Our Greatest Wealth Is Health

Andrew Siegel MD    2/10/18

This is a continuation of last week’s entry.  Remember, PFMT is equally appropriate for males as well as females –both genders have these important muscles that can benefit from whipping them into shape.

The basic PFMT programs that follow are “low tech” exercises of the PFM without added resistance.  They can be thought of as PFMT 101, the goal of which is to provide the foundation for pelvic muscle proficiency. After mastery of basic PFMT, progression to the next phase of conditioning—resistance training—is in order.

PFMT is the essence of “functional fitness,” exercises that develop PFM strength, power, stamina and the skillset that can be used to improve and/or prevent specific pelvic functional impairments. PFMT regimens must be flexible and nuanced, designed and customized with particular functional needs in mind, i.e., issues of pelvic support, urinary control, sexual function, pain, etc., as opposed to a one-size-fits-all approach.  An additional consideration is baseline PFM strength and stamina.  After determining an area of weakness, focused effort should be applied to this deficit.

Time to Begin

You do not need to go to a gym, wear athletic clothing, have any special equipment, or dedicate a great deal of time to PFMT. It is vital to do properly performed, quality PFM contractions with the goal of slow and steady progress. Experiencing some aching and soreness as you begin is not uncommon.

If you are pursuing PFMT for specific pelvic issues, expect that it may take a number of weeks or more to see an improvement in your symptoms.  After you have noticed a beneficial effect, the exercise regimen must be maintained, because regression can occur if the pelvic muscles are not consistently exercised…”use it or lose it” applies here.

Basic PFMT exercises can be performed lying down, sitting upright in a comfortable chair with your back straight, or standing. It is best to begin lying down, to minimize gravity, which makes the exercises more challenging. Regardless of position, it is essential to maintain good form, posture and body alignment while doing PFMT. It is important to relax your abdomen, buttocks and thighs. Breathe slowly and do not hold your breath. Even though no muscle group works alone, by trying to isolate the PFM and focusing on squeezing only the PFM, you will make more rapid progress. You should not be grimacing, grunting or sweating, as PFMT is, in part, a meditative pursuit that employs awareness, focus, mindfulness and intention while performing deliberate contractions of the PFM.

Helpful metaphor: “Snap” describes a brief, vigorous, well-executed contraction of the PFM. With increasing PFM command, these pelvic muscles can be “snapped” like your fingers.

There are six variables with respect to PFM contractions:

1. contraction intensity
2. contraction duration
3. relaxation duration
4. power
5. repetitions
6. sets

Contraction intensity refers to the extent that the PFM are squeezed, ranging from a weak flick of the muscles to a robust and vigorous contraction. The contraction duration is the amount of time that the squeeze is sustained, ranging from a “snap”—a rapid pulsing of the PFM, to a “sustained hold”—a long duration contraction. The relaxation duration is the amount of time the PFM are unclenched until the next contraction is performed. Power is a measure of contraction strength and speed, the ability to rapidly achieve a full intensity contraction. Repetitions (reps) are the number of contractions performed in a single set (one unit of exercise).

It is relatively easy to intensively contract your PFM for a brief period, but difficult to maintain that intensity for a longer duration contraction. It is unlikely that you will be able to maintain the intensity of contraction of a sustained hold as you would for a snap.

The better PFMT regimens utilize a combination of snaps, few-second contractions and sustained duration contractions to reap the benefits of both strength and endurance training.

Fact: Short duration, high intensity contractions build strength and power, whereas longer duration, less intense contractions will build endurance, both vital elements of fit PFM.

Incremental change—the gradual and progressive increase in the intensity of contraction, duration of contraction, number of reps and number of sets performed—is the goal.  Performing the program 3-4 times weekly is desirable since recovery days are important for skeletal muscles.

PFMT is not an extreme program; nonetheless, it is by no means an undemanding program, and certainly requires effort and perseverance.  Depending on your level of baseline PFM fitness, you may find the exercises anywhere in the range from relatively easy to quite challenging. Your PFM are unique in terms of their shape, size and strength and consequently expectations regarding results will vary from individual to individual.

After a month or so, you should be on your way to achieving basic conditioning of the PFM. Reassessing the PFM by repeating the Oxford grading and the PFM endurance tests that you measured at baseline should demonstrate objective evidence of progress. More importantly, you should start noticing subjective improvement in many of the domains that PFM fitness can influence.  Once you have mastered non-resistance training, it is time to move on to resistance training, in which you squeeze your PFM against the opposing force of resistance in an effort to accelerate the PFMT.

If you are challenged by the non-resistance PFMT or cannot or prefer not to use resistance—which for women requires the placement of a device in your vagina and for men the ability to achieve a rigid erection—you can continue with the non-resistance training using it as a “maintenance” program.  PFM maintenance training typically requires continuing with the PFMT program, but performing it less frequently, twice weekly usually being sufficient.

To be continued next week…

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

Tags: Andrew Siegel MD, Kegel exercises, Kegels, Kegels for men, Kegels for women, pelvic floor exercises, pelvic floor muscle training, pelvic floor muscles

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