Methods of pelvic floor rehabilitation in women

What are Kegel exercises?

The exercises proposed by Arnold Kegel are aimed at training the pelvic floor muscles. These exercises can be performed independently, without the need for a doctor. They don't require any special clothing or equipment and can be performed almost anytime and anywhere.

How to do Kegel exercises?

Kegel exercises:

1. Contract your vaginal muscles strongly for 1-2 seconds, then relax them; to achieve the desired effect, perform 5-30 contractions several times a day.
2. Contract your vaginal muscles for 10 seconds, then relax for 10 seconds. Perform this exercise for 4 minutes a day. Then, perform quick contractions (1 second each) for 1 minute, alternating with equally quick relaxations.
3. Exercise "elevator": contract the vaginal muscles ("1st floor"), hold for 3-5 seconds, continue contracting with greater force ("2nd floor"), hold again. Continue this way for 4-5 "floors." Continue the same downward movement, pausing at each "floor." You can do these exercises at home, on public transport, or while watching TV.

How to do Kegel exercises correctly?

• • Do these exercises as often as possible. The more often you do them, the better the results will be.

• • Begin performing the exercises at five-second intervals, holding the contracted muscles for five seconds. Gradually lengthen the contraction time.

When can the results of the exercises be assessed?

You may notice immediate improvement within a few weeks of starting the exercises. However, to achieve significant results, you need to continue the exercises for at least four months.

What to do if the exercises don’t work?

If gymnastic exercises have not yielded positive results due to poor muscle sensation, training with vaginal cones can bring the desired result.

What are vaginal cones?

Vaginal cones – These are specially designed conical weights with adjustable weights that are used to strengthen the vaginal muscles. The cone is placed into the vagina like a tampon. A set of four cones of varying weights has been developed. The woman's task is to learn to hold the cone in place by contracting her pelvic floor muscles.

When is the use of vaginal cones recommended?

- to prevent prolapse of the vaginal walls and body of the uterus, as well as other pelvic organs;
- during pregnancy and after childbirth to prevent weakening of the pelvic floor muscles and restore their original tone;
- in order to reduce the risk of infection and the penetration of unfavorable flora, as well as to change the pH environment of the vagina with a gaping genital slit;
- to eliminate and prevent urinary incontinence (stress urinary incontinence when coughing, sneezing, or during physical activity);
- for controlled management of the contraction and relaxation force of the vaginal muscle group in order to enhance sexual sensations during intercourse. Long-term training with vaginal cones promotes pelvic floor muscle awareness and development. During pregnancy, cone training develops the pelvic floor muscles and prevents them from weakening.

How to use vaginal cones?

It is necessary to select a cone of the appropriate weight (to begin with – the easiest). Insert it into the vagina with your index finger, in the same way as a vaginal tampon.

• It is necessary to hold the cone in a standing position.

If it works, then:

• Hold the cone while taking a few steps.

If it works, then:

• Hold the cone while walking.

It's important to determine the maximum amount of time you can hold the weight. This holding time should be gradually increased.

• Hold the cone while walking up the steps.

• Hold the cone while coughing.

• Keep the cone in place throughout the day.

How often and for how long should I do vaginal cone exercises?

These exercises should be performed at least twice a day, and more often if possible. If the cone is easily retained throughout the day, the weight of the vaginal cone can be increased. Therefore, the ability to hold the heaviest cone without straining should be achieved during normal daily activities.

Can you do Kegel exercises using vaginal cones?

Combining Kegel exercises with the use of vaginal weight cones is very effective.

• • You can perform pelvic floor muscle contractions with a cone placed in the vagina.
• • You should move on to the next weight if you are able to perform the exercise for at least 5 minutes.
• • You can extend the exercises to 10 minutes, switching back to the lightest weight, and so on.

What to do if you can't maintain the vaginal cone while standing?

Start doing the exercises lying down. Once your pelvic floor muscles have strengthened, you can progress to a standing position.

What are the benefits of using vaginal cones:

• • Individuality for every woman.
• • It takes little time to teach a woman how to use cones.
• • It takes little time to start training.
• • The number of consultations with a doctor is reduced to one visit.
• • Cones — one of the forms of biofeedback.
• • The weight of the cones can be increased by increasing the load.
• • You can start using it without any additional research.

How to evaluate the effectiveness of using cones?

If pelvic floor muscle exercises are performed under the supervision of a doctor, in case of urinary incontinence or in the presence of gynecological problems,  then the doctor can evaluate the effectiveness of the treatment both based on the results obtained (the symptoms will disappear) and using special digital devices — perineometers. A vaginal probe is inserted into the woman's vagina. She then contracts the perineal muscles as much as possible, and a quantitative measurement of this contraction appears on the device's scale. The perineometer operates on the same principle as a tonometer for measuring blood pressure, meaning it measures the pressure generated in the vagina.

How long should I continue using the cones?

With regular daily use, improvements are noticeable after just 8 weeks. To maximize the benefits of the cones, it's important to practice every day for at least 12 weeks.

Can cones be used for vaginal dryness?

A small amount of lubricant must be applied.

What to do after your pelvic floor muscles become stronger?

To maintain muscle tone, you should continue to use the cones only once or twice a week.

How soon after birth can I start using Kegel exercises and cones?

Kegel exercises and cones can be started as soon as a woman feels comfortable after childbirth. On average, it is recommended to begin training 6-8 weeks after childbirth.

