Stop Kegel

[00:00:01]Yes. Uh so very very very good evening to all of you and let's start our today's discussion very important discussion about Keegan exercise.

[00:00:12]Uh so many of you might be already working as a pelvic rehab therapist experts might be some of you have get training from me directly uh through this workshops and webinars and where I have already you know explained a lot of things about pelvic floor uh detailed explanation about pelvic floor the NFP physiology the function the dysfunction the action the uh you know then how to assess the muscles how to uh treat the muscles And you might have heard about in my workshop also the word keigle. Sometimes I have done specific webinars on keigull. How to do keigle. But how to do keigle? How to isolate the muscles?

[00:00:56]That's the one different term. But today our session is stop kele. So in which cases we should not go for kele exercises. I'm going to give you that understanding from this today's webinar.

[00:01:12]I have not created a very fancy uh pity for that because uh I wanted to give you some facts which is already visible on uh kind of you know Google. So I have some screenshots from the Google. So we can just go precisely what if a normal people, normal layman and a normal physotherapist if they want to just understand pelvic floor to dysfunction and which exercise I can do for pelvic floor dysfunctions. So what terms comes in? You might have heard about the keal exercises are very effective for urine leakage. So that is also another important uh understanding you know being a physio being a expert in pelvic health we should understand that urine leakage itself is a big uh uh term and there are different types of urine leakage. So what Google is telling us not only us as a physio what the Google is telling to the community to the society and how the society is perceiving and why how they are doing it and how these keal exercises are failed.

[00:02:18]So this is very important discussion we are going to do in this session today.

[00:02:23]So uh I will share my screen with all of you.

[00:02:59]And yes, before I start presenting my screen, I want to have understanding that how many of you are already practicing pelvic floor and you have done you have attended did any course or any kind of webinar any learning thing about the pelvic floor and you are already helping your patient. So please send yes in the chat box that I'm already working and if you're you're new so please write down I'm new so this is a new concept for all of uh whoever it is new concept so uh that is going to give me clarity that how I should take my session if you are very new so I might have to give you some understanding what the pelvic floor muscles are and if you are already practicing it so you are familiar with the pelvic floor muscles is the layer, their functioning, their dysfunctioning, their assessment and the treatment. You are already aware about that.

[00:04:05]Okay. So, please um write down in the chat box how many of you are already practicing that. Let me understand my audience.

[00:04:20]Yes. Yes. New. New. Some girls they are new.

[00:04:25]Okay. New. Yes. Yes. Some girls are new.

[00:04:29]New new. Okay. So, it's a kind of mixed population we are having. So, let me give you a very superficial over uh view of the pelvic floor. So, I will not take much time because there are so many people who are already having a depth knowledge about this. But still this is our pelvic bone and we all understand this pelvic bone. Uh at the floor of this pelvic bone we have one important muscles skeleton muscle is lying and the name of this muscle which is covering the floor of it is the we are calling it as a pelvic floor muscle. And by creating this floor we can see there's a one cavity which is formed. So into this cavity which is a kind of bowel shape we have some important organs lying anterior to posterior. So very important organ first organ which is available in both present in both male and female is the bladder. So that is the most anterior organ which is lying into the pelvic cavity. Then we and this bladder is having urethra and this urethra is coming out from this pelvic floor. So pelvic floor muscles are giving some uh space. So uretha can come outside and it is helping in uh per performing all these bladder functioning. So whenever we want to pass the urine the muscles will relax and whenever we want to hold the urine the muscles will contract. It means this closing and opening around this muscle this urethra is very important function of the pelvic floor and this is where we are calling them as a sphinctric action of the pelvic floor.

[00:06:04]Sphinctric means completely circular action. uh swing trick. So that is a great you can feel my you can see my fingers how the way I'm squeezing if I want to hold urine and if I want to pass urine how I will relax. So muscles will relax during the urine urination and it will squeeze during the holding. So that's way these muscles are performing and helping very important in maintaining the bladder functioning.

[00:06:31]Same way we have another organ in a female body. This is the blood. This is the uterus with vaginal canal. So you can see that uterus is present in middle middle of this pelvic cavities. It's the middle organ and that organ has a canal and canal is also coming out from the pelvic floor muscles. It means pelvic muscles are giving space for this opening. So it can come out. So every day like you know we have seen this menstrual cycle going on monthly cycle is there and every day some kind of liquid is keep coming out from the vagina. So we need lubrication we don't want any dryness into that as per the hormonal effect into the our reproductive system and they they during the periods also we want this uh you know menstrual blood flow to come out.

[00:07:22]So that also comes from comes out from the vagina. When the female want to have a sexual intercourse, the uh the sexual penetration happens through the vagina and uh when the we want to get pregnant the sperms enter from the vagina itself.

[00:07:36]So vagina is a very important part of reproductive system and this vag vagina is also coming out from this pelvic floor orifies. I'm so sorry I need to put my phone on silent. Okay. So it is very important functioning around that vaginal muscle vaginal area and that's that's how we are calling them these muscles as a vaginal muscles. So you can say that if I want to have a periods coming out.

[00:08:07]Okay. So we we don't want too much of tension on that area otherwise there will be always some kind of vulvver pain around the perennial body during even which will be increased during that uh menstrual cycle. And same way any female who wants to have intercourse and not only intercourse any palpation or any insertion inside the vagina that insertion can be the insertion of menstrual cup or it can be the insertion of tempons or just a simple finger insertion during the gynecological examination. So if you want to insert your finger inside the vagina at that time of uh you know at that time we want these muscles to help us and they should go for relaxation. So relax pelvic floor. So I can have a opening and I can insert my finger inside. If we cannot do that, you cannot insert the finger, you cannot insert the menstrual cup or there's a difficulty in insertion of the tampon or difficulty in having uh the sexual penetration also. It means that orifies is somewhere you know tightened.

[00:09:17]So who is creating tightness around that vagina? So these are the muscles. So muscles can be tight which will stop you to go inside the uh you know vagina. So this is again which can give you lot of issues like vulvo denia is a issue. Uh there might be vaginismas like means vaginal muscle spasm. So means these muscles which is around the vaginal they will get spasm or might be pain during the insertion. Pain after the insertion.

[00:09:46]So we also call it as a disparunia pain during sexual activities or having pain after that sex means it might be levator and I spasm. So the muscles around the vagina might get tense in this way. You will not be able to have insertion inside the vagina. So you can understand that can affect a female uh you know normal life. It can affect the sexual life. It it can even affect the fertility of a female because if the penis insertion will not be there not happening so the sperm cannot enter. If the sperm will not be able to enter so the she will not get pregnant. So it can directly affect that uh uh fertility of any female. So very important that these muscles which is around the vagina they should not be tight and we want them to relax and this whenever it is required as per the functioning of a female and the second thing is it is also same time it is also very important that I don't want that this support of this muscle is not there so muscle has a strength they are they have this uh kind of endurance all the time they have We have this slow slow pitch muscle fiber action fast twitch muscle fiber action into these muscles.

[00:11:05]So these muscles are providing a base of support and this support is important to support that or these organs. It means the vagina which is coming outside the organs should be supported. So if the muscle has a good tone then it will only support that.

