bladder fitness - twitch and shout

8/13/2019 Bladder Fitness - Twitch and Shout

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Twitch and ShoutPelvic

Muscle Exercises

by Jennifer Stephens, M.A., BCIAC


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Twitch and Shout

Pelvic Muscle Exercises


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Copyright 2005 by

Jennifer Stephens, M.A., BCIAC

P. O. Box 1293Trinidad, CA

www.bladderfitness.org

[email protected]

All rights reserved. Except for brief quotations in books,

articles, and reviews, no part of this book may be used or

reproduced in any form without written permission from

the author.

Printed and bound in the United States of America

Published by

Fox Farm Publishing

P.O. Box 1293Trinidad, CA 95570

ISBN: 0-9726938-0-7


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Table of ContentsForeword ................................................................6

A little background about Kegel exercises......9

Learn to exercise the correct muscles .............. 11

Pelvic Muscle Exercise descriptions .................12

There are two basic types of pelvic muscle

exercises ..............................................................15

Starting the exercises .........................................20

Exercise regularly. Develop a routine. ..............22

The Exercise Routines ........................................23

Twitch and Shout Exercise Plan ........................25

Exercise Success Chart......................................27

Index .....................................................................30


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ForewordJennifer Stephens first approached me about her interest in

the treatment of urinary incontinence in 1992. At that time, themost common approach, especially for incontinence in women,was surgery. During my residency training in obstetrics andgynecology, I learned procedures designed to helpdecrease urinary incontinence by supporting the bladder neck.Unfortunately, this abdominal surgery (with its associated compli-cations) didnt always work. If it did help, long-term studies

showed that many womens incontinence returned after five toten years. When a woman then had repeat procedures, theprognosis for long term cure rates was dismal, and sometimesmade the problem worse secondary to nerve and blood supplydamage. Obviously, there was and is a lot not understood about

womans pelvic floor.

When Jennifer described newer techniques which seemingly

offered a risk-free alternative to surgery, I was very interested ifslightly skeptical. At that time, there were only a few studieswhich discussed pelvic floor rehabilitation via biofeedbacktechniques. Jennifers experience with biofeedback and herexcitement over its use to improve pelvic floor strength anddecrease incontinence convinced me to look further. I decided totake a chance on this new approach to incontinence and was not

disappointed by what I observed over the years to come.My patients were clearly getting better after seeing Jennifer.

I believe it was not only because of the focused exercise tech-niques she taught, but also because of her holistic approach

which empowered these patients with everything they needed toknow about their bladders and how to retrain them. Even incases in which this approach was not the definitive solution, its

initial application provided a more reliable indication for surgery.In the years since Jennifer and I first consulted, the most

interesting thing that has happened in my specialty of obstetrics/gynecology is the wide acceptance of pelvic floor rehabilitationas first-line treatment for most forms of urinary and fecal incon-tinence. In 1992, most other doctors thought we were crazy, now


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just about everyone is convinced it should be a first-line treat-ment for incontinence. The information presented in re-flects much experience and insight, and as I tell my patients, You

have nothing to lose and much to gain if you are a good stu-dent!

Kim Ervin, M.D., F.A.C.O.G.


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Twitch and Shout - Pelvic Muscle Exercises

None of us want to live our later years with the indignity of

having incontinent accidents and yet the statistics tell us that atleast half of the women past menopause have these problems.Previous generations of women werent given the informationthey needed to prevent this or to correct it once it started. Thisbooklet provides you with the information you need tostrengthen your pelvic muscles and cure stress incontinence, fecalincontinence, pelvic floor relaxation, prolapse, rectocele, cysto-

cele, post void dribble and other problems.Many bladder control problems are cured simply by doing

pelvic muscle exercises correctly on aregulardaily basis. Perhapsyoure tempted to just skim over this thinking that you alreadyknow how to do pelvic muscle exercises. Maybe you tried Kegelsand they didnt help. But are you sure that were you really exer-cising the correct muscles?

