hi, i thought i would send my final research paper, post it on the
site.
for some reason when i cut and paste, it
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peace and happy kegeling :)
dana
>
The Pubococcygeus Muscle:
Urinary Incontinence, Uterus Prolapse, Labor, Sexual Dysfunction, and
Orgasm
In the 1940’s Arnold H. Kegel, MD, a surgeon and gynecologist from
California, was trying to help older patients who could not retain
their urine. Previously, the only way of addressing this condition was
with surgical repair (Alexander, 138). Dr. Kegel developed a technique
that exercised the pubococcygeus muscle and found these exercises could
prevent a lot of unnecessary female surgery.
The pubococcygeus muscle is one of the most important muscles in the
body.
This figure-8 muscle encircles the dorsal of the clitoris, the base of
the urinary bladder, the vaginal opening, as well as, the rectum
(Danforth, 56). The pelvic floor muscle is more like a hammock than a
floor, supporting the pelvic cavity. The muscles functions are
involved in urinating, pregnancy, orgasm and sexual intercourse.
Many women are not aware of the pubococcygeus muscle. The easiest way
to locate the muscle is by stopping the flow of urine midstream.
Whenever urinating the flow of urine should be stopped and started
several times (Sloane, 50). After awareness of the muscle is
established, the exercises can be practiced outside of urination. To
practice Kegels, the pubococcygeus muscles should be contracted for 2
to 3 seconds and repeated 10 times. The seconds held can be gradually
worked up to 10 seconds and there are no limits to the sets that can be
repeated. Many women find it easiest to do lying down. It is,
however, possible and even encouraged to practice kegels anywhere as
they are undetectable (AMA, 238). Practiced consistently, a few times
a day, in proper form, results should be noticed within a month.
It is important to practice Kegels correctly, or the beneficial effect
will not be seen. Furthermore, just like working any other muscle, the
exercises need to be performed regularly for results. Kegels will not
work if abdominal, thigh or buttock muscles are being contracted at the
same time. To make sure the muscle is being practiced correctly, Dr.
Northrup, MD, author of Women’s Bodies, Women’s Wisdom, advises to
begin practicing using two fingers inside the vagina in order to feel
the muscles contract around the fingers. At the same time, the other
hand should be placed on the lower abdomen to make sure it is not being
contracted (Northrup, 322).
Vaginal barbells or cones produce faster and more dramatic results, as
strength resistance works any other muscle. They also make sure the
correct muscles are being contracted, as the vagina will have something
to clamp down on. There are cones made specifically for women with
urinary incontinence. The cone weight should be increased over time.
(Northrup, 253). Other devices have two to four springs inside and as
the vagina gains increased strength, more springs can be closed. Due
to the large statistical evidence of effectiveness, some of these
devices are now insurance reimbursable.
Dr. Kegel found that strengthening the pubococcygeus muscle is
effective in preventing and healing involuntary loss of urine. The
reason is that when the PC muscle is lax, the pelvic organs press down
putting pressure on the bladder. Kegel exercises also strengthen the
muscles surrounding the urinary opening, giving better control of the
opening and closing of the urethra (Danforth, 975).
Under the slightest physical stress, such as sneezing, laughing or
running, certain women experience an involuntary loss of urine.
Urinary stress incontinence, the involuntary loss of urine, is one of
the most common and also distressing urologic problems that face women
(Shephard, 178). Incontinence is often caused by relaxation of the
muscles that surround the bladder and urethra. Often occurring in
women who have had several births, the condition worsens with age
(Derbisnire, 85).
After childbirth, the fibers of the PC muscles are stretched or torn
and no longer meet around the base of the bladder. Then, even the
slightest abdominal pressure pushes against the bladder and results in
a release of urine that can no longer be controlled by the lax muscles.
This annoying and embarrassing condition afflicts millions of women
(Sloane, 50). According to Dr. Northrup, 30 to 50 percent of women
will experience urinary incontinence from time to time.
Even though so many women suffer from incontinence, few talk to their
doctors about the problem. In one study, Dr. Burgio, coauthor of
Staying Dry: A Practical Guide to Bladder Control, found that only 25
percent of women who suffer from incontinence talked to their doctor.