[00:11:25]Please mute yourself.

[00:11:31]Mute yourself.

[00:11:33]So it's very important that muscle should be relaxed and uh whenever it is required and the muscle should be always having a maintained tone good strength.

[00:11:43]So it can support the organs. It can support the vagina itself. If these muscles will be weak. So you can understand the vagina will be saggy vagina. And according to that whatever content is there inside the vagina it can be anterior wall anterior side bladder urethra it can be posterior rectum it can be upper uterus or cervix they can start coming outside and we can term it as a pelvic organ prolapse. So means the supportive function of these pelvic muscles are not good. So means muscles uh are not strong enough and the organs are falling outside. So we need a good strength and this contract contractability ability of these muscles which can help uh in maintaining the good strength and good support to those organs which is lying into this cavity.

[00:12:35]So yes it is important to have a better contraction, better strength, better power, better endurance and it is simultaneously very important to have a better relaxation. Both properties are important and the coordination according according to the brain the muscles should be able to react. So that coordination function is also very very important. So we understand that that how important these muscles are around the vagina. Same way we have another last organ which is present most posteriorly and that organ is the rectum. So rectum is having rectum is collecting the stool from that large intestines and you can say that rectum is having one canal and this canal is passing through this pelvic floor. So now same way around this because rectum is collecting the somewhere weighted material which is the kind of feces they have some weight and we are all always doing this defication once or twice a day depending upon your your food habit and your defication habit. So it might be once or twice a day we are not passing that like know throughout the day. So this activity just to support that the muscles around that we are calling it them we have there are different muscles around that area pubalis muscle that we have external analic muscle. So you can understand the sphinctric muscle I mean circular complete kind of grabbing of the anal uh area. So this kind of circulation the spring we call it as a string tick muscles open and close. So now these muscles has a good tone good strength uh good strength will have a good tone good tone will have a good endurance that is helping all the time to maintain the continence of the stool inside the anus. So that is very very important that yes I want to hold my stool so I can I I have that strength throughout the day. My muscles are always maintaining the tone. So the puboralis muscle is maintaining anorctyl angle throughout the day 24 hours. The time when you want to go for defecation only that time these muscles go for relax relaxation and you pass that stool otherwise after doing the defication again the muscles will uh pull the rectum anteriorly and by maintaining this anorctyl angle 90° or 100° angle.

[00:14:59]So that is very very important functioning of this pubctalis muscle which is a part of levator ni and same way the sphinctric muscle the analic muscles are maintaining the sphinctric action around the anus. So this any particle which might go down from the pubric muscle should not come outside and we should not have this leaking of the stool or any liquid from this uh that area anal area or or so that that that is very important. So this continuence maintaining this continence around that area. So this synicic action squeezing action is very very important.

[00:15:34]Not only the squeezing even maintaining the squeeze throughout the day is very very important action of the pelvic floor and also not only this contraction ability is important. The simultaneously other hand when I want to defecate my muscle should be relaxed. So this is very important functioning that I want to defecate. So muscle should not be overtight all the time. they should have this relaxation ability. So you can understand that these are the three important function this muscle is doing of which is helping in are all these organs which is situated into the pelvic cavity. So bladder health urination or holding the urine muscles are important.

[00:16:14]If you want to urinate muscles should be relaxed. If you want to hold the muscle should be having the strength to create a contraction. Same way around the vagina also if you want to have a penetration inside the vagina muscle should be relaxed. If you want to even uh pass something from the vagina. Now what we have to pass from the vagina. So we need like you know they should have a good strength all the time. So it can have a you know u holding capacity, supporting cap, good capacity, good tone but it should also be relaxed during penetration. It should be relaxed during the child birth during when the baby's going to come outside. So muscles should have this capacity that they the muscle fibers they should not have any tension around the vaginal uh you know orifice.

[00:16:59]It can be superficial muscles bulb. It can be the deeper muscles your throgenous fingers. It can be more inner pubenis. These muscles around that should be relaxed completely. And even the around supporting muscles the muscles which is going around the pineal body they should also be having the relaxation. So you can understand that we need that muscle to have a good uh you know work to be done as per the requirement. Same way around that. So it is supporting our reproductive system.

[00:17:28]It is because I can get pregnant if the sperm will go inside. It helps into childbirth. I can have my baby out if the muscles are relaxed. So, uh it helps in supporting the baby uh these organs inside. Pelvic organ content will be there in their uh positions. So, pelvic uh supporter we are calling these muscles. So, because vagina is a central muscle, center of gravity is also all that time going on through the panal body. So it's very important to have a good muscles around the perennial body, good strong muscles around the penal body. So we can have a good uh you know angles be created into that area. Same way if these muscles are helping in our sexual functioning because during the sexual activities these muscles are pulling the penis towards the cratorries and female can have a good uh sensations during the orgasm and during the uh and during that penetration and during the stimul. So just to give a better stimulation to the clitoris so that orgasm can happen. So muscles are very important for sexual functioning also.

[00:18:29]If the muscles are tight you cannot have penetration they might affect the couple life. Same way these muscles are very very very important for maintaining the anorctyl functioning as well. So bladder health uh sexual health, reproductive health as well as our and u like you can say bowel health all are important and the muscles is performing its action and they should have a good strength of contraction, good tone and good relaxation ability and good coordination. Not only that these muscles are all coming out from all the sides of the bones. So from pubic to from each to pubic penal body. So muscles somewhere are helping into stabilizing stability. They maintain the stability of the east tip, back, pubic fascis. So muscles are important to have uh right uh you can say pelvis right neutral pelvis in our body. We don't want the tight muscles will bring the structures closer. So in this case when these muscles are very tight so you can understand there will be narrowing of the outlet. So when the outlet is narrow so inlet will increase and outlet will narrow. So you can understand there will be definitely issue with either defication either urination either sexual activity or some other uh you know uh stability or might be back pain.

[00:19:55]So we don't want that kind of too much of grabbing from the down outlet should not be tight and the same way outlet should not be completely uh out from too much open outlet. So you can understand the open outlet. So muscles will start getting sagged down. So when the muscles don't have stability, they they they don't have any tone, they don't have any strength, they will they will fail to maintain the stability between these each tuberosities and you can say that they will start going away from each other. So that can uh give some kind of descent to the paranal body. So this is the importance so far of our these muscles in our body pelvic floor. So yes they are important for everything. They are important for urinal health bladder we are calling as a bladder health sexual health stability support centric action and very important we have so many veins into the area into that area around the pelvic area and we are calling them the pelvic veins. So these veins are as we know that blood supply like venus return is very very important. So the good pelvic floor muscles keep creating a upward tone and that to all helps into Venus draining towards the heart. So that is the fifth function of this pelvic floor. We are calling it as a circulatory action. You might have heard about piles and hemorrhoids which is affecting so many of the people. What is the piles or hemorrhoids? They are the protrusion or dilation of the pelvic veins uh from around the anus. So that is uh you can understand why this is happening. That might happen due to the tight pubctalis muscle or it can also be due to the weak uh external uh sphincters. So weak external anal sphinctic muscles. So muscles should have a good tone. So they can help even in better venus pumping.