After looking at the biofeedback EMG readings of hun-dreds of women while theyre doing pelvic muscle exercises, it isclear to me that very few of the women who had bladder controlproblems were using the right muscles even though they weresure that they had been doing Kegels the right way. At thebeginning of their sessions, many of these women said, Oh,Ive tried these exercises and they dont work for me. Thesepatients had each tried doing the exercises for several weeks ormonths and concluded, My problem is too severe for exercisesto help. However, once we corrected their technique so they

were actually contracting the correct the pelvic muscles instead ofabdominal or buttock muscles, and once they became regularexercisers, their incontinence was cured.

To emphasize the possibility that you may not know how tocontract the correct muscles, I can tell you thisI have looked atthe EMG readings of dozens of nurses and physicians who hadproblems with either urinary or fecal leakage or urinary fre-quency and urgency. Many of them were certain they knew howto do pelvic muscle exercises correctly. You can already guess


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what Im going to say. Most of them used the wrong muscles.Most of their exercising had been wasted effort.

The Twitch and Shout Pelvic Muscle Exercise Pro-

gram is a step-by-step method to increase strength and curebladder control problems related to weakened musculature. Themost crucial first step is to identify the right muscles to exercise.This is easy for some people but for most it is quite difficult.During the first two weeks of the exercises, your goal is not reallyabout strengthening as much as it is to just establish the connec-tion between your mind and the correct muscles so you can do

the exercises correctly.A little background about Kegel exercises

Pelvic muscle exercises, often called Kegels, pronouncedkay-gels, are named after an obstetrician/gynecologist, ArnoldKegel, who was practicing medicine in the Los Angeles area inthe 1940s and 1950s. He certainly didnt invent these exercises

and he was not the first physician in the U.S. to advocate usingthem instead of doing unnecessary surgeries to treat inconti-nence.

There was an Ob-Gyn in Virginia in the late 1800s andanother physician in New York in the 1930s who used theseexercises with women. There have been other doctors who haveadvocated this noninvasive approach but Dr. Kegel was the one

who really popularized these exercises in the United States. Hedid some of the early research about using pelvic muscle exer-cises for better bladder control and for improving sexual re-sponse.

Dr. Kegel did more than just use pelvic muscle exercises inhis practice and research. His unique approach also includeddeveloping early biofeedback instruments for teaching women

how to do the exercises correctly and for motivating them toexercise on a regular basis. His system was similar to many of thebiofeedback systems used today. A sensor, in this case an air-filled tube, was inserted into the vagina and was connected to agauge that measured changes in pressure as the woman squeezed


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with her pelvic muscles. These measurements let the woman andDr. Kegel know how tight the muscles were contracting andenabled them to assess progress over weeks of exercising.

This helped motivate the women to do their exercises. It wasmotivating to see measureable changes in strength because itsometimes takes several weeks of exercises before symptomsbegin to improve. Dr. Kegel knew that it was essential to keep

women exercising during these initial weeks, and his biofeedbackequipment helped provide that motivation.

People from around the world have used these exercises

without biofeedback equipment for generations. During the1980s and 90s, international health care providers came to theinstitutes where I was teaching in order to learn the principles andtechniques of biofeedback. I remember in particular a group ofnurses from the Philippines who came for an intensive two-weektraining program. When the topic of biofeedback and inconti-nence came up as part of the course work, I was surprised by

their comments. They said that in their culture these exercises areregularly taught to girls as they reach puberty.

YOU HAVE TWO CHALLENGES

1. Learn to exercise the right muscles.

2. Exercise regularly; develop a routine.

Learn to exercise the correct muscles

Done correctly, pelvic muscle exercises are usually per-formed much more gently than people think they should be. You

may be quite surprised by how gentle your contractions are onceyou are no longer using abdominal, leg or buttock muscles at thesame time.

The pelvic muscles consist of layers of muscles that create ahammock, or bowl, of muscle that supports the bladder, uterus


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and rectum. This diaphragm of muscles is often called the pelvicfloor, the pelvic floor muscles or the pelvic muscles. For the sakeof clarity, this book just uses the term pelvic muscles.