And oftentimes, these women have had incontinence for 12 to 20 years
(Foley, 225).
Women outnumber men five to one in incontinence. In a survey of 326
gynecology patients at the University of Michigan, 47 percent of women
were found to be reporting stress incontinence. Also, 31 percent of
pre-menopausal women, younger than forty, had some sort of
incontinence. Incontinence, however, is not a disease; it is a
symptom. If the woman suffering from incontinence, is not found to
have a urinary infection, or any other malfunction, incontinence can be
addressed as a lax in the pelvic muscles, which is can be easily
restored.
Pelvic relaxation, or the loss of support by the pelvic muscles, leads
to stress incontinence. Most surgical treatments are aimed at
restoring the integrity of the PC muscles to surround the urethra.
Kegel exercises can alleviate and even cure many that would otherwise
resort to surgery. Women with mild urinary incontinence have been
shown to have very positive results by strengthening their PC muscles.
Kegel exercises strengthen the muscles that surround the openings of
the urethra, vagina and anus, preventing leaking of urine and
rebuilding pelvic support (AMA, 234). The more firmly toned the
pubococcygeus muscle is, the more a woman is able to avoid urinary
problems (Thompson, 1451). Incontinence, therefore, is very
treatable.
Dr. Whitmore says that 50 percent of incontinent people can be cured,
while 30 percent greatly improve. Other studies show even more
dramatic results. When done properly and consistently, Kegels have been
found to help 75 percent of women to overcome urinary incontinence.
In his initial studies, Dr. Kegel reported 90% improvement in stress
incontinence among 455 women trained with this method. Although Kegel
exercises don’t cure every type of incontinence they are worth doing
before resorting to surgery. Developing strong PC muscles not just
prevents incontinence but increases the blood supply to the pelvis
making the urinary tract more resistant to infection (Northrup, 322).
The pubococcygeus muscles make up the pelvic floor, making them vital
in the holding of the pelvic organs in their anatomically correct
positions. The pelvic organs: the uterus, bladder, urethra, rectum and
vagina, are held in place by ligaments and muscles. These supporting
tissues are attached to the sides of the pelvis and the opening of the
urethra, vagina and rectum. If these muscles lose strength they slack,
causing the uterus or bladder to sag (AMA, 234). This overall condition
is called pelvic relaxation.
When the pelvic floor can no longer support the pelvic organs, the
ligaments that used to hold the uterus in place weaken, allowing the
uterus to sag, and eventually fall or prolapse into the vagina. This
shortens the vagina and pulls the bladder backwards (Whitney, 330).
This can be accompanied by a falling of the bladder or rectum.
The first signs of pelvic relaxation is stress incontinence. Once the
muscles become even more lax, the uterus starts to fall and produces a
heavy feeling in the vagina, creating uterine prolapse. This condition
is both preventable and treatable (Our Bodies, Ourselves, 597).
Most women who have given birth have some degree of uterine prolapse
(Shephard, 177). The reason for this is that during childbirth the
ligaments supporting the uterus become stretched and weakened sometimes
to the point where the uterus drops (Thompson, 274).
Uterine prolapse in mild cases can be symptom less. Common symptoms
include frequent and painful urination, lower back pain, and pressure
on the vagina which is relieved when lying down (Thompson, 714).
Treatment of uterine prolapse in the past included the use of a
pessary, a ring placed inside the vagina to keep the uterus in its
correct position. The rubber ring needs to be removed and cleaned by a
gynecologist every two months (Danforth, 950). In cases of uterine
prolapse hysterectomies are sometimes performed, usually in older women
(Whitney, 333).
The best way to prevent pelvic relaxation and uterine prolapse is to
regularly practice Kegel exercises. Kegel exercises strengthen the
pelvic floor that supports the pelvic organs. Strengthening these
muscles keeps the organs in place prevent pelvic relaxation and
prolapse of the uterus.
A third area in which the Kegel exercises are important is in
childbirth. By strengthening the pelvic floor, discomfort is reduced
and the pelvic organs can return to place more easily after birth.
