Andrew Siegel MD 4/16/16
This first piece (of a two-part entry) reviews the history of pelvic floor training from antiquity up to 2015. The second piece (the 4/23/16 entry) is a discussion of the Kegel “renaissance” and “revolution” that is underway. This “sea change” in pelvic floor medicine that is currently evolving in the urology/gynecology medical community will most certainly permeate into the mainstream in the near future.
His and hers pelvic floor muscles (Dr. Henry Gray, Gray’s Anatomy, 1918, public domain)
The pelvic floor muscles have long been recognized as instrumental for their roles in pelvic organ support, healthy sexual functioning and for their contribution to urinary and bowel control. They also contribute to core stability and postural support. The pelvic muscles anatomically and functionally link the female pelvic organs—the vagina, uterus, bladder and rectum—and also affect the independent function of each. Pelvic muscle “dysfunction” (when the pelvic muscles are impaired and not functioning properly) in females can contribute to pelvic organ prolapse and vaginal looseness, urinary and bowel control problems, sexual issues and pelvic pain (tension myalgia). Pelvic floor dysfunction in males can play a role in the urinary incontinence that follows prostate cancer surgery, dribbling of urine after the completion of urination, erectile dysfunction, ejaculation issues and pelvic pain.
Pelvic floor muscle fitness is vital to healthy pelvic functioning and pelvic muscle training therefore plays an important role in the management of many pelvic conditions. Pelvic muscle training has the potential of not only treating pelvic floor dysfunction, but also delaying and preventing its onset.
Pelvic floor exercises date back over 6000 years ago to Chinese Taoism. The Yogis of ancient India practiced pelvic exercises, performing rhythmic contractions of the anal sphincter muscle (one of the pelvic floor muscles). Hippocrates and Galen described pelvic exercises in ancient Greece and Rome, respectively, where they were performed in the baths and gymnasiums and were thought to promote longevity as well as general health, sexual health and spiritual health.
However, for millennia thereafter, pelvic floor exercises fell into the “dark.” Fast-forward to the 1930s when Margaret Morris, a British physical therapist, described pelvic exercises as a means of preventing and treating urinary and bowel control issues. In the 1940s, the seminal work of Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. Dr. Kegel wrote four classic articles that put the pelvic floor muscles and the concept of training them to achieve pelvic fitness “on the map.” Kegel’s legacy is the actual name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Kegel determined that a successful program must include four elements: muscle education, feedback, resistance, and progressive intensity. He stressed the need for pelvic floor muscle training as opposed to casual exercises, emphasizing the importance of a diligently performed routine performed with the aid of an intra-vaginal device known as a perineometer to provide both resistance (something to squeeze against) and biofeedback (to ensure that the exercises were being done properly).
Despite Kegel’s pelvic regimen proving effective for many female pelvic issues, what is currently referred to as Kegel exercises bears little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that are unfortunately not upheld in most of today’s programs.
In the post-Kegel era, we have experienced a regression to the Dark Ages with respect to pelvic training. Easy-to-follow pelvic exercise programs or well-designed means of enabling pelvic exercises to improve pelvic floor health have been sorely lacking in availability. The programs that are out there typically involve vague verbal instructions and a pamphlet suggesting a several month regimen of ten or so pelvic contractions squeezing against no resistance, to be done several times daily during “down” times. These static programs typically do not offer more challenging exercises over time. Such Kegel “knockoffs” and watered-down, adulterated versions—even those publicized by esteemed medical institutions—are lacking in guidance, feedback and rigor, demand little time and effort and often ignore the benefit of resistance, thus accounting for their ineffectiveness. With women often unable to identify their pelvic muscles or properly perform the training, outcomes are less than favorable and the frustration level and high abandonment rate with these regimens is hardly surprising.
Bottom Line: In the post-Kegel era, pelvic floor muscle training has been an often ignored, neglected, misunderstood, under-respected and under-exploited resource.
Coming next week: The Kegel Revolution
Wishing you the best of health,
A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com
Author of The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle (paperback and Apple iBooks, B&N Nook and Kobo editions will be available in May 2016).
Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48
Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc
Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon. In the works is the female PelvicRx.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use code UROLOGY10 at checkout for 10% discount.
Tags: Andrew Siegel MD, Arnold Kegel MD, bowel incontinence, ejaculatory dysfunction, erectile dysfunction, Kegel exercises, Margaret Morris, pelvic floor muscle training, pelvic floor muscles, pelvic muscle dysfunction, pelvic organ prolapse, pelvic pain, perineometer, sexual issues, urinary incontinence, vaginal looseness