Because there are layers of different muscles involved whenyou do your exercises, you will experience a variety of sensationsdepending on which of these muscles you are contracting. Sensa-tions vary because of the different positions and the differentphysical conditions of the muscles since some muscles may havebeen damaged or strained through pelvic surgeries or childbirth.

pelvic

muscles

urine

bladder

Position of the pelvic muscles


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Pelvic Muscle Exercise descriptions

Many people make the mistake of trying to do pelvic muscleexercises reallytight because they think thats the best way to get

fast results. They remember contracting these muscles when theywere younger and the muscles were stronger. In order to get afeeling thats as tight as they thinkit should be, they contract a lotof other nearby muscles including the legs, buttocks and/or theabdominal area. Ive seen people tighten everything from theirteeth to their toes trying to get a strong contraction. Some haveactually experienced pain in their buttocks because they were

trying to contract so tight. These efforts, though well-inten-tioned, do no good. Improved bladder control comes only byspecifically exercising the pelvic muscles themselves.

Over the years, Ive heard many descriptions of how to dothese exercises. Ill share a couple of the descriptions that stand

Another view of pelvic muscles

pelvic

muscles

pelvic

muscles


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out in my mind. The first description is one I read over 30 yearsago. It was written in a Dear Abby or Ann Landers column and

went something like this:

Lie on your bed on your back with your knees bent and

spread. Now imagine that there is a pencil placed at the

opening of your vagina. Imagine grasping the pencil with

your vaginal and drawing it inside yourself. Then let go,

grasp it again and draw it in further. Do this repeatedly.

This next description was told to me by a patient severalyears ago. This is how her doctor told her to do the exercises:

Imagine you are lying on the examination table, feet in the

stirrups and ready for your annual pap exam. Think about

the small area between the vaginal opening and the anus

right along the center line. (This area is called the centralpoint of the perineum).

Next, imagine that the doctors hand is coming towards

you but rather than holding a speculum to insert for the

exam, he has a large needle aiming directly at that central

point. Your goal is to escape being stuck by the point of

the needle by pulling that central point area inward, away

from the needle. Be careful to do this without tighteningthe abdominal muscles or buttocks or legs.

Another description comes from a practitioner in SouthernCalifornia. She often speaks to groups of people. Once she haseveryones attention, she asks them to wink at her. Then she says,Now, wink your anus.

She suggests this because the muscles that form theexternal anal sphincter and hold the rectum up in place are partof your pelvic muscles. In the beginning, its often times easierfor women to isolate this area rather than the muscles of thevaginal area.


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Now you have the idea! You want to get movement in thepelvic muscles while all else stays relaxed.

If the muscles are thin and weak there may not be muchsensation of movement or tightening. After a few weeks ofconsistent exercise the muscles will be stronger and sensations

will be clearer. In the beginning, I suggest you do the exerciseswhile lying down so that all the surrounding muscles can be asrelaxed as possible. This will help you to feel and to isolate thepelvic muscles from other muscles. Once the pelvic muscles have

strengthened a bit and sensations are stronger, its possible toexercise in the seated position without tightening the wrongmuscles. Eventually, many people are able to do pelvic musclecontractions while standing.

Once the pelvic muscles are strong enough, tightening themenables you to slowdown the flow of urine or to stop it com-

pletely. You can try this next time you use the toilet. Dont try tocompletely stop the flow of urine because youre too likely toinvolve other muscles. Instead, gently slow the flow of urine andfeel where the muscles are moving around your vagina, rectumand anus. Keep the legs, the buttocks and the abdominal muscles

You get better strengthening

if you concentrate on thesensations from the muscles

you're tightening.

Feel the movement in your

pelvic muscle area, not the

abdominal muscles or leg

muscles and not tilting yourpelvis or tensing your


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as relaxed as possible. You want to clearly feel movement in yourpelvic muscles. Dont worry if it feels like theres hardly anymovement or tightening. As long as you tighten the correct

muscles and keep up with the exercises, the muscles willstrengthen.

