Keck : Department of Colorectal Surgery : Clinical Activities : Sphincter Exercise : Ileo-Pouch Anal Anastomosis Guide

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Ileo-Pouch Anal Anastomosis Guide

Digestive System Digestive System Disorders Surgical Options Preparing For Surgery Ileo-Pouch Anastamosis After The First Surgery Discharge To Home Sphincter Exercise Stoma Management		Ileostomy Closure Perianal Skin Care Medications Diet Transition Period Potential Complications Long-Term Complications Conclusion Resource List

You may begin pelvic floor muscle exercises in the hospital after the bladder catheter has been removed. A pelvic floor muscle exercise (also called a Kegel exercise) is a contraction and relaxation of the pelvic floor muscles. These muscles work with the sphincter muscles, which surround the urethra, rectum and vaginal opening (in women). When you contract these muscles, the urethra and the anus close to hold in urine, gas and stool.

You will need to strengthen your pelvic floor muscles through regular exercise. The abdomen, buttock and thigh muscles are not part of the pelvic muscles and must remain relaxed when you do your pelvic floor exercises. Initially, the thigh or buttock muscles may be involved, but it is important that the abdominal muscles remain relaxed.

Your exercises should be done six times every day-twice each in the morning, afternoon and night. Do five to six repetitions each set. Then wait at least an hour between sets to avoid muscle fatigue. For the first few weeks, do the exercises on your back. Later, you can progress to the sitting and standing positions.

To find the pelvic floor muscles:

Think about your anus and squeeze. Pretend you are trying to keep from passing gas. Feel the entire pelvic floor lift up with the contraction.
For women: Insert one finger into the vagina and contract the pelvic muscles. You should feel pressure high in the vagina as well as in the vaginal opening.
For men: Stand and do a contraction of your pelvic floor muscles. You should feel your penis move upwards slightly if you are doing the contraction correctly.
When urinating, slow or stop the stream for a second or two-this is a pelvic floor contraction. Then finish urinating-this is the relaxation. Notice that not a lot of force is needed. Do this once a week to check progress.

Lying down

Take a deep breath. As you exhale, contract your pelvic floor, drawing your tailbone toward your pubic bone. Think about trying to keep from passing gas. Hold the contraction for as long as you can while you are exhaling. If you cannot feel the contraction, bring your knees up and try squeezing a pillow between your knees while contracting the pelvic floor. Do not hold your breath. Remember, the contraction does not require a lot of force-just enough to turn the muscles on and keep them on for five to 10 seconds.

Sitting

Assume a normal sitting position-feet and shoulders relaxed. Take a deep breath. As you exhale, squeeze the pelvic floor muscles. You should feel a lift as the muscles contract and your tailbone is drawn toward your pubic bone. If you cannot feel the muscles contract, place a pillow between your knees and try again, squeezing the pillow as you squeeze your pelvic floor muscles. Keep exhaling during the contraction.

Standing

Take a deep breath. As you exhale, contract the pelvic floor. Think about being in a crowded elevator and trying to keep from passing gas. Hold the contraction as long as you exhale without holding your breath. If you cannot feel the contraction, turn your legs out and try squeezing from your heels up while exhaling. Relax your abdominal wall as much as possible as it is most active in this position.

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