[00:21:48]So this is all the functioning of the pelvic floor. Importance of the pelvic floor. If we say so this is what we I'm telling you and you might be also aware about that through your you know learning yourself learning your education from different workshops webinars different people uh they are giving all these kind of you know uh now nowadays pelvic is very loud but today's webinar when we are talking about stop kele so what is this kele so kele if you just write down on the google which I have already done for you uh let me just show you Uh I need to share my screen window and this is Ker.

[00:22:32]Can you see the screen all of you?

[00:22:35]Visible.

[00:22:36]>> Yes.

[00:22:36]>> Yeah ma'am.

[00:22:37]>> Okay. Visible. So now today's you understand the what is the pelvic floor now? Okay. These muscles are know so many muscles layered into different they are layered in three they're like they're they arranged into three layers.

[00:22:51]superficial, middle and deeper. That is their functioning. This is how they are helping. And you might have heard about the word keigle or reverse keigle. So keigull means creating the contraction increasing the strength of the pelvic floor muscles. And like whenever you feel the muscles are not having tone and they are hypotonus muscle. So muscles can be hyper or it can be hypo. So whenever hyper term is means too much tight and too much tone is there. And when we call it the hypo very less very loose muscles which is not able to provide the supportive sphinctic action.

[00:23:24]So leakage is there and sphinctic action is not good something is falling outside piles is there. So these kind of things can happen due to the weak pelvic floor muscle stability is not maintained back health issues are going on. Uh so this can be the uh issue. So whenever muscles are weak you might have heard that we need to go for keigle and whenever muscles are very tight so you understand that we should not go for keigle we have to stop kele instead of doing keigle we need to do we need to focus on something which can relax the pelvic floor it means instead of creating contraction we should focus on to relaxation so reverse the keigle so keigle and reverse keigle are two different terms keigles means do these exercises is whenever your muscles are uh weak keigull and do reverse reverse the keigle when your muscles are tight it means don't do keigle reverse whatever like you know uh relax don't do squeezing instead of that do relaxation so you might have about heard about that reverse keigle word as well into pelvic floor rehabilitation for restoring the better functioning and wellness in a people's life so far and yes I have given you a brief about the importance of pelvic pelvic floor muscles. You can see that these are the muscles how they are doing this stabiliz stability of this pelvic bone. They have this kind of opening. So through that urethra, vagina and anus is passing. This is muscles are working as a base. So they're providing the support to the organs because organs is lining to that. Say these muscles are not only the muscles of a female, the same muscles are present in a male also.

[00:25:03]But some muscles orientation is different as per their organs which is different in a male or female. So posteriorly anal muscles are absolutely same but the anterior muscles around that are different according to the presence of like two opening in a female body. There are we have three three organs in a female body anteriorly. We have clitoris. So there are muscles which is supporting that sexual functioning. We have the urethra muscles which is supporting the urethra separately. Then muscles which is supporting the uh vagina separately. But in male the all these functioning sexual bladder as well as the sexual sexual bladder they are maintained by that one organ penis. So muscles are somewhere some muscles are less in female in in male actually as compared to female because female has three openings. So there should be three parts supporting but in male we have one organ is doing the functioning. So muscles is less into number. So uh this is that yeah orientation is somewhere different in male and female but yes muscles are present and they are doing the same functioning. Okay and these are the how the organs are placed and how their canals are passing and how these muscles are supporting uh they are working as a supporter or sphinctric action and stability is very very important and which is bowel bag sexual that's functioning. So this is a support stability sexual circulation. So muscles should be those muscles are good who can contract whenever we want to let them contract. I want you to create a contraction of your pelvic floor. So you should be able to understand what the pelvic floor where they are present and how to contract them. Okay? And that is very important the muscles which can contract. I want to hold my urine. So they they are supporting me. I want to hold my guest. They are supporting me. I want to hold my fees. They are supporting me. I want to hold anything inside my vagina. So they are supporting it. So these muscles which is creating a good contractions are good muscles. Now they they are active at the right time.

[00:27:05]Now active means they should have that kind of trampoline effect that kind of reflex is coming in. So which can support me during any sudden activity sudden activity inside my whenever any activity increasing intraabdominal pressure. So we have abdominal area. So whenever any holding of breath is going on or any pressure is getting built up into the abdomen. So that pressure is going to go downward as per the downward descent of that uh abdominal pressure isn't it? That can put pressure over the organs and organs can that can put pressure over the pelvic floor. So at that circumstances whenever intraabdominal pressure is raised our muscle should not go for distend descending down it should go ascending upward as a trampoline effect. So we we want that kind of strong uh you know supporting muscles which can be active at the time whenever I am jumping whenever I am coughing I'm sneezing I'm doing exercise I'm lifting lifting something so all these activities I should not voluntarily be able to will try to squeeze my muscles my muscle has that reflexes that they will definitely go for squeezing whenever this kind of action will be performed so those muscles which active at the right time.

[00:28:21]What is the right time? Right time when when when I when I'm lifting, when I'm pushing, when I'm loading myself, when I'm holding my breath, when I'm sneezing, when I'm cuffing. So that is a or when I'm I'm doing my sexual activity, the orgasmic activities. So whenever orgasm is happening, so or you cannot control your orgasm. Orgasm is a reflexive activity from the brain depending upon the stimulation. So that is also very very important that that kind of reflex should come and the muscles should keep giving you that kind of squeezing. So uh they are active during the sexual activities also or the the muscles are good when they relax completely. If I'm defecating so my muscle should not have the tension which muscles muscles around the anus they should not be tense the pubctus muscle external anospectic muscles or all the muscles which is present posteriorly towards my anorctyl region those muscles should not be tight and muscles around the back which is pulling my like you know which is maintaining my sacrum angle which is maintaining my cockix so those muscles should not be tight the coxial muscle so they should be always relaxed so I should not have all the time back pain back pain but the back pain can be due to the tight pelvic muscles around the sacrum which is in which is all related to the sacrum and the cockix and the same way I my muscles should be relaxed when I'm defecating I'm doing sexual penetration or I'm doing any insertion of the tempon or any insertion inside the vagina or I'm having my sexual um activities or my urination or defecation so muscles should not have any tension it should be relaxed completely so those muscles which do those functioning. They are the good muscles. Now what is the dysfunction of the pelvic floor? As I told you too much tightness can give you hypertonus dysfunction. The muscles are very tight. It can be muscles tight around the urethra, muscles tight around the vagina, muscles tight around the penal body, muscles tight around the uh anus, muscle tight around the cockix or that sacrum. So that can give you hyper too much like kind of something ascending all the things is congestion something is upward. So you are you will fail to relax. So defecation problem, urination problem, penetration problem.

[00:30:34]So that can be one issue related to the hypertonous pelvic floor. And if your muscles it means we need a good tone into that muscle. Um like as you all understand that pelvic muscle has a 70% slow twitch muscle fiber 30% fast twitch muscle fiber. So there is some slow twitch action throughout the day stability throughout the day support. So this this is important throughout the day endurance is the requirement of these muscles. So it can work against the gravity and it can help in supporting the organs isn't it? So we want the good tone. So muscles should have a good firm tone. We don't want these muscles to go for hypertonus. The tone is hyper or we don't want these muscles to lose the tone also that there's no tone at all hypo. So these are the dysfunction of the pelvic floor.