Your pelvic muscles are made up of two different types ofmuscle fibers: fast twitch fibers and slow twitch fibers. Both needto be exercised and require slightly different exercises forstrengthening. There are many different suggestions about pelvicmuscle exercise routines but all of them basically include combi-

nations of Quick Flicks and Sustained Contractions.Fast twitch fibers constitute about 10% of the pelvic muscle

fibers. These fast twitch fibers are exercised when you do quick,strong contractionsthe type of contractions often called aQuick Flicks. Quick Flicks are just like the words sound. Ideally,they are maximal contractions; in other words, as tight as themuscle can contract.

Quick Flicks are done in relatively quick succession with justa few seconds rest between each Flick so that the muscles have achance to return to their resting position before doing the nextQuick Flick. Exercise physiology tells us that muscles generatethe greatest contractions if they start from their full restingposition. Giving a few seconds of rest in between each QuickFlick allows the muscles to return to this resting length, resulting

in more strengthening for your effort. These few seconds of restalso give you a chance to really think about which muscles you

want to contract, which also improves the effectiveness of yourefforts..

During the first two weeks of the exercises, you will only

There are two basic types of

pelvic muscle exercises


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do Quick Flicks. After a few weeks, youll be able to do QuickFlicks at a faster pace.

If we were looking at the electrical activity from the pelvic

muscles on an EMG biofeedback system Quick Flicks wouldlook something like this:

In addition to exercising the fast twitch fibers with QuickFlicks, you must also exercise the rest of the pelvic muscle fibers,the slow twitch fibers. These are exercised by doing SustainedContractions.

Strengthening these muscles helps hold everything up inplaceyour bladder, urethra, rectum and uterus. If thesemuscles are not maintained with adequate exercise the internalorgans begin to sag downward resulting in prolapse, cystocele,rectocele and/or urethrocele. When the bladder drops down, theurethra which is attached at the bottom of the bladder begins tostretch and widen and then its even more difficult to keep the

urethra closed when you cough or sneeze and as a result, yoururinary stress incontinence worsens.

People with bladder control problems often have pelvicmuscles that might be strong enough to do Quick Flicks but aretoo weak to do Sustained Contractions. The muscle fibers tireout too quickly and other muscles, most commonly the abdomi-nal muscles or the buttocks, will unconsciously be added into the

contraction to create a sensation of strong, sustained tightening.This, of course, is of no help in curing incontinence.

Sustained Contractions, like the words sound, are contrac-tions that you hold for a while. How many seconds you holdeach one depends on how strong your muscles are. In this


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program, you are guided to gradually increase the length

of time you sustain each contraction.

If we were looking at the EMG activity from the pelvicmuscles doing fairly effective Sustained Contractions, the electri-cal signal would look something like this:

If the muscles are too weak to sustain the contraction

effectively, the EMG signal would look something like this:

You can see that the muscles fatigue. If we were looking atthe electrical activity from the abdominal, buttock and legmuscles at the same time, we would see that one or more of thesemuscle groups tighten up as the pelvic muscles fatigue. This is an

unconscious process of the mind and the body to create thefeeling of sustaining the contraction, even if its with the wrongmuscles. The person usually has no idea this is happening andbelieves that the pelvic muscles are still doing the work. Weeks ormonths may be spent doing this and theres little or no improve-


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ment in symptoms. The person then mistakenly thinks pelvicmuscle exercises wont help her bladder problem.

How can you tell if your pelvic muscles are fatiguing and

other muscles are substituting when you do Sustained Contrac-tions? If the pelvic muscles are fatiguing too quickly, you wontfeel a release of muscle tension in the vaginal, perineal or analareas when you intentionally stop the contraction. Pay attention

when you are letting go of the Sustained Contraction. If thepelvic muscles are working for the full number of seconds youintend, you will feel a distinct release of muscle tension in the

appropriate areas. If the pelvic muscles have already pooped out,you dont feel a release in the vaginal, perineal, anal or rectal areasbecause the pelvic muscle fibers already let go.

