a verbal description or reading instructions, has lead to the development of many devices that help a woman isolate the correct muscle and aid in the discipline required to perform repetitive, boring exercises.
What different types of Kegel devices are available?
The catalogs have basically two type of devices, those that are placed in the vagina and carried around for a short while, and those that are placed in the vagina to offer resistance to contract the muscle around. Weighted vaginal cones are the most common intravaginal devices. They have been shown to be as effective as either electrical stimulation or pelvic floor exercises alone.
Pelvic floor microelectrical stimulation and also chairs with magnetic muscle stimulation are treatments that have been developed to accomplish the same goal. They are not devices that you can buy in catalogs, however. There are some devices made to put between the thighs rather than inside the vagina and squeeze together using the thigh and buttock muscles. I do not know of any evidence that these devices would work and on a theoretical basis they are very unlikely to help exercise the correct muscle.
The answer to the original question is that the catalog devices (used intravaginally) are probably just as effective as performing the isometric contractions without any devices. Therefore if they help to remind and stimulate you to regularly perform the exercises, then they are worth using.
How successful are the Kegel's exercises in the long term to prevent surgery for stress incontinence.
The general rule-of-thumb among physicians has been that Kegel exercises are more effective if a woman has mild stress incontinence, but if there is severe incontinence or moderate to severe prolapse involved, then surgery is much more effective. As with any physical training program, the more diligent a woman is in sticking to the daily routine of exercise, the more effective the exercises are in curing even severe incontinence. Most physicians have had some women patients who are very dedicated and perform the isometric perineal contractions almost religiously. Severe incontinence can be cured in this manner.
If a woman is successful initially in the exercises producing continence, then it is fairly likely (66%) that she can avoid surgery in the long run. Also, if she learns to give a quick squeeze of the bulbocavernosus muscle (perineal lock) just before any sudden increase in intraabdominal pressure from a sneeze or a cough, that can be the most effective mechanism for maintaining long term success.
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