Kegels or alum?

Dear Dr Mitchell,

Can you explain how kegel exercises work? My doctor suggested that I do them, but I’ve been trying for a while and it doesn’t seem to make me any “tighter”. My aunt suggested that I use blue washing soap to bathe down there, or get some alum. Is this dangerous?

Pelvic floor weakness is a common problem in women especially after a vaginal delivery. It tends to be more common if you have delivered a big baby, forceps or vacuum delivery and prolonged second stage of labour with excessive pushing. Diabetes Mellitus also causes the nerve supply to the pelvic floor to be damaged and cause laxity of the muscles.

Laxity of the pelvic floor may result in prolapse of the uterus, bladder, rectum or small bowel. Some patients have laxity of the vaginal walls which results in reduced sensation in the vagina during intercourse. If vaginal prolapse is the main problem then painful sexual intercourse may also result. This is significant as it may result in significant problems with sexual satisfaction in both partners leading to problems in the relationship.

Kegel exercise is named after Dr Arnold Kegel and is an exercise designed to strengthen the pelvic floor.

The exercises consist of the regular tightening and relaxation of the muscles of the pelvic floor. This helps restore strength and muscle tone to the muscles to prevent or reduce pelvic floor problems and increase sexual gratification. After a vaginal delivery it is important to practice pelvic floor contractions and this can be done during sexual intercourse. This will allow for immediate feedback from the male partner who can feel the pelvic floor muscles tightening around the penis. This helps to restore the pelvic floor muscles to the pre-pregnancy strength and tone.

Kegel exercises can be done anywhere and anytime, while driving, relaxing or at work. To exercise these muscles you need to pull in or “squeeze” your pelvic muscles as if you are trying to stop your urine flow in mid-stream. This squeeze is held for about 10 seconds, then rest for 10 seconds. This should be done at least 10 times, three to four times per day. The results are not immediate so you have to be patient. Some improvement is seen in a few weeks but significant improvement is definitely seen by six to 12 weeks.

Blue washing soap or the use of alum is not advised. This might irritate the vagina and vulva and make things worse for you. There is no documented scientific evidence to suggest that these work. If you are overweight, it is a good advice to lose some weight as excessive weight weakens the pelvic floor. A chronic cough, asthma or any chronic obstructive airway disease such as Emphysema also will make things worse and need to be dealt with. Chronic constipation, lifting heavy weight and smoking also are significant risk factors that should be dealt with.

If Kegel’s exercises do not work and you are still unhappy with sexual intercourse or have other pelvic floor problems, then surgery can be done to correct the problem. Consult your gynaecologist who will advise you further. A ring pessary may be recommended by your doctor to help keep the pelvic floor in place while contemplating surgery and this will offer some relief, especially if uterine prolapse is significant or there is urinary stress incontinence.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.