This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2021. For the original video go to https://www.youtube.com/watch?v=JeLyt67rMak&t=60s
Bob: Today we're going to show you how to cure urinary incontinence with Kegel exercises.
I was asked by a family member a ling time ago to show her how to do these. I really didn't have much experience with them though. So now, I've read a couple books on it and I've been doing them myself, but I'll talk about that some other time.
Brad: You read some self help books then?
Bob: Yep. So, what is urinary incontinence? It is an involuntary loss of urine.
Brad: It's embarrassing.
Bob: It is embarrassing. You could be laughing, you could be getting off the floor, you might be jumping. It's really common among young women in sports. You might be on a trampoline, obviously. And as you know, you have to rush to the bathroom if you don't make it. I had an older family member that really had trouble with this, and it really socially isolated him. It's not a laughing matter at all.
Brad: No it isn't.
Bob: It causes depression and loneliness. It's going to effect your social life. It's hard to date someone if your afraid or it.
Brad: Or your spouse might not want to be with you. I mean they do, but it's awkward.
Bob: So a lot more common in women, some reports, I saw one out of three women have it. And over 65, one out of two women.
Bob: So that's very common. Actually, believe it or not, one out of 20 men also have it. My wife made the observation, she goes, you go into the store and there is all these male Depends diapers there.
Brad: Which are made for incontinence.
Bob: So it may be a bigger problem than we're letting on.
Brad: I think men just won't admit it.
Bob: Men won't admit it. They'll, let it go.
Brad: Not me though, I wouldn't.
Bob: Yeah. All right. So what we're talking about here for Kegels exercises is we're trying to strengthen the muscles on the bottom of the pelvic floor. So the pelvic floor is attached to the
coccyx or tailbone, and up to the pubis. So it's right in this area here where my hand is.
Brad: It is, that's why they call it the pelvic floor. It's literally on the bottom of the pelvis.
Bob: Right, it supports everything. It supports all those structures down there. You've got two layers of muscles a superficial and deep layer, but you don't have to worry about that because you can't work them separately. If you're working one, you're working on both. So it was developed by Dr. Arnold Kegel in the fifties, very popular now. So the pelvic floor, you can control voluntarily, which is an intentional muscle contraction but it is also an automatic type of muscle that's working when you're not even thinking about it.
Brad: Right, it'll automatically contracts to take care of business.
Bob: Yeah. So like when you're lifting something or carrying something it's kicking in so that you don't go to the bathroom while you're doing it.
Brad: Yep, it closes those sphincters off and you're sealed.
Bob: So, what should happen when you feel a pelvic floor contraction? You know, you're going to have like a gathering of the pelvic floor muscles, and it's going to contract and lift up a little bit. That muscle is actually going to lift up. And also we are going to apologize ahead of time here. We're going to use some graphic language here. I mean, it's appropriate.
Brad: We'll be professional.
Bob: Yeah. But your anal sphincter it should also be lifting up. Now with the ladies and the men too, you're going to feel the perineal body lift up. Now the perineal body is the area between the vagina and the anus. And for the men, that's between the scrotum and the anus. So that you and you we'll talk about that. That you can actually feel that with your hand, you won't do it in public, but you know, when you're trying to learn them.
Brad: So you want to feel that movement and you want to be able to do it on command, your mind is telling you and you feel like you have good control.
Bob: Yep, you should continue to breath normal. People should not be able to know that you're even doing it. My wife and I are joking that we've been doing these and you could be talking to each other and doing it. I mean, we could be doing it right now. What should not happen when you're doing the pelvic floor, Brad is you don't want to contract outside muscles. I've seen this on some other channels. Like you don't want to tighten up the glutes, the inner thigh, or the abdominals. You don't. The muscle that you want is working down there.
Brad: You want to isolate it.
Bob: Isolate it. Don't hold your breath. You should be able to talk, don't tense your eyebrows, or your shoulders, or your body parts.
Brad: I would think that this is going to require initially some practice by yourself.
Bob: Practice by yourself get used to it and becomes easier. And if you have trouble, there's therapists that specialize in this area, we had a couple of therapists that's all they did. See our experts page for those therapists.
Brad: Right. Sure.