Kegel exercises strengthen and tone the musculature of the pelvic area
in a way that can make vaginal delivery during childbirth easier.
During delivery, the mother who has developed strong pubococcygeus
muscle control is able to release the muscle greatly diminishing the
possibility of rectocele, prolapse of the rectum, or cystocele,
prolapse of the bladder into the vaginal walls, both common
aftereffects of pregnancy that require surgery to recover.
Kegel exercises give control over the pelvic muscles. Doctors and
midwives counsel women to practice kegels because they provide the
ability to relax the muscles used in childbirth, alleviating discomfort
and reducing risk of tearing (Foley, 83). Kegel exercises help keep
the stretched vaginal muscles toned after birth. According to Dr.
Barnaby Barratt, "… kegeling improves the flow of blood to the vagina,
and for any woman who gets pregnant, it's a way to recover the
elasticity of the vaginal canal."
Practicing kegel exercises prevents and helps in healing sexual
dysfunction. Vaginismus, the third most common cause of sexual
dysfunction in women, involves an involuntary tightening of the muscles
surrounding the opening of the vagina and the outer one third of the
vagina, preventing penetration. The consequence is painful, if any,
sexual intercourse. Although some sources claim it has a psychological
basis sexual functioning can be recovered using Kegel exercises. By
voluntarily tightening and releasing the pelvis muscles, the woman is
given control over the vaginal muscles (Foley, 432). There has been
shown an 83% of women in one study that reported less pain in sixteen
weeks by progressively learning to relax and rehabilitate the pelvic
muscles. Dyspareunia, a condition where sex is accompanied by pain has
also been shown to be alleviated by kegel exercises. By giving women
control over their vaginal muscles, they can learn to relax the muscles
(Northrup, 314).
Dr. Arnold Kegel first developed kegels for controlling stress
incontinence in women. After several months of monitoring his patients,
Dr. Kegel found that some women reported having experienced their first
experience of orgasm. Consequently, he found his patients were
experiencing greater frequency and intensity of orgasm. Kegel
exercises resulted in increased control of the vaginal walls producing
the rhythmic contraction necessary in attaining orgasm. His work proved
that strengthening of the pubococcygeus muscle improved sexual response
and contributed to the attainment of orgasm. Research has since
demonstrated that this muscle contains specialized nerve endings which
contribute to a satisfactory sexual experience.
According to Betty Dodson, Ph.D., author of Sex for One and sexologist,
“Orgasm and the PC muscles are related. There is no doubt about that.
The stronger the muscles, the stronger the orgasm.” Dr. Dodson has
taught thousands of women to increase their orgasmic capacity by
strengthening their PC muscles. She is coming out with a product
called Betty Dodson’s Vaginal Barbell, a device used in practicing
kegel exercises.
The Midwest Institute of Sexology teaches Kegels as an exercise that
improves capacity for sexual pleasure. They explain that the health
of the pubococcygeus muscles play a vital role in sexual arousal and
climax. Every female orgasm involves a vaginal contraction.
Consequently, the PC is the major muscle involved in contraction during
female orgasm. Women with strong and healthy pelvic muscles are not
just less prone to vaginal problems, but they have more fulfilling
sexual functioning (Northrup, 252). Practicing kegel exercises
increases stimulation and lubrication production.
Kegel exercises help preorgasmic women as well as women who are able to
achieve orgasm with direct clitoral stimulation but not during
intercourse not involving direct clitoral contact. But, according to
Dr. Barnaby Barratt, “For all women, kegeling improves the quality of
orgasmic responsiveness and intensifies and strengthens orgasmic
capacities.”
Strengthening and gaining control over the pubococcygeus muscle
enhances and intensifies orgasm with oneself as well as with a partner.
Kegel exercises are advocated for improved sexual relations between
couples due to the increased ability of the vaginal sphincter to
contract around the penis during intercourse (Sloane, 50).
