Kegels: Essential Exercises for Mamas on Bed Rest

February 16th, 2010

Most women have heard of Kegels and at one time or another have  been advised to perform Kegel exercises. But in my experience as a woman’s health professional, I find that many women have no idea what muscles are involved in Kegel exercises and as a result have no idea how to perform one properly.  So I offer here a short review.

Kegels are essential exercises for all women, but especially for pregnant women on prescribed bed rest. Mamas on bed rest, with their prolonged inactivity and growing uteri are at increased risk of weakened pelvic floor muscles which will be further stretched and potentially weakened if they vaginally deliver their babies. The results can be urinary incontinence (involuntary loss of urine with coughing, laughing, sneezing), organ prolapse (bladder, uterine or rectal prolapse (bulging or protrusion of the bladder, uterus or rectum through their respective openings to the outside), or decreased sexual sensation due to the lax musculature. But I don’t want to get ahead of myself here. Let me start with the basics and work forward.

Dr. Arnold Kegel developed “Kegel” exercises to help women strengthen the pelvic floor muscles following pregnancy. Dr. Kegel noted that women frequently became incontinent following pregnancy and found that if they could strengthen the pubococcygeus “PC” muscle (the muscle that is suspended along the pelvic floor like a hammock and holding all of the pelvic organs in place), they could often improve or reverse urinary incontinence as well as bladder, uterine or rectal prolapse. He started teaching his patients how to contract the PC muscle and Kegels were born

So how is a Kegel done? First, you have to be sure that you are working the proper muscles. If you are squeezing and releasing your buttocks, you are probably not working your pelvic floor muscles-at least not effectively. You can be sure you are working the pelvic floor muscles:

  • By stopping the flow of urine while urinating. While this is a good way to get to know the pelvic floor muscles and what they feel like when contracted, do not stop the flow of urine ROUTINELY as a way to strengthen the pelvic floor muscles. This practice will actually weaken the muscles and cause or worsen urinary incontinence.
  • You can look at your perineum and watch as you contract the muscles. If you are performing the exercises correctly, you will see the anus “wink” the perineum move up and down and the clitoris “nod” (thanks to Desiree Andrews of Prepforbirth.com for these great visuals!). This is a great way to see and learn which muscles are working. You can place a mirror on the floor and squat over it to see the muscles or hold a mirror between your legs. However, if you’re pregnant, it may be hard to hold the mirror between your legs and see and this is really hard of you are on bed rest. But for non-pregnant women, this is a good way to start learning how to Kegel.
  • You can feel for muscle contractions by placing a finger or two into your vagina and then contracting the pelvic floor muscles around your fingers. Again, once you know which muscles to contract, you can effectively perform Kegels.
  • There are devices that one can use to help stimulate the PC muscles. Physical therapists often use such devices when teaching clients how to do Kegels. Additionally, one can buy such devices and learn to Kegel using the devices.

Now once you get the basic muscle contractions down, you can then move on to some “advanced” Kegeling.

Squeeze, Hold, Release : This is just as it states. Squeeze your PC muscle, hold for a few seconds and release.

Elevators: This is an increasing contraction and likened to making floor stops while on an elevator. You begin by lightly contracting your pelvic PC muscle. After about 2-4 seconds, increase the contraction further pulling up the PC muscle. Hold for another 2-4  seconds and then tighten the contraction again. Hold for 2-4 seconds and then release. A variation is to gradually release the contractions holding for 2-4 seconds as the “elevator goes down.”

Quick Bursts: These are just what they say, quick contractions. You quickly contract the PC muscle, say 10 times. Rest for a brief moment and then repeat the series. This should be done several times over the course of about 5 minutes.

Some people recommend that women “Kegel” approximately 20o times a day-performing a variety of contractions. If you Kegel regularly, say 3-4 times a day performing 10 or more Kegels at a time, you will strengthen the PC muscle. But as the saying goes, the more you work a muscle, the stronger it becomes. So if you want to keep your PC muscle strong and have a strong pelvic floor, Kegel often, several times a day and in various situations so that you not only develop pelvic floor muscle strength, but also muscle control which can help prevent incontinence and enhance sexual pleasure.

Note: First image courtesy of Mayo foundation for Medial Education and Rsearch

Second image courtesy of www.menstruation.com.au

Pregnant Mamas, Make Your Exercise Count!

January 12th, 2010

“Light Resistance Exercise During Pregnancy Does Not Affect Type of Delivery”.

This is the headline that came across my desk from Medscape  about a study published in the American Journal of Obstetrics & Gynecology. I have to admit my first reaction was shock, then outrage. For years we perinatal fitness instructors and other proponents of exercise have been trying to stress the importance of prenatal fitness to pregnant women. Our arguments stem from research done by obstetricians and researchers such as James Clapp, III, MD and Ann Cowlin, Dance and Movement Specialist. In their decades of research, they have found that regular, moderate intensity exercise, tends to shorten labor, increase the effectiveness of pushing, reduce the need for pain medications and interventions. The aforementioned study was in direct opposition from what I know and believe to be true anecdotally from my own perinatal fitness clients. But rather than just rant, I went and read the study to see how the researchers generated their data and how they reached their conclusions.