Bob: So these are the common cues and these are the ones that tend to help. We'll talk about it for women and for men. So women, they tell you to squeeze lift the pelvic floor. They've told you the contract like you're trying to stop the stream of urine from happening, but they don't recommend doing that because it can actually result in a urinary tract infections. I guess you can screw up your urinary reflex. So you don't want to actually start going to the bathroom and then stop it.
Brad: Oh, sure. Mid stream.
Bob: Yeah. You want to think about how that feels and then apply it. You can, again I'm going to get a little graphic here, Brad but you're supposed to imagine lifting and holding something in your vagina. That's another one, you're supposed to squeeze like you're trying to hold in gas. I think we've all done that. Or imagine pulling your sit bones together. So these are the sit bones. I first misstated at first, that's these two bones. They're the bones you can feel when you're sitting down.
Brad: If you're on a hard surface, you can feel those bones.
Bob: Yeah. You're supposed to feel like you're pulling those together.
Bob: And that'll help lift that area up. Now for men, this is kind of interesting. They did a study on this Brad, and they had all these cues and the best cue that worked for men was you're supposed to feel like you're shortening your penis. Don't make a joke.
Brad: It's like a turtle.
Bob: Like a turtle right.
Brad: Guys understand that.
Bob: Yeah. But it's funny, when I do that it feels like, one it works, and at two, it's an easy cue to understand. So I don't know why?
Brad: I bet your wife knows when you're practicing that.
Bob: Yeah. (laughing)
Brad: I mean, she knows you.
Bob: Okay for positioning, you can lie on your back propped up on a pillow or you can have your knees up. You can be in a quadrupedal position, Brad. And if you don't start that way you might want to progress that way to doing it that way, to do it sitting, to do it standing so you can apply it to all.
Brad: So you would start lying on your back.
Bob: You'll start lying down, yes. That's what I would do.
Brad: How many repetitions?
Bob: They have different ways of doing this. One, you can start with eight to 12 reps and do a ten second hold. So hold for 10 seconds. Do another one, do eight to 12 of those.
Brad: And then rest for 10 or?
Bob: Then you can do it like three times a day.
Brad: So you're going to hold it for the contraction and then rest for whatever.
Bob: Yeah, whatever.
Brad: And then do it again.
Bob: They said, you want to get up to like a hundred reps a day.
Brad: Not in a row.
Bob: Not in a row. And there's also, it's a slow Twitch and a fast Twitch muscle fiber. So you can actually do some where you do one second hold, one second release, one second hold one second release.
Bob: So you want to throw both of them in there Brad. So, these are the ways to feel it. This is a little bit, I don't know if you want to say grotesque, but one way you can tell whether or not it's working is you could take a small piece of tissue paper and put it over your anal sphincter. And if you're doing it right, it's actually gonna kind of suck that paper up a little bit.
Bob: Yeah. It's going to grab onto it and pull it up.
Brad: Well, it's like therapists, when we talk about working your gluten muscles. Since I started therapy back in the eighties as the teacher would say, well pretend you have a quarter between your butt cheeks and you're trying to squeeze that quarter, so it doesn't fall out. And it's like, boy that works.
Bob: It works.
Brad: Patients really respond to it. And they do it right.
Bob: You won't want to do that now because you're not trying to move the butt cheeks. But this is the one that I thought worked the best for me. And for people, it seemed like. So again, the perineal body is that area between the vagina and anus or the scrotum and the anus. That area right there. If you put your hand on that, again you won't want to do it in public, but you just put your hand there when you do it, you'll feel it lift up. I think that's the best cue you have. It seems like it works really well.
Brad: Basically biofeedback here. You're feeling what's going on with the muscles.
Bob: Speaking of biofeedback and we can laugh because we're men. You can actually see your penis lift a little bit if you're doing it right so.
Brad: I have to laugh.
Bob: I should have said, see if you cannot laugh. We're laughing but we know this is a serious problem. We really do.
Brad: You have to have fun with life, don't you Bob?
Bob: I know. Because it's a terrible thing. So you wouldn't be doing this after surgery unless you're doctor has okayed that. And you don't do it with a urinary catheter either.
Bob: So that's it, Brad. I know we're not experts on this but it's definitely, it's helped me
with some issues and we'll talk about that in another video.
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