Margo Anand, Tantra educator and author of The Art of Sexual Ecstasy,
teaches kegel exercises as a technique for enhancing sexual pleasure
and intimacy. She teaches the strengthening of the PC muscle benefits
intercourse by being able to hold the penis more tightly. During
orgasm, the pubococcygeus muscle naturally rhythmically contracts. By
becoming more conscious and in control of the muscle it is possible to
slow down orgasm, prolonging the pleasurable experience.
Her exercise technique is called the PC pump. When practicing the PC
pump, women rhythmically contract and release the pelvic muscles in
short intervals (Anand, 178). During intercourse the woman can draw
the penis deeper into the vagina and create rhythmic contractions
without moving by using the muscles inside the vaginal canal. With
increased control these muscles can move like a wave, comparable to
fingers milking a cow. (Thompson, 1451) In high levels of tantric
practice, it is possible to have intercourse while completely still,
the inner muscles doing all the movement. There are no limits to the
abilities of the pelvic muscle.
The pubococcygeus muscle is vital in a woman’s healthy functioning.
The PC muscle which surrounds the clitoral dorsal, the urinary bladder,
the vaginal and anal opening, is crucial in the functioning of all
these organs. The pelvic muscle also provides a pelvic floor, holding
the pelvic organs in place. When week or torn due to age or pregnancy,
urinary incontinence, uterus or rectal prolapse, sexual dysfunction and
preorgasmia can occur.
On the other hand, strong pelvic muscles increases blood supply to the
pelvis making the urinary organs more resistant to infection. Strong
pelvic muscles also contribute to a healthy labor and faster recovery
thereafter. Strengthening of the pubococcygeus muscles also contributes
to heightened orgasmic capacity and enhances sexual functioning.
Practicing Kegels contributes to a person’s overall health. Kegel
exercises, according to Dr. Northrup, should be part of every woman’s
health care routine. Although not discussed in traditional exercise
and fitness models, the pubococcygeus muscle is a muscle like any other
and in order to function, needs to be exercised (Alexander, 137). It
is unfortunate that millions of women are not informed on how to care
for their bodies and inevitably suffer and resort to unnecessary
surgery (Northrup, 323). Through educating ourselves we can learn
that our bodies are worthy of our ongoing respect and care.
Bibliography
Alexander, LaRosa, Bader. New Dimensions in Women’s Health. Boston:
Jones and
Bartlett Publishers Inc, 2001.
American Medical Association. Complete Guide to Women’s Health. New
York:
Random House, 1996.
Anand, Margo. The Art of Sexual Ecstasy. New York: Penguin Putnam
Inc, 1989.
Baron-Faust, Rita. Being Female: What Every Woman Should Know about
Gynecological Health. New York: Quill, 1998.
Boston Women’s Health Book Collective, The New Our Bodies, Ourselves.
Simon and Schuster: 1992.
Danforth, David (editor). Obstetrics and Gynecology. Harper and Row:
1982.
Derbyshire, Caroline. The New Woman’s Guide to Health and Medicine.
New York:
Appleton-Centry-Crofts, 1980.
Dodson, Betty Ph.D. Sex for One: The Joy of Selfloving. New York:
Three Rivers Press,
1996.
Dodson, Betty: phone conversation and e-mail.
Foley D., Nechas E. Woman’s Encyclopedia of Health and Emotional
Healing.
Pennsylvania: Rodale Press, 1993.
Kegel, Arnold H. Exercise in the Treatment of Genital Relaxation,
Urinary Stress
Incontinence and Sexual Dysfunction. Chicago: Year Book Medical
Publishers, 1965.
Northrup, Christiane M.D. Women’s Bodies, Women’s Wisdom. New York:
Bantam,
1998.
Shephard, Bruce and Carroll M.D. The Complete Guide to Women’s Health.
Florida:
Marinor Publishing Co, 1982.
Sloane, H. Biology of Women. New York: Wiley Medical Publication,
1980.
Thompson, Douglas M.D. Every Woman’s Health. New York: Simon and
Schuster,
1993.
Whitney, Lauerson M.D. It’s Your Body: A Woman’s Guide to Gynecology.
New
York: Grossett and Dunlap, 1977.
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