Although pelvic organ prolapse and urinary incontinence do not endanger the life of patients, they certainly affect their quality of life. Prolapse is the descent of vaginal walls and/or uterus, which begin to appear through the entrance of the vagina and cause weight sensation, discomfort due to friction, alteration of sexuality, etc. Sometimes the descent is severe, and the entire vagina and uterus are outside.

Stress incontinence is the involuntary loss of urine during physical effort, heavy lifting, laughing, sneezing or coughing. This is very uncomfortable because the urine wets the clothes and generates an unpleasant odor forcing the patients to use sanitary napkins or diapers.

Surgery to correct these problems have a success rate of approximately 80%; it means that a non-negligible percentage of patients are left with the same problem after surgery or relapse after some time.

There are some exercises, very easy to do, aimed at strengthening the pelvic floor, specifically a muscle called the levator ani, on which rest the bladder, urethra, vagina, uterus and rectum. This muscle covers the entire pelvic floor and supports all these organs. To the extent that this muscle is healthy and strong, you can avoid these prolapses and incontinence, not only urinary, but another one more serious: fecal incontinence.

These exercises are known in the Western world as Kegel exercises. However, it was the Chinese, more than 10,000 years ago, who described these exercises for the first time. They noticed that the deer were very prolific animals, and could engage in sexual intercourse frequently. So they followed and studied the daily habits of the deer to see if they could increase sexual powers in human ills. They found that the deer frequently squeezed their anal muscles throughout the day. They applied this anal muscle squeezing to human sexual health practices. They found it to be highly effective for strengthening the sexual powers. Dr. Kegel, in 1948, simply brought the ancient Chinese Deer Exercise to the attention of the Western world. He incorporated different size devices to insert in the vagina to aid sensation and feel during the exercise.

Pelvic floor exercises or Kegel exercises have been shown to improve urinary incontinence in 80% of patients, and are the first line of treatment for it. In relation to the prolapse of pelvic organs, the evidence suggests that in early stages, these exercises can prevent the progression of prolapse, and in some cases even reduce them. Furthermore, if these exercises are performed by young women, the likelihood of developing prolapse or incontinence would be reduced to a minimum.

Hypertrophy of the levator ani muscle is achieved in approximately 15 weeks of exercise. There are about 100 ways to do these exercises. I'm going to show you what we do at the University Hospital of Caracas, in the pelvic floor clinic. Usually, I perform a vaginal exam on my patients to feel how they do it, but you can do them with or without introducing your fingers into the vagina to feel the contraction.

In any position, relax and contract your vagina. The feeling is that the anus rises when you do the exercise correctly. Be very careful not to use your buttocks or abs. These are called "parasite" muscles, that should not contract during exercise. If you have trouble identifying which muscle to contract, close your eyes and imagine that you are urinating and you want to stop the stream of urine suddenly. To do that you must contract the levator ani. This does not mean that you are going to do it while urinating, it is a frequent mistake, just imagine that moment. Once you achieve the exercise, you will distinguish two types of contractions: the fast and the sustained. The fast ones are made quickly contracting and relaxing; the sustained ones are achieved by contracting and maintaining that contraction as long as possible. Over time you will manage to count to 10 before relaxing. Each day, 15 fast contractions and 15 sustained contractions must be done, which adds 30. You should repeat this 3 times a day for a total of 90 daily contractions. These exercises are especially important during pregnancy and after delivery.

The exercises are very easy to do once they are learned. The problem is to remember to do them because they are very effective only if they are done 3 times a day. You can place an alarm on your phone as a reminder or stick a paper in the sink if you are a housewife and should wash the dishes at least 3 times a day, or choose the reminder method that best suits your daily life.

IF YOU DO NOT WANT TO SUFFER FROM PROLAPSE AND INCONTINENCE OR WANT TO STOP THEM IN TIME, DO KEGEL EXERCISES EVERY DAY!