[00:31:24]If you understand now if I I'll take you to today's session. So this was the like kind of no understanding of pelvic floor for all the people who were new in my session today. But now let's come to uh the importance which everyone of us even me you everyone should be understanding if you are working from last 10 12 years or if you are just working from last one year or you are very new. So if you write down that uh for pelvic floor dysfunction um okay yeah keal exercise or let me just I have just taken some screenshots actually okay so these are all the screenshots from the Google you can also do that and u now today we want to clear so many uh myths which is going on so you might have heard that pelvic floor dysfunction. Okay. So for pelvic floor dysfunction which exercises we are aware about so far if you have not done the training in pelvic floor. So uh might be the kele is one word which you are aware about. Okay. So now what is kele? So keigle is a effective exercise for pelvic floor. The whole whole world is kn knowing it. So Keal exercises are important for pelvic floor dysfunction.

[00:32:49]If you just write down this word into the Google search, the answer will come.

[00:32:53]Yes, Keal exercise are important for pelvic floor dysfunctions because they strengthen the pelvic floor muscles that support the bladder, rectum, uterus, helping to prevent and treat symptoms like urine incontinence and bowel control issue. Now, keal exercise are important for pelvic floor dysfunction.

[00:33:14]So it is very important to understand that what type of pelvic floor dysfunction you're talking about. If your pelvic floor dysfunction is hypotonus, you have a weak pelvic floor. So definitely Keigle is good to go because you have weakness because what is Keigle? Actually if you say what is Keigle? So Keigle exercises strengthen the painful muscles by contracting and relaxing the muscles used to stop the flow. is the command actually which is we are giving that try to squeeze your uh pelvic floor try to stop your urine try to hold your gas so now what how to do the kele exercise like how to perform the kele exercise lie down with the empty bladder tighten your pelvic floor so tighten your pelvic floor for 3 to 5 seconds hold and then relax perform 10 repetition it is the set which is given that not only 3 to five 3 to five is nowadays because of so much of awareness but if you go for last decade decade ago so it was squeeze the pelvic floor hold that for 10 seconds repeat it for 10 times and perform three times a day can you understand? So squeeze your pelvic floor hold it for 10 seconds and repeat 10 times and perform three times a day. If this is the keal exercise and then they're saying the keal exercise are important for pelvic floor dysfunction. So now if the person who is having hyperthonus pelvic floor and that person will give will do keigle what will happen? So is it good for the doing the kele for that person who is having tight pelvic floor? The answer is no because muscle are already to tight.

[00:35:07]We don't know their status. They they failed to relax. When they have spasm, they have shortening, they have tension, they have tightness. Why? To create squeezing in creating that kind of squeeze will worsen the situation. So that is now giving that is ruling out very important thing that ke exercises are not for hypertonous pelvic dysfunction. Yes, most of you are aware about this fact. Okay. So what is new into that? There is something ahead which I'm going to add. Okay. So this is completely ruling out that we should not give keull if the patient is having tightness into the pelvic floor.

[00:35:48]Hypotonus p hypertonous pelvic floor means any pain during urination. Any difficulty in passing urine, any difficulty passing stool, any difficulty inserting inside the vagina, any sexual pain. Whenever difficulty pain that word come so we should not do we should not give keigle to that cases. Yes it is completely clear. So now it is ruling out that okay so in which case we should do keigle we should give keigle. So yeah we should give keigle when the muscles are weak. Clear? Am I clear to all to all of you?

[00:36:29]>> Yes.

[00:36:31]Yeah ma'am it's clear.

[00:36:32]>> Okay. So it's clear. So we should not do in that one two tight muscles but we we can. Now let's understand can we do keal exercise in hypothonus pelvic floor dysfunction. Okay. So now uh pelvic floor muscles are weak or they are not weak. Who is going to decide that? that we are going to uh as a pelvic therapist first we need to check take the history up from the patient and after that we need to go through the signs and symptoms bladder bath and sexual health and after that we need to go for assessment so we need to first instead of like know if I'll if you have some kind of issues going on if I'll tell you okay you have urine leakage okay do keal exercise urine leakage means muscles what does it mean urine leakage might mean that his her muscles are not strong enough that's why leakage is going outside. Okay. So that's the urine leakage because sphinctric action of these muscles are weak stool leakage. So yes we should go for pip for muscles. So urine leakage stool leakage. So now again if I'll tell you urine leakage so but urine leakage is again uh can be different types. So we need to understand what type of urine leakage it is. So if you just broadly if you go on Google search you will find out that there are three types of leakage going urine urinary incontinence. There are there are three types of urinary incontinence which is a term of blad which is affecting the uh bladder health. You might heard about stress incontinence. You might heard about urge incontinence. You might heard about overflow. So what is this stress urge and overflow? They are very important to understand for all of us as a pelvic therapist as a physiotherapist. What is the symptom of your patient? If your patient is telling you that whenever I'm doing sneezing cuffing, so sneezing cuffism is increasing the stress inside the abdominal area, it means it is increasing the intraabdominal pressure.

[00:38:29]So any activity which is increasing intraabdominal pressure will definitely going to put stress over the organs. It can be all the organs. Uh so that stress is uh going to push the organ down means that is going to create a squeezing uh going assume that this bladder is like uh like a balloon. So it will squeeze the bladder downward and squeeze this kind of what do we say balloon. So you can understand downward pressure will increase. So if the downward is pressure is increasing if these muscles during this stress downward pressure. So whatever content is there means urine is there the liquid will go downward it will st ascend down. So during this ascending down now we have this urethra and around the urethra. Urethra itself we are calling it the internal sphinct.

[00:39:19]Urethra is creating one pressure and same way we are calling it the internal sphinctic pressure. So it means urethra is weak. So the tone of urethra is not there. The sphinctric action of the urethra itself is not good and that relaxes and same way so urethra is also weak as well as that muscles around that urethra pelvic floor muscle we are calling as the urethral sphinctic muscle those are part of skeletal muscles they are also not creating the contraction trampoline effect if the muscles are strong during the stress they will create a trampoline effect you will not come out but if the muscles they don't have torone so they will open up relax their fibers are not strong enough, they don't have that much of endurance. In this case, the trampoline effect is missing. So that can affect that your uh due to this stress which is happening onto that area during pushing, sneezing, jumping, laughing, coughing that can push the bladder, squeeze the bladder and bladder can squeeze the urine downward and urine can come outside because the squeezing effect from your pelvic muscle is missing. If that is the situation. So if you the first question which we have to ask our patient is are you leaking during uri during sneezing cuffing laughing all these stressful activities. If the answer is yes it is telling us oh there are chances that her or his pelvic floor muscles are weak.

[00:40:44]Okay. Or internal snetic action is weak.

