The pubo-coccygeus muscle is located on the floor of the pelvic cavity, and extends from the pubis to the coccyx.
It is made up of three rings whose function is to keep the bladder, uterus and rectum in position, counteracting the force of gravity.
What is genital prolapse?
With age, the muscles weaken and lose strength, which can cause a fall of these organs called prolapse. If only the uterus descends it is called uterine prolapse, if the bladder descends it is called a cystocele and if the rectum descends it is called a rectocele. Pregnancies weaken the pelvic floor muscles due to the force that the pressure of the belly exerts on the pelvic floor.
Other risk factors for having a genital prolapse (of any of the three organs) are:
- Pregnancies and especially vaginal deliveries with large fetuses.
- The performance of impact sports, with jumps and lifting important weights,
- Constipation, with the force that is made against the pelvic floor,
- The hormonal changes of menopause, with tissue weakness and atrophy from lack of estrogen.
- The obesity, for the greater weight should hold these muscles.
- Chronic cough, due to the force that abdominal pressure exerts on the pelvic floor muscles
In addition to prolapse, weakening of these muscles can lead to stress urinary incontinence. It is characterized by the involuntary loss of urine when making some effort such as coughing, sneezing, laughing, jumping, running … The prolapse of the urine bladder produces a change in the outlet angle of the urethra, the tube that conducts the urine from the bladder to the outside. This anatomical change hinders the correct closure of the urethra with pressure and, therefore, the involuntary exit of urine. Improving the tone of the pelvic floor muscles can correct mild stress urinary incontinence.
This type of incontinence must be distinguished from urinary urgency that is produced by involuntary contraction of the urinary bladder muscle without the order to do so. For this reason, the patient has a compelling sensation to urinate and sometimes cannot prevent the bladder from emptying before reaching the bathroom. This type of incontinence is not caused by a structural change in the pelvic floor and therefore the treatment is different from that of stress incontinence.
How to exercise this zone with KEGEL exercises
In the 1940s, the gynecologist Arnold Kegel described a series of exercises to prevent and solve stress urinary incontinence after childbirth. These exercises were later found to improve the support of the pelvic organs and also the sexual function.
The success of these exercises depends on proper practice of technique and adherence to exercise planning. Physiotherapists are the specialists in planning a good Kegel exercise tablesuitable for each patient. First of all, the woman must learn to locate and control the pelvic floor muscles well. An easy way to become aware of where these muscles are located is to try to hold back the flow of urine while urinating while sitting in the bathroom. Many patients locate it incorrectly or instead of contracting it, they push it towards the ground, worsening the pressure on the muscles.
- In order to be aware of the muscles to work and how to work them, biofeedback and electrical stimulation can be used. Electrodes are placed on the abdomen, in the perineal area and in the vagina, in order to monitor the contraction of the muscles to work. Contractile activity is recorded on a monitor so that the patient can tell if she is really doing the exercises well. The electrical current stimulates the muscles in a way that forces them to contract repeatedly.
- Another way to work the pelvic floor muscles is with the vaginal cones. They are devices that are placed in the vagina as a tampon with a thread that is let out through the vulva to be able to extract it easily. These cones have different weights to be able to start with the one with the lowest weight and progressively increase the weight of the cone to be retained. For the insertion of the cone, some type of lubricant can be used if necessary and inserted as a tampon with the narrowest part in the upper area of the vagina. The cone should be kept inside the vagina for about 15 minutes a couple of times a day while walking, standing, doing normal active life at home … so that the muscles must work to keep the cone there.
- With age and pregnancy, the pubo-coccygeal musculature weakens and can cause the bladder, uterus or rectum to fall, called prolapse, as well as urinary incontinence.
- The exercises described by gynecologist Arnold Kegel in 1940 help prevent and solve urinary incontinence and improve the support of the pelvic organs.
- Physiotherapists are the specialists in planning a good Kegel exercise table suitable for each patient.