People tend to be careful of their cardiovascular fitness and their overall muscle strength. To achieve this, they walk or do some form of aerobic exercise, weight lifting and yoga. They exercise regularly and are proud of the fact. However, hardly anyone remembers their pelvic muscles. These are tucked away inside the body, unseen and unexercised. Most people are unaware that weak pelvic muscles eventually give rise to all kinds of problems.

In women with weak pelvic muscles, there may be embarrassing moments with loss of control while coughing, sneezing or even laughing. A few drops of urine may dribble out. This may stain the clothes and be visible to all. As the weakness progresses, the motion may come out, or there may be smelly gas. Constipation may occur with difficult evacuation as pelvic muscles are needed to strain and push out motion effectively. The uterus may slowly start to descend. Initially, there may just be some lower abdominal discomfort, but it may finally come down and be visible outside the vagina (prolapse uterus).

These problems are more likely to occur in obese women and are common after childbirth. It can occur with increasing age, even in women who have never become pregnant. It can occur with chronic strain and overuse, as with running, dancing, weightlifting and constipation with constant straining to pass motion. Younger women may get affected if they are in the habit of constantly holding in their urine as there is no proper facility to void either in school or their place of work.

All these may seem like women’s problems, but men can also develop weak pelvic muscles as they age. It can cause urinary incontinence or an uncontrollable urge to reach the toilet quickly. The muscles may have been accidentally damaged during prostate surgery. They may have become weakened by diabetes or due to an overactive bladder. It can cause constipation or an inability to control motion. Weak pelvic muscles can cause depressing erectile dysfunction. Instead of being taught pelvic exercises, many men with this problem are treated (often unsuccessfully) with a cocktail of allopathic, ayurvedic and Siddha medications.

The pelvic floor can be successfully strengthened in both men and women by doing specific exercises. Benefits are seen within two months. It is better to start doing these exercises prophylactically before any problems start.

First, the muscles need to be identified. To do this, as you pass urine, try to stop the flow midstream. The muscles you are tightening are the pelvic muscles. Kegels exercises are an effective and efficient way to tighten and tone pelvic muscles.

First, the bladder needs to be emptied. Then tighten the muscles, hold for five seconds, and release and then repeat 10 times. This should be done three times a day. If you cannot remember or don’t have the time, you can do another set each time after you urinate to get rid of the last few drops of urine. Also, remember to tighten and hold your pelvic muscles when you cough, sneeze, laugh or lift weights.

The advantage of Kegels exercises is that they can be discreetly done anywhere at any time, even while just sitting. There are several other exercises to strengthen the “core” muscles, which will help not only with balance and stability but also complement the Kegels exercises. These exercises are front and side planks and specific yoga poses like cobra, bridge and downward dog. Try to do them at least three times a week.

These problems are common and affect as many as one in three adults. Unfortunately, they are embarrassing to discuss with your physician, leading to years of unnecessary suffering.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in