[00:40:47]Still if the urethra tone is not good but still if your muscles are good like after menopause you can understand estrogen effect. So urethra tone is rel directly somewhere depending upon the level of esttogen around the urethra. If the ur estrogen is not there you can understand the urethra tone might be somewhere get hampered. Uh but still if the muscles are strong female will not have urine leakage. But if the tone is weak, your throat tone is not good and the muscles are also weak. So what will happen in this case? Urine will come out. And now another thing is uh suddenly during the stress urine can come out. So in this case we can understand yes uh can we do kele here in this case because pelvic muscles are not strong. They are weak. They cannot do their sphinctric and closing action. So can we go for keal exercise?

[00:41:42]What do you think? Please write down in the chat box. Yes, ma'am.

[00:41:46]>> Yes, we can go for keal exercise in this case. Okay. Now, another case the patient is saying that I have sudden urge to urinate. I like know suddenly I'm I was just passing I was crossing the toilet and there was a sudden urge.

[00:42:01]I was just hearing the sound of water. I was having a sudden urge. So sudden urge. So when we say that sudden urge so urgency of urinate so urgency suddenly created why because there was some stimulus there might be some signs some signboard toilet was returned there might be break time there might be you are free at home the water sounds something is uh stimulating your what nerves so nerves which creating that bladder so this is not creating your muscles to get relaxed and contract Urge means your bladder the muscles which is around the bladder detrus muscle the middle middle layer of the bladder that get sudden contraction. So when this detruser which is the organ itself that is squeezing so and then due to that the pressure is increased and then you are having leakage. So this urgency like I have a urge to urinate.

[00:43:01]So urgency means neurogenic bladder patient is have the bladder itself the nerves which supply the bladder they are not functional. So now when the bladder if I'm saying then then the second question comes here that do you have urgency only but you can you can maintain the urge and you can go to the washroom and then but you don't have urine leakage going on. I have a urge I'll I'll just control it. I'll go to washroom. I'll I'll sit down on that uh toilet seat and then I'm passing my urine. So my frequency of urination is very high because of this urgency. So I go again and again to the toilet because suddenly our urge is coming out. The second question are you leaking on the way of washroom? If the patient is not leaking on the way of washroom it means the urgency is there which is triggered by this detuser muscle but the pelvic floor muscles might be strong. That's why muscles are whenever this downward pressure is going on due to the squeezing of the detruser muscles are strong enough to hold that urethra and she's maintaining the way of washroom.

[00:44:11]So in this case when she can maintain going to way of the washroom only urgency is there.

[00:44:19]So we should go for kele exercise.

[00:44:23]Think about it when urgency is there but you can maintain you're not leaking on the way of washroom you are maintaining that hold so we should go for keal exercise in this case >> no ma >> no okay so no okay same way if the patient is telling you I cannot I have urgency and on the way of washroom I leak it means the patient is suffering from to dysfunction hertus muscle is also alo contracting. So nerves which is supplying that is also overactive and the same way the pelvic floor muscles are also weak. So when urine urgency and leakage is also a part on the way of washroom then only we have to go for two. So only doing exercise keal exercise will help the patient yes or no in this urgency if urgency is a symptom only doing keal exercise will help the patient.

[00:45:20]No. Okay. We have to stimulate the nerves, relax the nerves and we have to strengthen the pelvic floor both. So only focusing on the pelvic floor muscle that oh if you are suffering from urine leage go for pelvic floor muscle or go for a keal exercise. So uh no don't go for keal exercise if you have only urge symptom. Yes, there might be you can go for keal exercise. If you found the stress is there, stress leakage is there or if you found the urgency with leakage is going on. Yeah, we can think yes in that case we can count on keigle. But will the kele will be 100% effective in this case urgency with leakage? The answer is again no. It will not be able to you know treat that overactivity of the deterive muscle. You need neurological treatment in this case. Now third case you will find out the type of urine incontinence overflow.

[00:46:17]Overflow means that something your blood is getting filled and it is not coming outside. It means urethra somewhere is obstructed outlet is obstructed. You are not able to pass out the urine. Okay. It is not coming out. Drippling of the urine is going on or you are taking lot of time in urination. you know spending uh know 30 minutes, 20 minutes, 5 minutes, 10 minutes, urination is a uh is a activity of fractions within 20 to 30 second we should be urinating completely and but if you are taking long long time 2 minutes 3 minutes 5 minutes 10 minutes and you're not you are still dripping dibbling dibbling is happening going on.

[00:47:01]So this way can we go for pelvic uh keigle exercise here? What the kele do?

[00:47:08]squeezing squeezing squeezing. So is in this case when this obstruction is into the outlet and due to this obstruction urine is keep filling into my bladder and due to this my blood is overflow already hyper expended. So shall we go for kegal exercise here?

[00:47:31]>> No >> no it will not affect. So now when we say that types of urine incontinence there are three types not only three types there are so many types of incontinence actually but we can understand that detail uh you know some other day during webinars and workshops but understand that the now if you write down on the Google keal exercise are effective for urine leakage or so the answer is written yes keal exercise are effective for treating and preventing urine leakage.

[00:48:05]Please mute yourself. Mute yourself girls. Mute yourself please. Thank you.

[00:48:14]So you understand that. No don't don't just urinate is there. Okay. Go for again it is wrong. You please try to take detailed history. Go for symptomatic uh you know treatment. If urgency is there different treatment will be there. urgency with leakage is there different treatment will be there and if only stress incontinence is there then yes you can think about the cable exercise squeeze your pelvic floor and that is going to help you understood I I hope you understood same way another thing that how do I know that if my patient is having uh distress incontinence so how to assess is it only this one symptoms leakage uh this kind of uh kind of you know verbal verbally a patient is telling you that I'm suffering from leakage and I can't I have this during sneezing coughing so we'll tell them okay start keal exercise we might tell them now start keal exercise as per what is written into the books what is written into that everywhere so what is that hold your pelvic floor squeeze it for 3 to 5 second and uh then repeat it for 10 times this is what what is the no leftover isn't Great. How to do kele in case of stress incontinence? So means that squeeze it squeeze your pelvic floor hold it for 3 to 5 second or 10 10 second and then repeat it. This is what we are doing it isn't it? But very important if as per the standard test which is we are performing again you can write down on the Google pelvic floor assessment scales we can like know same way we have MMT uh scale isn't it for that muscle testing for our uh just testing the strength of our muscles whole body same way Oxford MMT they have modified in pelvic floor you can check the strength strength of pelvic floor by using Oxford MMT and after that this this uh scale is by Lakeok and the second is one scale is already there perfect scale you can also use these two you can use these two scales and according to these two scales you can tell your patient that oh you have to you have a weak pelvic floor and do keep isn't it because you're going to do that if you found so what is this pelvic floor assessment uh scale Okay. So you will find this is what I written on that uh I wrote on the Google and there were so many different different variations came up in front of me and then I just selected which is very easy so you can understand and combination of both. So pelvic floor muscle function because I know my patient is suffering from stress leakage and it might be prolapse she's having it might be uh some she don't have a sexual sensation she have a saggy uh vaginal laxity so so many like no hypotonus pelvic floor isn't it because in case of hypotonus pelvic floor only we are thinking about the keal exercise so if you're thinking about the keal exercise so my recommendation to you please check the symptoms and after checking the symptom if the symptom comes stress or that mixed where the urgent stress both symptoms are there.