If your pelvic muscles are unable to sustain the contractionas long as you want, what do you do? There are a couple ofthings you can do. The simplest solution is to reduce the numberof seconds youre trying to sustain the contractions and rest a few

extra seconds between each contraction. If this doesnt work, doa few more weeks of just Quick Flicks so your muscles can buildup a bit more strength before trying the Sustained Contractionsagain.

A second possible solution that works for many people is asimple technique of doing gentle twitches or gentle flicks at thesame time youre doing a Sustained Contraction. To accomplish

this, while you do your Sustained Contraction, repeatedly con-tract the pelvic muscles with little twitches.

Physiologically, every few seconds some of your musclefibers are fatiguing. These intentional twitches are signals to thepelvic muscles to tighten up again. Your twitches are like thesports coach who says, Keep on going or Go, girl, go! If

we were looking at EMG signals, the combination of a Sustained

Contraction with the twitches would look something like this:


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The muscles fatigue andcant do Sustained Contraction athigh levels. But Quick Flicks alone often wont improve bladdercontrol. People then think pelvic muscle exercises wont helpthem and that only a surgery will improve their conditions. Ifonly they knew to do both types of contractions and how to getthe right muscles working!

Now you can see that its crucial that you strengthen boththe fast and slow twitch fibers and to do this its necessary to doboth types of contractions, Quick Flicks and Sustained Contrac-tions.

Starting the exercises

You now have the information you need to begin exercis-ing. A large part of the problem of stress incontinence stemsfrom weakened pelvic muscles and the time to start exercising isright now! It makes no difference if youve had the problem foryears or for just a few months. If youll follow the Eight-Weekexercise routine on page 61 youll be on your way to freedomfrom incontinence.

This is a step-by-step program and the most crucial step isto first identify the right muscles to exercise. This is easy forsome people but for most it is quite difficult. In the first weeks,dont worry about how tight you are contracting the muscles.Focus instead on the sensations you get from the pelvic region as

Twitches

Fatiguing muscles would

look like this.


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you attempt to isolate the pelvic muscles from other muscles inthe area. During the first two weeks of the exercises, your goal isnot really about strengthening as much as it is to just establish the

connection between your mind and the correct muscles.Day 1 is about identifying the right muscles. If you are

seeing a biofeedback therapist this is a fairly simple process ofwatching EMG signals from numerous muscles as you learn tocontract only the pelvic muscles. But at home on your own, thisis a trickier process. You must rely solely on the sensations youfeel from your body. To help identify the correct muscles, physi-

cians will often suggest that you stop the flow of urine whiletoileting. These muscles, the ones that tighten around the urethrato stop the flow of urine, are the ones you want to exercise.

Unfortunately, once people are experiencing leakage, theyare often unable to contract these muscles tightly enough to dothe job. Because they sincerely want to follow the physiciansinstructions, they try harder and harder to stop the flow of urine.

This effort invariably causes a lot of the wrong muscles tocontract.

My suggestion is to start by slowing down the flow ofurine while you are on the toilet. I say slow rather than stopso you dont mistakenly tighten abdominal, leg and/or buttockmuscles. Tightening the wrong muscles interferes with strength-ening the correct ones. Let the other muscles stay relaxed and

tighten only the pelvic muscles to slow the flow of urine. Onceyou have identified the correct muscles the first day, dont exer-cise on the toilet anymore. Set aside a specific time that yo willlieor sit down and do your exercises.

Different people achieve clearer sensation of the contrac-tions from different positions. The sitting or reclining positions

work best for doing pelvic muscle exercises in the beginning.

You might experience clearer sensation from the pelvic muscleswhen youre lying on your back with pillows supporting yourknees, or while lying on your side with a pillow between yourknees. Or you may get better sensation when you are sitting.Youll need to experiment to find out what works best for you.


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When you are in a position that you think will work, the firstthing to do is to relax all your muscles. Take a few minutes forthis and if you dont know how to relax, go to

www.bladderfitness.orgfor relaxation tapes or CDs.Next, identify your pelvic muscles. Whether sitting or

reclining, simply become aware of these parts of your body. Ifyou are reclining, you can insert a coupleof fingers into yourvagina or one into your anus so you can feel the contractions.Place on ehand on your abdominal muscles so you can monitorthem to assure they remain relaxed. Now, gently contract the

pelvic muscles. Feel the movement. Follow the Eight-WeekTwitch and Shout exercise routines beginning on page 24. Theywill guide you to gradually strengthen your pelvic muscles.