Study Design

In this particular study Spanish researchers took healthy yet sedentary pregnant women of low to medium moms2socioeconomic status in Madrid Spain and looked to see if having them do a limited amount of low intensity exercise impacted their deliveries. The women were all aged 25-35 years old with uncomplicated singleton pregnancies. The women in the study group began exercising at the beginning of the second trimester and continued for approximately 26 weeks. Their exercise regimen consisted of 8 minutes of warm up, approximately 20 minutes of toning and light resistance exercise and 8 minutes of cool down stretching performed 3 times a week. Exercise specialists monitored the exercise sessions to be sure that each lady’s heart rate remained at 80% of maximum output or less.  The researchers found that, in this study, there was no difference between rates of natural deliveries, instrumented deliveries or Cesarean deliveries even when potential confounding variables were controlled. While the researchers concluded that prenatal exercise is good for both mother and baby and did not complicate pregnancy, cause preterm labor or reduce the incidence of natural delivery, it did not alter the type of delivery a woman had.

Where They Went Wrong

Not intense enough exercise

After reading the study I completely understood why the Spanish researchers saw no impact of exercise on delivery. According to their journal article, they did not have the women engage in moderate intensity activity. Clapp, Cowlin and others have all found that pregnant women reap the most benefit from prenatal exercise when they engage in low impact moderate activity exercise.  Moderate intensity is defined as a rate of exertion in the range of 12-14 on a scale of 1-20 on Borg’s Rate of Perceived Exertion Scale. Exercising in the range of 12-14 enables a woman to be able to talk, but increases her cardiovascular effort contributing to endurance training.

Many exercise professionals, myself included, don’t use heart rate to monitor exercise intensity in pregnant women.  The physiologic changes of pregnancy inherently make a woman’s baseline heart rate go up. The American College of Obstetricians and Gynecologists used to recommend that pregnant women not increase their heart rates above 140 beats per minute (bpm), but for many pregnant women they reached 140 bpm just walking across the room! That is why the Borg’s Scale has replaced heart rate monitoring in many clinical exercise settings.

Not Enough Exercise

In this study, the women only exercised approximately 36 minutes per session and increased their heart rates for about 20 minutes per session. To develop any sort of strength or endurance conditioning, the American College of Sports Medicine recommends 20-30 minutes of exercise at targeted intensity 3-5 times per week. A combination of brisk walking, swimming or prenatal aerobics classes with strength training using free weights (usually not more than about 5 lbs) or exercise bands or tubing to accrue the 30-45 minutes of intense activity works well. I typically warm my clients up for 10-15 minutes before and cool them down for 10-15 minutes following the work out.

PregnantwomanonballTypes of Exercises

The study did not indicate what types of exercises were performed, but given they used light resistance bands, I am thinking some sort of strength training. Hopefully they included some sort of cardiovascular exercise such as brisk walking, swimming or aerobic movement. The strength training should have focused on maintaining muscle tone, muscle strength (especially upper body) and providing strength and support to the skeleton. Pregnancy creates forward movement of the neck and shoulders (a round shouldered upper body posture with a “stork neck”) while also creating lordosis (sway back) in the low back. CORE strengthening will help strengthen and stabilize the spine and skeleton and reduce the risk of pain or injury to the neck, shoulders, hips and back. Pelvic floor strengthening (Kegels and other exercises) should also be incorporated into the program to help prevent the development of urinary stress incontinence, tearing and or the need for an episiotomy during delivery and organ prolapse after delivery.

My Take

Prenatal exercise stills remains controversial in some obstetric circles, yet all the data to date support the idea that regular prenatal exercise is good for both mother and baby. Amongst birth professionals there still remains controversy as to what type and how much exercise is best. I have found that even with previously sedentary mamas-to-be, if they start exercising early in their second trimester and continue until they are ready to deliver (or as close as is comfortable), they are able to increase their cardiovascular endurance and muscle strength and tone just as if they would in the non-pregnant state. This conditioning enables the ladies that I train to have less pain and discomfort, to utilize less pain medication during labor and delivery, to spontaneously go into labor rather than needing to be induced, to have shorter labors (I’m seeing about 6-8 hours) and to more effectively push. These ladies don’t need “instrumentation” during delivery and I see a lower rate of cesarean sections.

One my call my results “anecdotal” and this is correct because my clients are not organized in to controlled study groups. But if my small prenatal fitness training population is any indication, women who engage in low impact moderate intensity exercise (in the range of 12-14 on Borg’s Rate of Perceived Exertion) for 20-30 minutes 3-5 times a week, will be more likely to experience less pain and discomfort during pregnancy, shorter labors, fewer complications during labor and delivery and a shorter recovery.

Mamas on Bedrest, Don’t despair! You too have an exercise option. Bedrest Fitness is a set of exercises designed specifically for pregnant women on prescribed bed rest. The exercises are simple but effective and easily done while in bed. Do part or all of the DVD, depending on your provider’s instructions.  Order your copy of Bedrest Fitness Here

I would love to hear the experiences of other birth professionals, perinatal fitness instructors and women who have exercised throughout their pregnancies. Please add your comments below and encourage other professionals and mamas to do the same!