[00:51:31]The second is you please go for a pelvic floor muscle function and strength checking by using any scales which is available uh in the books. So the scale which is available is which is commonly used across the world by all the pelvic is a modified Oxford grading system. The same way 0 1 2 3 4 5 the scale is getting differentiated and you can uh it is arranged zero zero means uh if I'll just read this out so try to understand what is written here zero zero means no contraction no contraction of what pelvic floor one means flicker contraction of pelvic floor two means weak squeeze no lift weak squeeze from the pelvic floor patient is trying to squeeze but there's no squeeze and lifting is going on or very weak squeezes going on. Three, fair squeeze with good lift. Four, good squeeze with good lift. Five, strong squeeze with good with the lift. So this is what is written and you can give you can go in more detailed detail because it is all you will find it in the Google and the books also. Okay. So check the pelvic floor muscle strength first. So now how to check what you have to do for that?

[00:52:42]You have to insert your finger inside the orifies. If she's a female patient, you can check by inserting your finger in vagina or anus. There are two openings because muscles are around the vagina around the anus both. So insertion inside the vagina vag trans vaginal insertion or trans erectile insertion. So during that insertion you insert your one finger and then you give your patient command. Okay, squeeze the pelvic floor and whenever they squeezing your pelvic floor and then you can check if there's no contraction, flicker contraction, weak squeeze, no lift, fair squeeze, definite lift. Now tell me here if you're inserting your finger inside.

[00:53:25]So and if your patient is not showing you any contraction, your patient is either zero, either one, either two.

[00:53:36]So can you go for keigle?

[00:53:40]If your finger is inside, you are giving command to your patient, squeeze my finger, but there is no contraction been felt.

[00:53:49]So can your patient can you give that kele guidelines the squeeze for 3 second, hold for 3 second, hold for 3 second, sorry, squeeze and hold for 3 second and repeat 10 times. If >> I can't able to do >> Yeah. Why? Because there is no propriception. patient don't know what they have to do because muscles are not active they are inactive muscles so in this case when there is no feeling of the finger examiner finger it can be one finger two finger three finger no I can't feel so that in these cases when the patient don't know what to do and you are giving them the kele squeeze squeeze because you have weakness weak pelvic floor so squeeze your pelvic floor do keigle exercise so yes Definitely the answer is right. You cannot give keigle to the patient. If you give her teach her kele also she will not ended up in doing the right contraction right activation of the muscles because muscles are not active.

[00:54:52]She will keep doing the squeeze from glutes, adductors, abdominals that will start getting overactive and the muscles will keep going on underactive because muscle is already underactive. Muscles do they don't have any action. when they don't have any action. So what they have to do squeezing how they will lift isn't it? So this is very important. Check your patient if that there's no action no contraction no gigle gig will fail completely even in flicker contraction flicker contraction if the flicker contraction but she will be not able to maintain it isn't it because how she if she has a flicker squeeze relax squeeze there's no hold. So when this flicker is going on so how she will hold for even 3 second she can't hold for even 3 second and we are saying that hold for 10 second no she can't do it she has a flicker action so in case of one also she will not be able to do keull so you can understand zero one now two when she have a weak squeeze now squeeze is coming out from some part of the vaginal muscles some part of around the anal muscles can she go for kel there's no complete complete squeeze. So when there's no complete squeeze, she might keep doing action. Activation is going on. She's activating it. But you cannot increase the endurance. What is endurance? Hold it for 3 second. Hold it for 4 second. Hold it for 5 seconds.

[00:56:16]Holding it for some specific time of time. Period of time is a endurance. But endurance is only possible when muscle has a strength. When the muscle has a power of squeeze. When muscle don't have a power of complete squeeze. Can you work on endurance? The answer is no. So zero, one, two, definitely we cannot go for keigle. Okay. And this is only the patient when they come come to us uh you know they are severe cases otherwise they try to when they have a fair squeeze sometime leakage is going on they don't come out they don't speak out they try to maintain manage at home by themsel. So when the condition is not worsen they are trying to manage and when they it will be worsen then they will come to us when at the time when they will come to us they might have one zero might be uh might be the prolapses going on zero 1 2 that kind of uh you know cases are coming to us at even at the age of premenopause post menopause that age also so you can understand that age that much of weakness and there's no action as per the MMT scale here also.

[00:57:29]So will the kele work here.

[00:57:33]If you are guiding them kele answer me anyone of you no we can yes we can't give them kele exercise because keigle means squeeze and hold for certain time. This patient who have a flick curve weak no squeeze it means they will not be able to perform that action. So Keigle is not 4012 from where we can start kele. If the patient has a fair squeeze she can give lifting she can show you lifting on your finger then yes then we can tell oh yeah you have a lift. Now try to hold this lift for whatever your capacities. It might be 2 second it might be 3 second it might be 4 second. It might be 5 second up to 10 second and then when she has that kind of capacity of creating that endurance squeezing uh squeezing means endurance then only we can say oh yeah you can squeeze for 3 seconds now relax can you repeat it then after endurance we can go for repetition it means the perfect scale testing power endurance repetition that can come peer that can only be done on those cases after 3 plus where there's a rare squeeze is going on otherwise you cannot go for even perfect squeezing testing also that scale testing also if the patient is 0 1 and two you can't go for perfect the second scale assessment so very very very important to understand that depth of the pelvic floor before you prescribe something to your patient okay that's why 98.7% people who do kele there's no response there is no result that's why kele fails Now you understand how many patients are doing kele and uh the result is not there. 98.7% cases the result is not there. Why?

[00:59:33]Because 98.7 people their pelvic muscle is either 0, 1 or two. When this muscle status is like this, the therapist who is giving the doctor who giving them kele, the doctor himself is wrong. how I can give you keull if you don't have any action in your muscles. So I need to stimulate your muscles first. I need to create action in your muscle first. I need to make them uh creating that coordination according to the need. So re-education, understanding, isolation everything is very important. So that is very uh that is where I I tell all of you that stop kele if without checking your patient pelvic muscle strength.

[01:00:15]First check it and if you found this is three out of five fair squeeze with definite lift. Squeezing is also there and lift is also there. It can be on one finger, two finger or three finger doesn't matter but squeezing you can feel. So then we can say yeah squeeze is there you can do keigle and perform it 3 second and slowly slowly you can go for a progression but stop kele giving that if your patient has zero no contraction flicker contraction and weak scores.

[01:00:45]Okay. So this was my webinar for today and I hope you u you can understand and definitely we have to stop kele in hypotonus activities. So now if I tell you that this statement keal exercise strengthen the pelvic floor muscles by contracting relaxing the muscles uh you so this again uh is not good for all the you know as per the assessment pro programs 012 will not work in that those cases and um yes you should we should definitely stop it and I would request you to please take a screenshot of this scale because we are always concentrating on the scale of uh checking the power of our muscles. Our mind is always busy how much powerful this muscle is. It can be the biceps, triceps or same way the pelvic floor, how strong the pelvic floor. So to check the power of pelvic floor, there's one scale modified Oxford grading scale. But pelvic floor muscles, you cannot uh check the power of pelvic floor if you can't insert your finger inside the vagina. Isn't it? So it is very important to check the relaxation scale in case of uh pelvic floor isn't it?

