Post Partum Care
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: Second image courtesy of www.menstruation.com.au
Bed Rest is best in the first 1-2 weeks post partum.
January 5th, 2010A few months back I had a booth at a baby fair. During a lull in the participant traffic a woman strolled by and had the teeniest little bundle strapped to her chest. I asked her how old her baby was and she replied, “5 Days old.”
Her response took me aback. Okay, perhaps this is going to seem judgemental, but what could this woman have possibly needed at this baby fair, a consignment show I might add, that necessitated her bringing her 5 day old infant out amongst a throng of people? This show was at a local convention center and while it was mostly clean, it is not a place that I would have brought my newborn and most especially with the hundreds of people passing through.
But this mama’s presence brought up other questions for me. Why wasn’t she home resting after recently giving birth? How was breast feeding going? How was she feeling? Given that she was at the show, I can only surmise that she was feeling pretty well, but as a former clinician, I had to wonder what impact her early post partum sojourn was having on her recovery.
Pregnancy, labor and delivery (along with death) are very likely the most natural events in all creation. All animals experience these stages as they bear offspring and even though these are very natural events, I do believe and will state here that we need to treat the processes with respect. Obstetrics has become a very scientific, interventional discipline within medicine and we have gotten away from allowing a woman and her body to go through many of the natural processes surrounding pregnancy, labor and delivery. Sure, we are able to detect and intervene when abnormalities and/or problems arise, but we have also begun intervening when no intervention is necessary. Women are losing some of their inherent physical wisdom and as such we are seeing more and more reasons to ” intervene”.
In my opinion, this woman should not have been at this baby show. I would have rather she remained at home, resting and tending to her baby. Now I am sure that there are many out there who will vehemently oppose this view and I welcome your responses so that we can discuss the issue. But I believe for the first week, and possibly the first two weeks, new mamas should remain in bed, resting, nursing and recovering from their deliveries. Here are my reasons:
Pregnancy, labor and delivery are stressors on a woman’s body. On the scheme of things they are good stressors, but they are stressors none the less. The very process of developing an entire human being, bringing that being forth to this physical plane and then preparing to feed and nurture that being requires a lot of physical energy. For example, pregnant women are at greater risk for contracting colds and other viruses than their non-pregnant counterparts because much of the energy their bodies would normally use to fight infection is being used to help grow the baby. Their circulatory systems (heart and blood system) are temporarily stressed; their hearts are working harder circulating the increased blood fluid load which is being used to help feed and nurture the growing baby. The joints and connective tissues are stressed as they adapt to support the additional weight pregnant women must carry. All of these “stressors” miraculously take place and the body adapts to fulfill the task at hand, but once the stress is removed, it’s time to recover.
A woman’s Body needs to recover after pregnancy and delivery. I stated above that pregnancy, labor and delivery are natural processes that stress the body. So just like ordinary stress, once the stressor(s) are removed, the body needs a period of recovery during which it resets itself back to baseline. Robert Sapolsky, Ph.D, describes the effects of stress humorously and eloquently in his book “Why Zebras Don’t Get Ulcers.”
Sapolsky describes how zebras in the deserts of Africa are initially in a calm (resting) state. When a predator comes along, like a cheetah, the zebras’ bodies react with the fight or flight reaction in order to prepare to defend themselves or to escape. Once the Cheetah is gone and the zebras are relaxing in safety, their bodies revert back to their normal calm states. In his book, Sapolsky uses this analogy to explain why we humans are at risk for heart attacks and ulcers-when we stay stressed, remaining in the fight or flight state even once the stressors are gone, we use up all of our resources and over time don’t have reserves from which to draw to protect ourselves when confronted with future stressors.
The same analogy can be used for new mamas who get up too soon after delivery. A woman’s body has stretched and organs have moved in order to accommodate pregnancy. Now that the baby is delivered, a time of rest is needed for a woman’s body return to baseline; for the muscles of the abdominal wall to recoil and for her uterus to migrate back down within the pelvis behind the pubic bone. This process is aided significantly by breastfeeding in the early post partum. Many women (myself included) recount that as their newborn suckled, they could feel their uterui contracting. These contractions aid in the uterine migration back into the pelvis. If a woman is up and about, the contractions will occur during nursing (if she nurses) but the abdominal muscles won’t contract and “flatten out” as much because they are also being used to hold her upright. Likewise, the uterus may or may not fully migrate back into the pelvis leaving her with a “pooch”. Activity in the early post partum has also been associated with increased lochia (post partum vaginal discharge) dizziness and lightheadedness. Time to recover can alleviate these adverse reactions.
Rest aids in breastfeeding. Finally, as if a woman’s body has not done enough, those mothers who are planning to nurse will find it easier to “get nursing going” if they aren’t moving about trying to keep order in the home and resume full activity levels. Again, breast milk production takes a lot of physical energy (about 800 extra calories daily!). If a woman is trying to run her household, care for older children, heal from pregnancy labor and delivery and breastfeed her body may not have the physical energy to meet all of its demands. At least in the first 1-2 weeks, if a woman can focus on letting her body recover; eating well, sleeping as much as she can and establishing nursing with her infant, she is more likely to be have ample milk supply for her infant and to be able to nurse for as long as she and her infant decide.
I know that many will disagree with me regarding early post partum bed rest. Post partum bed rest is not as confining nor need be as stringent as bed rest prescribed in the high risk ante partum woman. However, in those first 1-2 weeks after delivery, if a woman can give her body that time to recover and to establish nursing, both she and her infant will greatly benefit.