Exercise regularly. Develop a routine.

I recommend that you develop a habit of daily exercises.Think if it like brushing your teeth. Its just part of your daily,

routine health maintenance program. Very few people are toldhow important it is to maintain the fitness of these pelvicmuscles. If you start exercising when you first begin to haveproblems or before you have any problems, you wont be leaking

when youre older. If you already have a problem, you need tostart exercising to correct it. Otherwise the problem will worsenover time.

One of the tricks to doing pelvic muscle exercises on aregular basis is to develop a routine of doing them at the sametime every day or to pair it with some other activity of dailyliving. If you have other exercises that you do every day, addingthese to your routine is one way to help yourself keep up withthem. Or perhaps you have some other activity that you doroutinely like take a nap in the afternoon, or take some time to

read the morning paper with a cup of coffee. If youll add yourpelvic muscle exercises to this daily activity, youll be more likelyto continue with them over the years.

A routine that works for a lot of people is to do them whenyou first wake up in the morning or when you first go to bed at


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night. Regardless of what else is happening in your life, you wakeup in the morning and go to sleep at night. If you will trainyourself to do your exercises at these morning and/or evening

times, you will be more likely to continue them during times likevacations and holidays when other parts of your normal dailyroutine might be interrupted.

Three weeks of not doing exercises and you can lose 50percent of the strength you have gained. Remember, consistencyis the key.

The Exercise Routines

So, how many Quick Flicks should you do and how longshould you hold the Sustained Contractions? At the office Idetermine this by measuring the EMG signals coming from thepelvic muscles and other surrounding muscles. This lets us seeexactly how much work the pelvic muscles can do before they

become too tired and other muscles come in to help. An exerciseprescription is then personalized, based on the demonstratedstrength of the pelvic muscles. The exercise routine is repeatedlychanged over a period of a few months, gradually increasing thedemands on the pelvic muscles as they get progressively stronger.

Since we arent using EMGs here we cant personalize yourexercise routine so well use a generic exercise prescription. Your

exercises for Week 1 and Week 2 are ten minutes of Quick Flicksdone at least one time a day. Think about the muscles as you aretightening. Its important that you focus on what you are doingand pay attention to the sensations of tightening the muscles. Ifyou notice that you cant feel the muscles tightening or releasing,rest for a minute and continue until your ten minutes is com-pleted. Over the next couple of weeks, youll notice the muscles

are getting stronger. Youll be able to keep the contractions goinglonger before you need to stop for a little rest.

If you purchased the audio materials, well talk youthrough the process, helping you feel the sensations from thecorrect muscles and helping you to continue through the entire


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ten minutes. Ten minutes doesnt sound like much and there isnothing sacred about this length of time. Its just what I havefound that people can actually work into their daily routines and

its generally enough to accomplish the necessary strengthening.Arnold Kegel recommended doing twenty minutes of pelvicmuscle exercises three times a day. So do more if you want to.

Each time you complete the full ten minutes, congratulate

yourself. Give yourself aon your exercise chart on page 24and give yourself a pat on the back for having done it. Youmight reinforce or reward yourself by exclaiming to yourself, I

did it, I did it, I did it. We all respond to reward and recognitionfor what weve accomplished. Give yourself aon your exer-cise chart, Youll feel good when you look at your chart after afew days and see all the evidence of your efforts. This will helpkeep you on track with your exercise program.

Youll notice on the exercise chart that the exercise sessionsare always ten minutes long but the routines change as the weeks

progress. After the first two weeks, you will do Quick Flicks for afew minutes and sustained contractions for a few minutes. It willstill be a total of ten minutes of exercise. The routine changesevery two weeks to keep your muscles working hard enough forcontinued strengthening.