“Sarah Jessica Parker looked fantastic 2 weeks post partum and I look like a blob!”

April 20th, 2017

About a week ago I (re) posted an article on the Facebook Page about a study out of England which states that ‘women need a full year to recover from pregnancy and childbirth’. There was also a response by a reader,

“That’s literally impossible for most moms in the U.S.”

Sadly, she’s right. America is probably the worst industrialized nation for new mamas, not providing any sort of paid maternity leave, routine in home support for new moms or adequate resources for self care. While I have always been a fierce proponent of the “Year to grow ’em, a year to recover” philosophy, I completely understand that in America, many women MUST get back to work as soon as possible to help support their families.

Unfortunately, Far too many times I’ve had mamas “up and at ’em” just days after giving birth, trying to tackle the responsibilities of running their homes, caring for their older children, back to work full time and starting right in on an exercise regimen in order to “get back to their pre-pregnancy” physique as soon as possible. Not long after, they call me; exhausted, achey, homes and families in chaos, they’re crying at work and with faltering milk supplies. They can’t understand what’s wrong? Some women have actually sustained injuries from trying to do exercise programs that are just too rigorous for the early post partum, and I can think of two clients that actually developed organ prolapses (internal organs coming out of bodily openings) from putting too much stress on their already weakened pelvic floors.

“But Sarah Jessica Parker looked fantastic 2 weeks post partum and I look like a blob!”

What mamas fail to realize is that Sarah Jessica Parker-and other celebrity moms-usually have nannies, housekeepers, personal trainers, chefs and a hoard of other helpers that help them not only manage their homes and their babies, but also are instrumental in helping them regain that “Hollywood glow”. Most of us are lucky if our mothers can come for even a week after we deliver! Sarah Jessica Parker said as much on “The View” after the birth of her son. She shared that she was required to be back on set and able to fit into her wardrobe, so she had private pilates sessions daily, a personal chef preparing special meals and a personal assistant just to handle her affairs! She had a nanny to care for the baby which allowed her to sleep, a housekeeper and a whole host of other staff at her disposal to handle everything else. So yes, she looked fabulous just weeks post partum.

But that isn’t reality.

Mamas, pregnancy and childbirth fundamentally change a woman’s body. Even women who look utterly fabulous after their childbearing years will still have “badges of honor” indicating that they have successfully been pregnant, labored and delivered children. For some women, there will be the very slightest of slack to her abdominal muscles (until she has a tummy tuck!). Others will have faint-or not so faint-stretch marks on the belly, breasts, hips and thighs. Some women will have c-section incision scars. And still others will have invisible badges; that little trickle of urine that escapes when she laughs, coughs or sneezes, hemorrhoids, and other “inconveniences.”But all of them had to allow their bodies to recover. I can’t think of one woman who has given birth of any sort and not said,

“I never had ______ until after I was pregnant and gave birth.”

It just goes with the territory. Most of the so called “badges” are minor, simply little reminders of our journey. However, if women engage in activity that is too vigorous too soon after delivery, even returning to work before their bodies have had a chance to recuperate from the marathon that was pregnancy, labor and delivery, what may have started out as a minor inconvenience can develop into a major problem requiring more time, therapy and sometimes surgical intervention to resolve. Truly it would have been far less traumatic to simply ease back into daily routines.

American culture does not make it easy for women to recuperate from childbearing. However, women themselves can take these 7 steps to ease back into their pre-pregnancy routines.

  1. No vigorous activity until at least 8 weeks post partum, but if post c-section, consider waiting until 12 weeks post partum to fully heal.
  2. Learn and do pelvic floor strengthening exercises.
  3. Rest as much as possible, and whenever you can, take a nap.
  4. Let major housekeeping go and even get help with the small stuff if possible.
  5. Say no to outside activities. You don’t need to chaperone, bake cookies or make calls for any event. Focus on you!
  6. Spend time at home with family. This is precious bonding time for you all.
  7. Reduce work hours as much as possible.

I realize that some of these suggestions will be easier to implement than others. This list is also not exhaustive, but just a starting point. It’s just imperative mamas that you take care of yourselves so that you can get back to your daily routines with full strength and joy. It’s also important to fully heal from this pregnancy, especially if are planning to have other pregnancies in the future. If you start back too soon, you may set yourself back several weeks or injure yourself making subsequent pregnancies more difficult.

I know that it’s been a long haul, especially if you’ve spent weeks to months on bed rest. But please, please, please take a little more time to heal. Don’t compare yourselves to other women, especially not celebrities. Your journey is your journey and its best to honor your inner time table as much as possible, allowing your body to heal and prepare for subsequent pregnancies or to simply chart new territory as a mom! Whatever you decide to do, do it with a healthy, strong body!

Do you have a tip for recovering after pregnancy you’d like to share? Do you have a question? Share your thoughts in the comments section below. Your words could be just the thing a mama needs to read today!