Kegel Exercise - Pelvic Toning Devices

Pelvic Toning Devices

A pelvic toning device (generically referred to as a Kegel exerciser, pelvic floor toner, pelvic floor muscle toner or pelvic toner) is a medical or pseudo-medical device designed to help women exercise their pelvic floor muscle and improve the muscle tone of the pubococcygeal or vaginal muscle.

The original pelvic toning device was the perineometer, invented by Arnold Kegel to facilitate the measurement of the strength of the pubococcygeus muscle when it was resting and being actively squeezed - sometimes referred to as the Kegel tone.

His device was a combination of rubber balloons and tubes that measured pressure using a column of water. It was neither easy to use nor portable.

During the latter part of the 20th century, a number of medical and pseudo-medical devices were developed and launched onto the market. Some of these are used in a clinical setting, but most are designed for women to use in the privacy of their own home.

Pelvic toning devices fall into a number of different types:

• barbells, vaginal weights or cones designed to be held in the vagina. The action of passively/actively retaining the device internally is supposed to improve muscle tone. Barbells are made of smooth, polished solid stainless steel, cylindrical in shape, with a rounded bulge at each end. They typically weigh one pound (454 g) and measure approximately 6+3⁄₄ inches (17 cm) in length with a diameter of one inch (2.5 cm) at the widest part. Being made of stainless steel, vaginal barbells are nonporous and can be wiped clean with a cloth moistened with mild soap and water.
• electro-stimulation or TENS devices that administer an electrical current through an internal probe. The current stimulates the adjacent muscles to twitch.
• rubber resistance balls and indicators. These devices provide a nominal resistance to squeeze against. An advantage of rubber bulb devices is that they provide visual feedback (via a gauge) of how much pressure is being applied.
• progressive resistance vaginal exercisers with springs are the only devices that meet all of Kegel's criteria. They provide a biofeedback that the correct muscles are being engaged and are capable of fulfilling the fundamentals of an exercise regimen by applying a variable and increasing resistive force to maximise the exercise effort.

Regular Kegel exercises should achieve tangible results (such as less frequent urine leakage) within about 8 to 12 weeks. For some women, the improvement could be dramatic. Unfortunately there are a number of products on the market that have no impact at all on the pubococcygeus muscle. If the PC muscle is not engaged then it is impossible to improve the muscle tone or strengthen the muscle. Devices that are used externally, for example between the thighs, may exercise the adductor muscle but do nothing for the pelvic floor.

Clinical research published in the British Medical Journal compared pelvic floor exercises, vaginal weights and electro-stimulation in a randomised trial. The research recommended that pelvic floor exercise should be the first choice of treatment for genuine stress incontinence because simple exercises proved to be far more effective than electro-stimulation or vaginal cones.

This situation was confirmed in a comprehensive review of the treatment of stress incontinence published in the British Journal of Urology International in 2010. The report author noted that electrical stimulation devices and weighted vaginal cones are not recommended by the UK National Institute for Clinical Excellence (NICE) and "are not universally advocated by clinicians as they have yet to produce sufficient evidence of efficacy".

Clinical trials of a progressive resistance vaginal exerciser concluded that the device was as effective as supervised pelvic floor muscle training, the gold standard treatment of the UK NHS where patients are referred to a specialist continence advisor for one on one training over a three month period. The report also noted that the device can help overcome the fundamental weaknesses associated with pelvic floor muscle exercises (PFME), i.e. poor training, lack of patient confidence and poor compliance with the exercise recommendations.

Key points noted by the research are that:

• the device gives “confidence to women that they were correctly contracting their pelvic floor, and this may be helpful encouragement when a woman is starting out on a regimen of PFME”.
• the biofeedback given by the device “may be particularly helpful to demonstrate to the woman that she is carrying out the PFME appropriately”.
• the device is particularly relevant to those women “who do not consult their physician and wish to maintain confidentiality regarding their SUI symptom”.

A progressive resistance vaginal exerciser is the only form of pelvic toning device available on prescription in the UK to women presenting with symptoms of urinary stress incontinence or pelvic floor weakness.