Rather than doing the exercises for a full ten minutes all atone time, some people do a few here and a few there and calcu-late that it probably adds up to ten minutes over the days time.My recommendation to you is that you do the whole ten minutesin one sitting. Muscles strengthen by being pushed to the pointof fatigue, being pushed to do a little more than they are com-fortable doing. Ten minutes will do this. Little bits here andthere might not. I think of the little bits here and there as icingon the cake. They are great and every little bit helps. But toachieve the results you want as efficiently as possible, youll bebetter off to do the whole ten minutes at one time.

You can do the exercise routine more than once a day if youwant to. Wait at least two hours before doing another ten minutesession so the muscles have a chance to rest and recover. If they


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become too fatigued, you might have a little increased stressincontinence because the muscles are too fatigued to workproperly. If this happens, just give your muscles a little more rest

between exercise sessions until they gain a little more strength.

.

Twitch and Shout Exercise Plan

Doten minutes of exercises each time,

one to three times each day.

Weeks 1 and 2:While reclining doQuick Flicksfor tenminutes. Each Quick Flick is done briefly and you should

wait a second or two between each contraction.

Weeks 3 and 4:Recline or sit. Do Quick Flicksfor fiveminutes and forfive minutes doSustained Contractions. Hold

for three to four seconds. Rest ten seconds in between each

Sustained Contraction.

Weeks 5 and 6:Recline or sit. Do Quick Flicks for twominutesand for eight minutes doSustained Contractions that

you hold for five seconds. Rest ten seconds in between each

Sustained Contraction. You may need to do the little twitching we

talked about on page 17

Weeks 7 and 8:Recline or sit. Do Quick Flicks for twominutes and for eight minutes do Sustained Contractions that

you hold for ten seconds each. Rest ten seconds in between

each Sustained Contraction.

I did it! I did it! I did it! ... Yippee!

For exercises beyond Week 8 go to



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Exercise Success Chart

Give yourself a each time you do a full ten

minutes of exercises (one to three times each day).

Use the corresponding CD if you wish.

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

M T W Th F S S

For exercises beyond Week 8 go to



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If your symptoms dont improve using this program gethelp. Find a therapist in your area to help you identify the rightmuscles using EMG biofeedback technology. Being able to

correctly identify the pelvic floor muscles is crucial to successfulstrengthening. EMG biofeedback uses computers to let you seethe electrical activity coming from your muscles as you areattempting to contract the pelvic floor muscles.

As your muscles tighten, they give off measurable amountsof electricity. Seeing this activity helps you learn to contract theright miscles, particularly if your pelvic floor muscles are weak.

EMG signals can provide the necessary information so you canlearn to contract the specific muscles you need to strengthen.The EMG signals are also used to test your muscle strength anddetermine a specific exercise routine for strengthening.

It would be to your benefit to see such a biofeedbacktherapist. If none is available in your area, there might be aphysical therapist or a nurse who works with biofeed


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Additional resourcesfor bladder retraining and for learning

relaxation techniques are available from

www.bladderfitness.org. You can also schedule personal

consultations from this website. Other sources ofinformation:

American Foundation for Urologic Disease

The Bladder Health Council

1128 North Charles Street

Baltimore, MD 21201

(800) 242-2383 or (410) 468-1800

American Uro-Gynecologic Society

401 North Michigan Avenue

Chicago, IL 60611-4267

(312) 644-6610

Continence Restored, Inc.

407 Strawberry Hill Avenue

Stamford, CT 06902

(203) 348-0601 or (914) 285-1470

National Association for Continence

P.O. Box 8310

Spartanburg, SC 29305

(800) BLADDER or (803) 579-7900

The Simon Foundation for ContinenceP.O. Box 835

Wilmette, IL 60091

(800) 23-SIMON


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Index

B

Biofeedback 27biofeedback 8, 10, 27

C

cystocele 17

E

EMG biofeedback system 16EMGs 8, 16, 23

K

Kegels 9

P

pelvic muscle exercises 8, 9, 12, 15, 21prolapse 17

Q

Quick Flicks 15, 16

Rrectocele 17

S

Sustained Contractions 17

U

urethrocele 17


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