[01:02:02]Because if the scale is telling you insert your finger and then ask your patient and then check the strength. But if you can't insert your finger then what what is the treatment for that case? So uh so can you so you will not go for assessment? No assessment is require required in this case there might be patient is having tightness.

[01:02:21]Tightness means the muscles around that will be tight. So this is how this is this is the scale digital pelvic muscle testing scale which is designed by me and I'm using this scale since many years and please take a screenshot and patient can be minus1 -2 -3 -4 - 5 minus1 means patient is not ready for pal assessment or finger testing or touch patient will not give you consent that okay I'm ready for my assessment patient is telling you no I don't want to go for assessment there might be patient is feeling uh fear of touch or it can be shy. Patient is shy. Whenever your patient is not letting you to touch the parinium and they are not ready for assessment that kind of patient we are calling we cannot go for assessment in those cases. So at that case we have to do external assessment and treat externally as much as possible and uh give them education psych physiological and psychological involvement is very important in this case. Counseling and the treatment. If your patient is having minus2 means the the patient is ready for the assessment. They have signed the consent form. She's lying down on the com on that couch. Even he's lying down on the couch. But the moment you start touching superficially over that vulva externally perinium and still their area is painful. So in this case we are calling the muscles around that area are tight. Hypertensive pelvic floor superficial layer is tight. So when externally tension palpation is giving them pain. So can you insert your finger inside the vagina? The answer is no. Can you insert your finger inside that anus?

[01:03:54]The answer is no. Because external touch is only painful. So the treatment will be according to that. Patient will be termed as a minus two. Hypertensive pelvic floor tensed superficial muscles.

[01:04:04]Patient is ready for penal assessment finger testing but very painful touch around the orifies. The answer that that message is that you cannot penetrate in this case external pain is there the treatment will be accordingly same way minus three patient is ready she you are touching the vulva there's no pain around pendal body no pain and anywhere there's no pain superficially the moment you start inserting your finger inside the vagina then the pain starts so pain is there in insertion so insertion is difficult insertion is painful she has discomfort discomfort penetration ation.

[01:04:42]So different kind of patient is not relaxed with this insertion and she's showing you like oh it is painful so tight orifies discomfort painful penetration she's doing the hip lifting adductor squeeze uh during that time so might be the superficial muscles are relaxed but the muscles deeper muscles around the vagina the middle layer or the deeper layer they might be tight that's why you cannot go for penetration so in this way you have to go for a dilation therapies uh the treatment will be treated minus four the partial tensed pelvic floor patient is ready you are inserting your finger inside the vagina or if is ans there is no pain the moment you start touching inside any organ or it can be uh any deeper layer of pelvic floor deep levator ni so that muscle has some kind of spasm internal spasm is present levator ni spasm puboris muscle tension tightness so means inner muscle deeper muscle is having tension so that patient pain after penetration, pain after sexual activity, pain during sexual activity. So that kind of question that kind of symptoms patient will tell you. So in this case patient don't have pain during penetration or during the touch. It she has a pain after the penetration during the sexual thirsting after having the sex after having a defecation. So that is the cases where deeper layer is tight. So this is the minus4 and minus 5 means you are inserting a finger inside the vagina.

[01:06:11]You are touching everything around the rectum touching everything all the organs all the muscles all the supportive structures but there is no pain at all. That type of femur is completely relaxed. So we are calling this minus 5 out of minus 5 is complete relaxed pelvic floor. So now in all these cases can you give keigle can you give keigle exercise here?

[01:06:39]Write it down in the chat box. Now after going inside the vagina when there is no pain at all or around the erectum when there's no pain at all. So we have already ruled out the relaxing scale is minus 5 out of minus 5. Then we will check that power of so that was a power of relaxation of the pelvic floor. Now let me check the muscles are completely relaxed. Now let me check the strength are they have any what type of strength they are having. So put this 1 plus 2 plus 3+ 4 plus 5 plus you can use the MMT scale also Oxford MMT modified Oxford MT or you can use my scale also.

[01:07:13]My scale is more kind of clear and detailed. It will give you more understanding. So oneplus means poor pelvic floor means mild very mild or no hold or flicker there's no no squeezing kind of very weak muscles not able to hold your finger even by use of accessory muscles she's doing everything but still there's no action you are feeling as a therapist on the female orifies the you can understand there's a pelvic pel pelvic area is like a clock okay 1 2 3 4 5 use the clock around the pelvic region so all out of this 12 reasons there will be only one or two sides might be flicker contraction will come not complete uh 12 sides so right left up or down so there's no contractions going on so these kind of muscles are completely poor muscles weak muscles well she's trying to create a contraction from some sides might be 12 and six is squeezing 3 and 9 is squeezing 2 and 8 is squeezing 10 and five is squeezing 10 and four is squeezing 11 and five is squeezing somewhere somewhere some muscles are active. Some part right is active, left is not active. So some muscles are active, some are not active. In this case we are calling those muscles as a weak muscles. Half of the muscles are inactive and half of the muscles are active. So those kind of muscles which is half off half they cannot give you complete squeezing of your finger. So no circumferential hold will be there on examiner finger. So again these are the weak muscle. No circumferential hold. So third is patient will give you complete circumferential hold. So muscles are active right and left always 1 2 3 4 5 6 7 8 9 10 11 everywhere muscles are active and you are giving her a command squeeze. So they are squeezing you. So they have a sensation also. So they they can sense your finger. They can squeeze your finger. So those kind of and the right and left right good strength and they can hold your finger. So in this case good hold on the examiner finger without use of accessory muscles we are calling it is the voluntarily active muscles because I gave you command by inserting my finger. Okay. Can you feel my finger? Yes. Now squeeze it. So then you are squeezing it. So voluntarily you are squeezing it and your muscles are active. They are giving that circumferential hold and I can feel it.

[01:09:27]3 plus 4 plus I inserted my finger inside and suddenly your muscles sense that something is there and then they did that reflexive action. So reflexive action without any command from the examiner there was a strong circumferential hold on the finger of examiner finger means I didn't told you to squeeze me hold me and your muscles grab me it means your muscles are involuntaryly functional there is a good reflexive action in your pelvic floor muscle it is not only the muscle even the nerves which supply the muscle they are intact so that is a very good muscles four plus and five plus means you can squeeze my my finger without any command and even you can uh like know keep holding it for 10 second as per ambulance you can keep repeating or for 10 times and even you can uh if I'll try to apply some if you try to apply some kind of resistance like if I tell you to sneeze and cough still you will keep you will maintain that hold and if I try to pull my finger out I'll give you resistance still you can grab my finger inside if that kind of things are there so we call it as a five plus very strong pelvic muscles So my request is please take a screenshot of this scale and you can use it as well if you and you can also use modified Xbox but it is all up to you. So >> slide is not seen ma'am.

[01:10:47]>> Slide is not seen. Oh >> from long time ago.