Useful tips

• • It is necessary to rinse the cone before each use (to prevent irritation or infection).
• • It is better to insert the cone after emptying the bladder.
• • It is necessary to wear underwear so that if the cone falls out, it will not be lost.
• • If possible, practice with the cone at the same time each day. It's convenient to do the exercises alongside your regular daily activities.
• • If you can't hold the lightest weight, place your finger on the tip of the cone (where the string is attached) to reduce the weight. Then perform the exercises.
• • If you can hold the cone in your body for 15 minutes, you can try going up and down stairs and doing household chores. Such activities can really help you learn bladder control. You may need to use lighter cones when performing these activities.
• • The cone must always be removed after use. It is intended for limited periods of time during the day and should not be used continuously.

Are there any contraindications for using cones?

The cones are not intended for use by women with or suspected of having any vaginal, genital, or pelvic conditions (infections, inflammatory diseases, or pelvic malignancies). They should not be used during the first six weeks after childbirth or pelvic surgery. It is not recommended to use the cones during or immediately after intercourse, or during menstruation. They should not be used with tampons, a cervical ring, or a diaphragm.

What to do if there is no effect?

Read the instructions and ensure the cones are used correctly. If there is truly no effect, consider surgical treatment.

Can exercises and cones be used to prevent pelvic floor muscle weakness?

These exercises are beneficial for virtually all women, not just those with signs of muscle weakness. They help prevent chronic pelvic inflammatory diseases, venous congestion, vaginal prolapse, and urinary incontinence, and improve sexual sensitivity. In addition to preventing many gynecological conditions, they also help prevent labor weakness (training the intimate muscles is advisable before and during pregnancy, given the strain of labor) and the early stages of urinary incontinence.

What types of treatment are available for stress urinary incontinence?

Conservative – special exercises to strengthen the pelvic floor muscles, discussed above.

Целью хирургического лечения недержания мочи при напряжении является создание дополнительной опоры для мочеиспускательного канала с целью устранения патологической подвижности последнего. Выбор того или иного метода во многом зависит от степени недержания мочи.

What is sling surgery?

There are many variations of loop (sling) operations, during which the effect of urine continence is achieved by creating reliable additional support for the urethra by placing a loop made of various materials (vaginal flap, skin, cadaveric fascia, etc.) under the middle part of the urethra. Recently, minimally invasive loop surgeries, which have certain advantages (TVT surgery, TVT-O surgery, TOT surgery, etc.), have become increasingly popular.

What are the benefits of minimally invasive surgery?

• • Well tolerated – used for any degree of urinary incontinence.
• • Using synthetic mesh as a loop material.
• • Possibility of performing surgery under local anesthesia.
• • Short duration of the operation (about 30 - 40 minutes).
• • Short postoperative period – the patient can be discharged home on the day of surgery or the day after surgery.
• • Good functional results – low probability of relapse of the disease.

What is pelvic floor reconstruction?

Pelvic floor reconstruction is a surgical procedure aimed at correcting pelvic floor defects that cannot be treated conservatively. Pelvic floor reconstruction remains one of the most complex issues, uniting the efforts of urologists, gynecologists, and proctologists.

What is the essence of pelvic floor reconstruction surgery?

Pelvic floor reconstruction surgeries restore the normal anatomical relationships of the pelvic organs using the woman's own tissue or special synthetic materials to strengthen the pelvic floor. These surgeries are used for prolapse of the bladder, uterus, vaginal vaults, and other pelvic floor anatomical abnormalities. In most cases, these surgeries avoid uterine removal if the prolapse is significant. Vaginoplasty is performed under general anesthesia, spinal anesthesia, or epidural anesthesia. The average surgery duration is 1-1.5 hours. The patient feels no pain during the procedure.

What happens to the implant after mesh surgery?

Prolene mesh is not resorbed or degraded by enzymes and maintains its strength and integrity throughout the patient's life. Being virtually inert, the mesh induces the formation of a thin layer of fibrous tissue, which can grow through the mesh pores. This fibrous tissue growth leads to a stronger bond between the mesh and the surrounding tissue. The large pore size allows macrophages to migrate to the site of inflammation, thus preventing infectious complications.

What are the characteristics of the postoperative period after pelvic floor reconstructive surgery?

• • The external genitalia and perineum are washed 4-5 times a day;
• • vaginal douching is not recommended;
• • the stitches on the perineal skin are removed on the 5th day;
• • the woman is advised to eat easily digestible food to prevent constipation (straining after surgery is contraindicated);
• • sitting is permitted only 15-20 days after discharge from the hospital. Lifting heavy objects (more than 5 kg) is not permitted, and physical activity should be limited.

Sexual activity is permitted 2 months after surgery.

Pregnancy should not be planned for the first 12 months after surgery. During subsequent births, vaginal ruptures along the old scar cannot be ruled out; however, this is rare, as the tissues have time to restore their anatomical and functional integrity. The presence of vaginal plastic surgery is not an indication for a cesarean section in the future.

When is surgery not possible?

• • For all general conditions of the body in which planned surgical interventions are contraindicated (fever, infectious diseases, oncological pathology, some blood diseases);
• • in the presence of a mild degree of the detected disorders, which allows for the successful application of conservative treatment methods.

Symptoms that require you to consult a specialist:

• • disruption of the physiological functions of the pelvic organs of varying degrees (bladder, rectum), which can appear both in the postpartum period and during pregnancy - incontinence of urine, gas, feces;
• • absence of previous sensations during sexual activity despite the desire (anorgasmia), painful sensations during sexual intercourse;
• • gaping of the genital slit, sometimes causing dryness in the genital area;
• • the appearance of complaints related to a violation of the microflora of the vagina, urethra (periodically increasing mucous whitish discharge with an unpleasant odor in the absence of any genitourinary tract infections);
• • prolapse of the vaginal and uterine walls (usually detected during a gynecological examination)