[01:10:50]>> Oh I'm so sorry. I thought it is it is there.

[01:10:55]I'm so sorry. I thought the screen is there.

[01:10:59]>> I am back.

[01:11:02]>> Okay. Is it visible now?

[01:11:07]>> No.

[01:11:09]>> Yes.

[01:11:10]>> Not yet. Now.

[01:11:12]>> Yeah. Okay. So, now let me give you Oh, god. God. Um, stop sharing.

[01:11:24]You know, I have opened the wrong wrong view. Share screen window and this one.

[01:11:33]>> Now can you see visible >> something?

[01:11:43]Google screen.

[01:11:44]>> Yeah, you can you can please take a screenshot of this this screen. Scale for relaxation and take a screenshot and scale for contraction. So these are the two important scale and according to that you have to decide you should give keigle to your patient or not. So in all these cases minus1 -2 - 3 -4us 4 you cannot give keigle stop keigle. Okay even one plus two plus you can keigle will not be effective. So stop kele you need detailed assessment of your patient and detailed therapy is required. Keigle will not uh be helpful and your patient will be again going to tell you and tell society that I've been to this doctor and she told me to give Keigle and I I'm keep doing it since last two months and but it is not working. Definitely it will not work on OnePlus and two plus understood all of you. So that was my session of the day and do not believe on what the Google tells you and even the books it is very important to understand the depth of your uh pelvic floor and a lot of people I know the pelvic floor dysfunctions are not life-threatening but it affects people's quality of life if someone is leaking someone is not having good sexual activities they have a prolapse they have leakage of stool They have a vaginismas, tight muscles. They can't have sex. They can't have penetration inside the vagina. It might affect their fertility. So yes, it is affecting their quality of life. It is affecting the individual. It is affecting their relationships. It is affecting their social life. So many of women's they are not going out of the home because they have uh this leakage going on. They have this urgency suddenly. They have this kind of uh triggering factors. The moment they will they can't hold outside. So you know it is affecting the people's quality of life. So it is very important that we should understand uh the right pelvic floor and u let's add this rehab in our practice and start giving them the complete care by treating their these issue in pelvic floor issue also very very very important. All right and thank you so much everyone for joining me today.

[01:14:01]I hope that you am I can you see me?

[01:14:07]Am I visible?

[01:14:08]>> Yes ma'am.

[01:14:10]>> Okay. Lovely.

[01:14:10]>> Yes ma'am.

[01:14:11]>> So I hope that you learned something.

[01:14:15]>> Yeah. Little bit doubt. So what should be done in grade one and two in that we cannot give the keises. No.

[01:14:21]>> Yeah. You cannot give you need this patient requires stimulation. So what you have to do that re-education. First you educate the person about this by giving the brain education that these are the muscles. These are the muscles.

[01:14:33]So education is the very important thing. Second is stimulation. So tactile bof feedback is important because if these are the muscles I'm inserting my finger I'm telling you to squeeze squeeze squeeze. But your muscles are weak. You can't squeeze isn't it? So what I'll do I'll touch right and left every point. One two three I'll keep touching. Keep moving my finger. Can you feel? Can you feel? Can you feel?

[01:14:54]Sensate focus therapy. So sensation she should be able to feel that what I'm telling you to squeeze. So I will make you aware for that first. So in these cases electrical stimulation bio feedback devices uh even um that uh even nowadays you might have heard about that chair keel chair. So many of doctors they are putting that chair in their clinic and they are telling oh if you have a leakage issue weak pelvic pronella chair will help you. And that Mella chair is working on a magnetic therapy and 12 thou 11,000 contractions.

[01:15:28]So you can understand that this Mella chair if the patient is having zero power, one power, two power, if you'll put that patient which has a very weak muscles, inactive muscles, if that person will sit on that chair, what will happen to them? Fatigue. Okay. So that is not good at all. So for this propreception is very very important or electrical uh bio feedbacks uh the transposal stimulators are available into the market. So those kind of things will be the first line of treatment. So once that this current will keep activating the nerve nerve activation.

[01:16:04]So nerve stimulations. So pedendal nerve stimulation is the treatment for one plus and two plus because muscles need that nerves the nerves will be active.

[01:16:12]They will make the muscle to be active.

[01:16:14]So 1 + 2 0 1 plus and 2 plus nerve stimulation is that first line of note no ker okay so uh can you suggest any reference for this topic uh look I I you can just go to um I don't know how can I give you my reference to this topic you understand that that come comes with experience Actually when you treat your patient you found that yes they are not getting result why they're not getting result because they're they're not doing the right thing they they don't know that what they have to squeeze actually and if you are giving that zero one and two they're giving them the kele exercise that's why the statistics are showing 98.7% people who perform the kele that statistics you will go you'll found a lot of in the everywhere in the Google and research uh sites that keles are not affected so when The keigles are not effective. Then who is doing keigle? One plus and two plus then only the keigles are not affected. If patient is three plus and she's doing keigle definitely it will be affected. Okay.

[01:17:28]All right. So u all right. I hope that um that session was okay for all of you and you might had learned something. Thank you so much for joining me. You can keep following on my Instagram page. I will send you the link. You can join me on workshop.

[01:17:50]We are coming up uh in Patna. We are coming up in hands-on workshop in Patna schedule. U Delhi schedule, coaching is scheduled and then uh what Hyderabad is scheduled and even online webinar is also scheduled. We are starting the online webinar every evening uh 8 to 10:30 starting from 13th to 23rd. So it will be 10 days continuous learning program with one or two day off in between uh whenever we have a festival 2 to three days festival we will be off otherwise it will be continue 2 to three hours of webinar and I'll I try to give you my level best breast uh education and you will understand the depth of it and uh it will help you in treating your patient who has pelvic floor weakness it can be tension weak or it can be the back health issues oxyenia piles hemorrhoids diastasis recta try they all are interrelated. So I'm going to like know catch all of these things. I'm going to cover all these things in my online webinar as well as in hands-on workshop. So if you cannot join the hands-on workshop, do join our online webinars. Thank you so much everyone.

[01:18:59]I'll I'll see you uh next whenever possible in life and keep doing your level best and um I I'm not saying the books are wrong. books will give you a lot of new information but more information your practice your experience will give you your each of your patient will teach you new things.

[01:19:17]This is how I learned in my life and uh learning is a continuous process. This is what I feel. Keep learning, keep sharing. This group will be open for uh next updates. Uh and u if you found something new interesting related to the women's health, related to the pelvic floor, please share that articles in the group so we all can learn together.

[01:19:38]Thank you. Thank you so much.

[01:19:40]>> Thank you ma'am.

[01:19:41]>> Thank you. And you can always keep uh asking the question in the group also.

[01:19:46]So Dr. Lina, you you are the my Dr. Lina who has done the pelvic floor with me.

[01:19:52]Yeah. Or I don't know. Okay. Thank you so much. Thank you so much everyone.

[01:19:57]Bye. Take care. Uh look after yourself.

[01:19:59]Love the person you see in the mirror.

[01:20:02]Okay. Smile always. Take care. Bye.

[01:20:07]Thank you ma'am. Thank you dear.